Kaposi's sarcoma (KS)-associated herpesvirus (KSHV) is etiologically associated with the angioproliferative KS, a chronic inflammation-associated malignancy characterized by a heterogeneous population of spindle-shaped activated endothelial cells, inflammatory cells, cytokines, growth factors, and angiogenic factors (
9,
11). In advanced lesions, spindle cells are the predominant cell type and are accompanied by elevated angiogenesis (
10). Multiple results suggest that inflammatory cytokines, angiogenic factors, and chemokines such as gamma interferon, tumor necrosis factor alpha, beta interleukin-1 (IL-1β), IL-6, platelet-derived growth factor, basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), and prostaglandin E
2 expressed in KS lesions are critical elements of in vivo AIDS-KS pathogenesis, possibly operating by mediation of spindle cell viability and angioproliferation.
Our studies showed that the microenvironment induced during de novo KSHV infection of primary human microvascular dermal endothelial (HMVEC-d) cells resembled that of KS lesions (
30). We have previously demonstrated that within minutes of infection, KSHV enters the adherent target cells, such as HMVEC-d and human foreskin fibroblast (HFF) cells, concomitant with the induction of preexisting host signal cascades such as those of focal adhesion kinase (FAK), Src, PI3K, AKT, PKCζ, MEK, extracellular signal-regulated kinase 1 or 2 (ERK1/2), and NF-κB (
29,
32-
34). KSHV infections of HMVEC-d and HFF cell infections are characterized by the transient expression of limited lytic cycle genes, persistent expression of latency-associated genes such as KSHV ORF71 (vFLIP), ORF72 (vCyclinD), and ORF73 (LANA-1 [latency-associated nuclear antigen]), and the establishment of latent infection (
22,
29). KSHV-induced ERK1/2 and NF-κB were critical for the initiation and maintenance of viral gene expression (
32,
33).
As an initial step toward understanding how KSHV establishes latent infection in vitro, we previously used oligonucleotide arrays to examine the modulation of HMVEC-d and HFF cell gene expression at 2 h and 4 h postinfection (p.i.) (
30). These studies demonstrated that KSHV reprogrammed the elements of host cell transcriptional machinery that are involved in regulating a variety of processes such as apoptosis, cell cycle regulation, signaling, inflammatory response, and angiogenesis (
30). Our subsequent cytokine array analysis showed that KSHV infection induced a significant increase in the secretion of several endothelial cell angiogenic molecules (VEGF, angiopoietin, and SDF-1), growth factors (platelet-derived growth factor, FGF, granulocyte-macrophage colony-stimulating factor, and insulin-like growth factor 1), chemokines (monocyte chemoattractant protein 2 [MCP-2], macrophage inflammatory protein [MIP], monokine inducible by gamma interferon [MIG], and eotaxin), and proinflammatory (IL-2, IL-3, IL-8, growth-regulated oncogene [GRO], and IL-16) and anti-inflammatory (IL-4, IL-5 and IL-15) cytokines and that many of these factors were induced in an NF-κB-dependent manner (
32). The angiogenic factor angiogenin (ANG) was among the cytokines that were highly upregulated during de novo KSHV infection (
32).
Under normal physiological conditions, angiostatic factors are more significant than angiogenic factors, whereas during the progression of diseases such as cancer, tissue regeneration and wound-healing angiogenic factors outweigh angiostatic factors, resulting in angiogenesis. KSHV-induced upregulation of angiogenesis factors may potentially be involved in KS development and progression. Angiogenesis is the growth of new blood vessels, which is the formation of new capillaries from existing ones. Normal angiogenesis is self-limiting and tightly regulated (
40). An increase in the levels of angiogenesis is seen under several sets of pathological conditions during the progression of inflammatory arthritis, diabetic retinopathy, psoriasis, and cancer (
40). Angiogenesis is initiated by degradation of the basement membrane and matrix, probably initiated by factors released from the endothelial cells. Subsequently, endothelial cells migrate chemotactically, proliferate, and form new capillary tubes.
ANG, a multifunctional 14-kDa angiogenic protein that performs several of the functions mentioned above, was first isolated from HT-29 human colon adenocarcinoma cell-conditioned media based on its angiogenic activity (
37). ANG has been shown to play a role in tumor angiogenesis, and its expression is upregulated in several types of cancers, including pancreatic, breast, prostate, cervical, ovarian, colon, colorectal, gastric, urothelial, and endometrial cancers (
37). Anti-ANG monoclonal antibodies used as antagonists inhibited the establishment, progression, and metastasis of human cancer cells inoculated into athymic mice (
31).
Upon secretion from the cells, ANG is known to interact with a 42-kDa cell surface form of actin and forms an actin-ANG complex (
19), which accelerates plasmin generation by triggering a plasminogen activator (
18). Plasmin helps in extracellular matrix (ECM) degradation, which is required for the migration of endothelial cells. Once endothelial cells migrate to the region with reduced vessel density, the cells arrange in monolayers and form tube-like structures (
20,
40).
ANG nuclear translocation is strictly dependent on cell type and cell density (
28). It remains cytoplasmic in fibroblast cells, suggesting that the nuclear function of ANG is limited to endothelial cells (
28). Nuclear translocation does not occur when the cells are confluent but occurs in cells of about 30% confluence (subconfluent cells) and in cells of >50 to 60% confluence (semiconfluent cells) (
28). ANG can initiate proliferation of endothelial cells upon binding to a 170-kDa protein expressed on the cell surface (
17). ANG is endocytosed; once inside the cell, it initiates signal transduction via ERK1/2. It also translocates into the nucleus in sub- and semiconfluent cells, moves into the nucleolus of subconfluent cells, and transcribes rRNA by binding to CT repeats that are abundant in the nontranscribed region of the rRNA gene (
41). Nuclear translocation of ANG in endothelial cells has been shown to be necessary for the angiogenic potential of ANG (
21). Mutating the nuclear localization signal (NLS) of ANG abolished the angiogenic activity (
24).
ANG activity is relatively low compared with that of other growth factors such as VEGF and bFGF (
21). However, nuclear translocation of ANG was reported to be necessary for that of VEGF and bFGF. The mechanism of action of ANG is still unclear despite a huge volume of work; this lack of clarify is due to the complexity of biological processes underlying the phenomenon of angiogenesis (
7).
Here we demonstrate for the first time that KSHV infection of endothelial cells upregulates ANG in a time- and dose-dependent manner, resulting in the performance of angiogenic and proliferative functions such as an increase in synthesis of the infected endothelial cell 45S rRNA, proliferation, migration, and angiogenesis. KSHV infection-induced ANG upregulation and nuclear translocation were critical for VEGF-C transcription and for angiogenesis mediated by both ANG and VEGF, thus suggesting that ANG could be playing a critical role in influencing the angioproliferative nature of KS lesions.