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Figure 1.
Production of vascular endothelial growth factor (VEGF) in cobalt chloride–stimulated nasal polyp fibroblasts. A, Cells were incubated with cobalt chloride (500 μmol/L) for various incubation periods. Then VEGF was measured by Western blot analysis. B, Results were quantified by densitometric analysis, normalized by the level of β-actin, and expressed as fold change relative to untreated control. Each bar represents the mean (SD) of 8 experiments. *P < .05 vs control. Note that cobalt chloride–induced VEGF synthesis was dose dependent.

Production of vascular endothelial growth factor (VEGF) in cobalt chloride–stimulated nasal polyp fibroblasts. A, Cells were incubated with cobalt chloride (500 μmol/L) for various incubation periods. Then VEGF was measured by Western blot analysis. B, Results were quantified by densitometric analysis, normalized by the level of β-actin, and expressed as fold change relative to untreated control. Each bar represents the mean (SD) of 8 experiments. *P < .05 vs control. Note that cobalt chloride–induced VEGF synthesis was dose dependent.

Figure 2.
Epigallocatechin-3-gallate (EGCG) inhibited synthesis of hypoxia-inducible factor-1α (HIF-1α) in nasal polyp fibroblasts stimulated with cobalt chloride (CoCl2). A, Cells were incubated with CoCl2 (500 μmol/L) for various periods, and HIF-1α levels were determined by Western blot analysis. B, Nasal polyp fibroblasts were incubated with CoCl2, alone or in combination with EGCG (10 μg/mL) (3 hours before the addition of CoCl2) for 4 hours, and HIF-1α levels were analyzed. C and D, Results were quantified using densitometric analysis, normalized by the level of β-actin, and expressed as fold change relative to untreated control. *P < .05 vs control. †P < .05 vs CoCl2 at 500 μmol/L. Each bar represents the mean (SD) of 8 experiments. Note that CoCl2 induced HIF-1α synthesis, whereas EGCG abolished CoCl2-stimulated HIF-1α production.

Epigallocatechin-3-gallate (EGCG) inhibited synthesis of hypoxia-inducible factor-1α (HIF-1α) in nasal polyp fibroblasts stimulated with cobalt chloride (CoCl2). A, Cells were incubated with CoCl2 (500 μmol/L) for various periods, and HIF-1α levels were determined by Western blot analysis. B, Nasal polyp fibroblasts were incubated with CoCl2, alone or in combination with EGCG (10 μg/mL) (3 hours before the addition of CoCl2) for 4 hours, and HIF-1α levels were analyzed. C and D, Results were quantified using densitometric analysis, normalized by the level of β-actin, and expressed as fold change relative to untreated control. *P < .05 vs control. †P < .05 vs CoCl2 at 500 μmol/L. Each bar represents the mean (SD) of 8 experiments. Note that CoCl2 induced HIF-1α synthesis, whereas EGCG abolished CoCl2-stimulated HIF-1α production.

Figure 3.
Epigallocatechin-3-gallate (EGCG) reduced cobalt chloride (CoCl2)-stimulated vascular endothelial growth factor (VEGF) production by inhibiting hypoxia-inducible factor (HIF-1α) synthesis. A, Nasal polyp fibroblasts were incubated with CoCl2, alone or in combination with EGCG (10 μg/mL) or oligomycin (10 μg/mL) (3 hours before the addition of CoCl2) for 4 hours, and HIF-1α levels were assessed by Western blot analysis. B, Results were quantified by densitometric analysis, normalized by the level of β-actin, and expressed as fold change relative to untreated control. *P < .05 vs control. †P < .05 vs CoCl2 at 500 μmol/L. Each bar represents the mean (SD) of 8 experiments. Note that EGCG and oligomycin attenuated the level of CoCl2-stimulated VEGF significantly. A more profound inhibition was noted when EGCG and oligomycin were administrated together.

Epigallocatechin-3-gallate (EGCG) reduced cobalt chloride (CoCl2)-stimulated vascular endothelial growth factor (VEGF) production by inhibiting hypoxia-inducible factor (HIF-1α) synthesis. A, Nasal polyp fibroblasts were incubated with CoCl2, alone or in combination with EGCG (10 μg/mL) or oligomycin (10 μg/mL) (3 hours before the addition of CoCl2) for 4 hours, and HIF-1α levels were assessed by Western blot analysis. B, Results were quantified by densitometric analysis, normalized by the level of β-actin, and expressed as fold change relative to untreated control. *P < .05 vs control. †P < .05 vs CoCl2 at 500 μmol/L. Each bar represents the mean (SD) of 8 experiments. Note that EGCG and oligomycin attenuated the level of CoCl2-stimulated VEGF significantly. A more profound inhibition was noted when EGCG and oligomycin were administrated together.

Figure 4.
Immunolocalization of hypoxia-inducible factor-1α and vascular endothelial growth factor in nasal polyps. A, Hypoxia-inducible factor-1α was identified in fibroblasts (arrowheads) or mononuclear round cells (arrows) (Congo red, original magnification ×400). B, Vascular endothelial growth factor was clearly visible in fibroblasts, mononuclear round cells, and endothelial cells. C and D, Higher-powered magnifications of boxed areas of A and B, respectively. Note the intimate alignment between spindle-shaped vascular endothelial growth factor (brown granules)–producing fibroblasts (arrowheads) and the proliferating capillaries (arrows) (avidin-biotin-peroxidase complex, original magnification ×400).

Immunolocalization of hypoxia-inducible factor-1α and vascular endothelial growth factor in nasal polyps. A, Hypoxia-inducible factor-1α was identified in fibroblasts (arrowheads) or mononuclear round cells (arrows) (Congo red, original magnification ×400). B, Vascular endothelial growth factor was clearly visible in fibroblasts, mononuclear round cells, and endothelial cells. C and D, Higher-powered magnifications of boxed areas of A and B, respectively. Note the intimate alignment between spindle-shaped vascular endothelial growth factor (brown granules)–producing fibroblasts (arrowheads) and the proliferating capillaries (arrows) (avidin-biotin-peroxidase complex, original magnification ×400).

1.
Hosemann  WGöde  UWagner  W Epidemiology, pathophysiology of nasal polyposis, and spectrum of endonasal sinus surgery. Am J Otolaryngol 1994;15 (2) 85- 98
PubMedArticle
2.
Lee  CHRhee  CSMin  YG Cytokine gene expression in nasal polyps. Ann Otol Rhinol Laryngol 1998;107 (8) 665- 670
PubMed
3.
Shun  CTLin  SKHong  CY  et al.  C-C chemokine ligand 2 gene expression in nasal polyp fibroblasts: possible implication in the pathogenesis of nasal polyposis. Ann Otol Rhinol Laryngol 2005;114 (11) 879- 885
PubMed
4.
Liu  CMHong  CYShun  CT  et al.  Inducible cyclooxygenase and interleukin-6 gene expressions in nasal polyposis. Arch Otolaryngol Head Neck Surg 2002;128 (8) 945- 951
PubMedArticle
5.
Carmeliet  PJain  RK Angiogenesis in cancer and other diseases. Nature 2000;407 (6801) 249- 257
PubMedArticle
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Folkman  J Angiogenesis in cancer, vascular, rheumatoid and other disease. Nat Med 1995;1 (1) 27- 31
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Ferrara  NGerber  HPLeCouter  J The biology of VEGF and its receptors. Nat Med 2003;9 (6) 669- 676
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Matsune  SSun  DOhori  J  et al.  Inhibition of vascular endothelial growth factor by macrolides in cultured fibroblasts from nasal polyps. Laryngoscope 2005;115 (11) 1953- 1956
PubMedArticle
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Sun  DMatsune  SOhori  JFukuiwa  TUshika  MKurono  Y TNF-α and endotoxin increase hypoxia-induced VEGF production by cultured human nasal fibroblasts in synergistic fashion. Auris Nasus Larynx 2005;32 (3) 243- 249
PubMedArticle
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Bunn  HFPoyton  KO Oxygen sensing and molecular adaptation to hypoxia. Physiol Rev 1996;76 (3) 839- 885
PubMed
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Semenza GL, HIF-1 and tumor progression: pathophysiology and therapeutics. Trends Mol Med 2002;8 (4) ((suppl 4)) S62- S67
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Balentine  DAWisweman  SABouwens  LC The chemistry of tea flavonoids. Crit Rev Food Sci Nutr 1997;37 (8) 693- 704
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Chung  JHHan  JHHwang  EJ  et al.  Dual mechanisms of green tea extract (EGCG)–induced cell survival in human epidermal keratinocytes. FASEB J 2003;17 (13) 1913- 1915
PubMed
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Pianetti  SGuo  SKavanagh  KTSonenshein  GE Green tea polyphenol epigallocatechin-3-gallate inhibits Her-2/Neu signaling, proliferation, and transformed phenotype of breast cancer cells. Cancer Res 2002;62 (3) 652- 655
PubMed
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Zhang  QTang  XLu  QZhang  ZRao  JLe  AD Green tea extract and (-)-epigallocatechin-3-gallate inhibit hypoxia- and serum-induced HIF-1alpha protein accumulation and VEGF expression in human cervical carcinoma and hepatoma cells. Mol Cancer Ther 2006;5 (5) 1227- 1238
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PubMed
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Original Article
May 01, 2008

Hypoxia-Stimulated Vascular Endothelial Growth Factor Production in Human Nasal Polyp FibroblastsEffect of Epigallocatechin-3-Gallate on Hypoxia-Inducible Factor-1α Synthesis

Author Affiliations

Author Affiliations: Departments of Dentistry (Drs Lin and Kok), Forensic Medicine (Dr Shun), and Otolaryngology (Drs Hsiao and Liu) and Graduate Institute of Clinical Medicine (Dr Wang), National Taiwan University Hospital, Taipei, Taiwan.

Arch Otolaryngol Head Neck Surg. 2008;134(5):522-527. doi:10.1001/archotol.134.5.522
Abstract

Objective  To verify the inhibitory effects of epigallocatechin-3-gallate (EGCG) on the synthesis of hypoxia-induced vascular endothelial growth factor (VEGF) in nasal polyp fibroblasts (NPFs).

Design  Eight primary cultures of NPFs were established from nasal polyps. Effects of EGCG on the production of hypoxia-inducible factor (HIF)–1α (the most potent VEGF stimulant) and VEGF by NPFs under hypoxic conditions were measured by Western blot analysis. Immunohistochemical staining was used to examine the in vivo expressions of HIF-1α and VEGF in 20 sections of nasal polyps.

Results  Western blot analysis showed that cobalt chloride induced HIF-1α and VEGF synthesis in NPFs in a time-dependent manner, reaching a plateau at 4 and 8 hours, respectively, following treatment. Epigallocatechin-3-gallate attenuated the level of HIF-1α induced by cobalt chloride and also reduced cobalt chloride–stimulated VEGF production by suppressing HIF-1α synthesis. Furthermore, oligomycin (a specific HIF-1α inhibitor) combined with EGCG resulted in a more profound inhibition of VEGF synthesis compared with oligomycin or EGCG treatment alone. Nevertheless, the synergistic effect seemed smaller than the sum of their individual actions. Immunohistochemical analysis revealed the presence of HIF-1α and VEGF in NPFs and mononuclear round cells. Intimate alignment of VEGF-positive fibroblasts and proliferating small capillaries was frequently found.

Conclusions  Nasal polyp fibroblasts contribute to the pathogenesis of nasal polyps by producing VEGF to promote angiogenesis under hypoxic conditions. Epigallocatechin-3-gallate substantially diminishes HIF-1α and VEGF synthesis in NPFs.

Nasal polyps are the most commonly found mass lesions in the nasal cavity.1 Although the pathogenesis remains unclear, many authors believe nasal polyps to be an inflammatory disorder.2 We recently found a connection between nasal polyposis and infiltration of macrophages, an indispensable element in inflammation.3 We have also demonstrated active synthesis of essential proinflammatory mediators such as interleukin 6 and cyclooxygenase-2 in tumor necrosis factor α–stimulated nasal polyp fibroblasts (NPFs), substantiating the importance of stromal cells in nasal polyposis.4

Angiogenesis, the process by which new vascular networks develop from capillary buds or sprouts sent out by preexisting vessels, has an essential role in the progression of tumor5 and many chronic diseases such as rheumatoid arthritis.6 The angiogenic process is precisely modulated by a vast array of proangiogenic (to increase blood vessels when needed) and antiangiogenic (to block pathologic angiogenesis) factors. Vascular endothelial growth factor (VEGF) is one of the most potent angiogenic factors, capable of promoting proliferation and migration of endothelial cells and increasing vascular permeability.7 By demonstrating increased levels of VEGF in cultured human NPFs, Matsune et al8 and Sun et al9 proposed the role of VEGF in the pathogenesis of nasal polyps.

The stimuli for VEGF expression derive primarily from hypoxia, which activates VEGF by increasing hypoxia-inducible factor-1 (HIF-1),10 a heterodimeric transcriptional factor consisting of α and β subunits. The availability of HIF-1 is determined primarily by HIF-1α, which is regulated in an oxygen-sensitive manner by degradation through the ubiquitin-proteasome pathway under normoxia, in contrast to the stably expressed HIF-1β subunit. With hypoxia, HIF-1α is stabilized, translocated to the nucleus, heterodimerizes with HIF-1β, and activates multiple genes involved in angiogenesis and other cellular functions.11

Green tea is made by brewing the leaves of Camellia sinesis to inactivate the polyphenol oxidase. Polyphenols are the major constituents of brewed green tea, of which epigallocatechin-3-gallate (EGCG) is the most abundant and active.12 The antioxidant and free radical scavenger properties of EGCG are believed to be primarily responsible for the protective effect of tea consumption against the risks of cancer, neuron degeneration, and coronary artery diseases.13,14 An inhibitory effect of EGCG on VEGF production has been reported in several cancer cell lines15; however, a similar action of EGCG has never been demonstrated in NPFs. This deserves further investigation because it may lead to the development of a new therapeutic strategy for nasal polyps. In this study, we demonstrated that EGCG inhibits cobalt chloride (CoCl2)-induced VEGF synthesis, possibly by diminishing HIF-1α synthesis in NPFs.

METHODS
TISSUE SAMPLES

Nasal polyps, mainly originating from the ethmoidal labyrinth and present in the middle meatuses, were obtained at functional endoscopic sinus surgery with the Messerklinger-Stammberger modification for treatment of bilateral chronic sinusitis with sinonasal polyposis. Patients with a single polyp (antrochoanal polyp) or with other diseases related to nasal polyposis such as cystic fibrosis, primary ciliary dyskinesia, and fungal sinusitis were excluded from this study. Bilateral chronic sinusitis with sinonasal polyposis was diagnosed on the basis of history and findings at clinical examination, nasal endoscopy, and sinus computed tomography. No patients had a history of nasal allergy, asthma, or aspirin hypersensitivity. All had normal serum antigen-specific IgE antibody (Opticon multiple allergen–specific IgE assay; Hitachi Diagnostics, Inc, Mountain View, California), and none had used regular topical or oral medication within 3 weeks. Informed consent was obtained before surgery. The study was approved by the ethics committee of National Taiwan University Hospital, Taipei, Taiwan.

CELL CULTURES

Eight primary cultures of NPFs were established from nasal polyps from 8 patients, respectively, as previously described.3,4,16 In brief, after removing the epithelial layer, the specimens were immersed overnight in Dulbecco modified Eagle medium (calcium chloride, 265 μg/mL; iron nitrate, 0.1 μg/mL; potassium chloride, 400 μg/mL; magnesium sulfate, 200 μg/mL; sodium chloride, 6400 μg/mL; sodium bicarbonate, 700 μg/mL; sodium phosphate,125 μg/mL; phenol red, 15 μg/mL;HEPES [N-2-hydroxyethylpiperazine-N-2-ethanesulfonic acid] buffer [pH 7.4], 25 mmol/L, and D-glucose, 1 mg/mL) containing 10% fetal calf serum and antibiotics (penicillin, 100 U/mL; streptomycin, 100 μg/mL; and amphotericin B, 0.5 μg/mL). The samples were minced into 1-mm3 fragments and covered with sterilized glass coverslips. After the fibroblasts migrated from tissue explants and became confluent, the cells were trypsinized and subcultured. Cells between passages 3 to 6 were plated at a density of 5 × 105/mL on 10-cm dishes and subjected to various stimulants. Before different treatments, the cells were made quiescent in serum-free media (media without fetal calf serum) for 24 hours.3,4,16 Data given herein are the means of 8 experiments.

WESTERN BLOT ANALYSIS

Western blot analysis was performed as previously described.17 In brief, cells were lysed in lysis buffer, fractionated by sodium dodecylsulfate–polyacrylamide gel electrophoresis, and transferred to nitrocellulose membranes. Antibodies against VEGF (R&D Systems, Inc, Minneapolis, Minnesota) and HIF-1α (Upstate Biotechnology Inc, Lake Placid, New York) were added at concentrations suggested by the manufacturers. Proteins were visualized with horseradish peroxidase–conjugated immunoglobulin and an enhanced chemiluminescence detection system (Amersham Biosciences, Piscataway, New Jersey). The membranes were reprobed with β-actin antibody after washing with stripping buffer.

IMMUNOHISTOCHEMICAL ANALYSIS

Sections were collected from the pedicle area of an entire nasal polyp in each of 20 patients, including the 8 patients whose nasal polyps were used for primary cell culture. Sections cut from 10% formalin-fixed, paraffin-embedded tissue blocks were deparaffinized, rehydrated, and subjected to antigen retrieved using the microwave method. After blocking endogenous peroxidase with hydrogen peroxide and nonspecific binding with rabbit serum in TRIS-buffered saline solution, the sections were incubated with antibodies against human VEGF (dilution 1:40; R&D Systems, Inc) or human HIF-1α (dilution 1:50; Novus Biologicals, Inc, Littleton, Colorado) in TRIS-buffered saline solution overnight. Sections were incubated with a biotinylated secondary antibody and colorization using diaminobenzidine or 3-amino-9-ethylcarbazole. Counterstaining was performed using Mayer hematoxylin for 1 minute.

STATISTICAL ANALYSIS

Data were subjected to analysis of variance for multiple comparisons and then the Fisher protected least significant difference test. P < .05 was considered statistically significant.

RESULTS
CoCl2 STIMULATED VEGF SYNTHESIS IN NPFs

The amounts of VEGF produced in NPFs stimulated by CoCl2 (500 μmol/L) during various incubation periods were assessed by Western blot analysis. The results showed that CoCl2 induced VEGF synthesis in NPFs. The increase in levels of VEGF were time dependent, reaching a peak at 8 hours following treatment (Figure 1).

EGCG REDUCED THE LEVELS OF CoCl2-STIMULATED HIF-1α

Cells were incubated with CoCl2 (500 μmol/L) for various incubation periods, and HIF-1α levels were determined by Western blot analysis. Western blot analysis revealed that the peak level of HIF-1α in NPFs treated with CoCl2 occurred at 4 hours and declined thereafter (Figure 2A and C). When NPFs were incubated with CoCl2, alone or in combination with EGCG (10 μg/mL) (3 hours before the addition of CoCl2) for 4 hours, HIF-1α levels were analyzed. Epigallocatechin-3-gallate significantly diminished CoCl2-induced HIF-1α synthesis (Figure 2B and D).

EGCG ABROGATED CoCl2-STIMULATED VEGF PRODUCTION BY REDUCING HIF-1α SYNTHESIS

To verify the involvement of HIF-1α in the synthesis of VEGF following CoCl2 stimulation, oligomycin, a specific inhibitor of HIF-1α,18 was applied in the subsequent experiment. Nasal polyp fibroblasts were incubated with CoCl2, alone or in combination with EGCG (10 μg/mL) or oligomycin (10 μg/mL) (3 hours before the addition of CoCl2) for 4 hours, and HIF-1α levels were assessed by Western blot analysis. The results showed that oligomycin attenuated the level of CoCl2-stimulated VEGF significantly. Epigallocatechin-3-gallate also diminished the level of VEGF induced by CoCl2 (Figure 3). Compared with treatment with oligomycin or EGCG alone, more pronounced inhibition of VEGF synthesis was obtained when oligomycin and EGCG were administered simultaneously. However, the synergism was incomplete, inasmuch as the combination effect seemed smaller than the sum of their individual action (Figure 3).

IMMUNOLOCALIZATION OF HIF-1α AND VEGF IN NASAL POLYPS

At microscopy, the presence of HIF-1α was detected in subepithelial fibroblasts and mononuclear round cells (Figure 4A and C). Fibroblasts usually are spindle shaped with an ovoid nucleus with no prominent nucleolus, and the immunohistochemical stain around the HIF-1α is located in the cytoplasm of the fibroblasts. The mononuclear round cells include macrophages, lymphocytes, and plasma cells. Differentiation of those cells is in their structure: macrophages usually have abundant cytoplasm and are the largest of these cells, lymphocytes have scanty cytoplasm, and plasma cells have an eccentric nucleus and are relatively the same size as lymphocytes. Vascular endothelial growth factor was located in some basal cells of the lining epithelium, plump endothelial cells lining the proliferating capillaries, mononuclear round cells, and fibroblasts. Intimate alignment of long, spindle-shaped, VEGF-positive fibroblasts and proliferating small capillaries was frequently found (Figure 4B and D).

COMMENT

By promoting proliferation and migration of endothelial cells and increasing vascular permeability, VEGF has an essential role in mediating angiogenesis in normal and pathologic conditions such as embryonic development, wound healing, and tumor growth.57 Vascular endothelial growth factor is also involved in chronic inflammatory and immunologic processes, leading subsequently to the formation of nasal polyps.8,9 The results of our study showed that CoCl2 induced VEGF synthesis in NPFs. In this experimental model, CoCl2 was used to initiate a hypoxic culture condition. Treatment of cultured cells with CoCl2 is a well-established method of inducing changes similar to those seen with hypoxia.19,20 Immunohistochemistry of nasal polyp specimens confirmed the in vivo expression of VEGF in NPFs, in addition to the previously reported cellular sources of VEGF such as epithelial cells, endothelial cells, and infiltrating inflammatory cells.21 Furthermore, neovascularization adjacent to VEGF-positive NPFs was frequently found. Together, our results suggest that NPFs may contribute to the pathogenesis of nasal polyposis by producing VEGF to promote angiogenesis in nasal polyps under hypoxic conditions.

Western blot analysis revealed that CoCl2 stimulated HIF-1α production in NPFs, and immunohistochemical staining also showed the in vivo presence of HIF-1α in NPFs and mononuclear round cells, implying that nasal polyps are in hypoxia. To our knowledge, this is the first demonstration of HIF-1α synthesis in NPFs. In hypoxia HIF-1α translocates to the nucleus, heterodimerizes with HIF-1β and activates multiple genes including VEGF.10,11 Our results demonstrate that oligomycin, a specific inhibitor of HIF-1α, attenuated the level of CoCl2-stimulated VEGF in NPFs, further confirming the involvement of HIF-1α in hypoxia-induced VEGF production.

By using oligomycin as an inhibitor of HIF-1α, the role of HIF-1α in CoCl2-stimulated VEGF production in NPFs was confirmed. The influence of EGCG on hypoxia-induced VEGF and HIF-1α production was examined subsequently, and suppressive effects on both molecules were found. Of the mechanisms on the alleviation of EGCG on CoCl2-stimulated VEGF synthesis, one explanation is that EGCG may inhibit VEGF production by downregulating HIF-1α or possibly by affecting the effect of CoCl2 on cell culture in creating or mediating the hypoxic effect. Inasmuch as non–HIF-1α pathways such as activator protein–122 and nuclear factor–kappa B23 are reportedly involved in VEGF expression, another scenario is inhibition of EGCG on hypoxia-induced VEGF synthesis by changing the effects of activator protein–1 or nuclear factor–kappa B in addition to downregulating the levels of HIF-1α. The proposal deserves further investigation because the results may, to a certain degree, account for our finding that the combined effect of EGCG and oligomycin on VEGF production was higher than that induced by either agent alone.

In conclusion, our data suggest that NPFs may contribute to the pathogenesis of nasal polyps by producing VEGF to promote angiogenesis under hypoxia. Epigallocatechin-3-gallate diminishes HIF-1α and VEGF synthesis substantially in cultured NPFs. However, real physical conditions are far more complicated than the in vitro culture system. Therefore, further clinical studies are needed to verify the feasibility of EGCG as a therapeutic agent for nasal polyposis.

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Article Information

Correspondence: Chia-Ming Liu, MD, Department of Otolaryngology, National Taiwan University Hospital, 1 Chang-Teh St, Taipei, Taiwan 10016 (a430008@ntumc.org).

Submitted for Publication: November 23, 2006; final revision received June 15, 2007; accepted August 16, 2007.

Author Contributions: Dr Liu had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Liu. Acquisition of data: Lin, Shun, Kok, Wang, Hsiao, and Liu. Analysis and interpretation of data: Lin, Shun, Kok, Hsiao, and Liu. Drafting of the manuscript: Lin, Shun, Kok, Wang, Hsiao, and Liu. Critical revision of the manuscript for important intellectual content: Shun and Liu. Statistical analysis: Lin, Kok, and Hsiao. Obtained funding: Lin and Liu. Administrative, technical, and material support: Shun, Kok, Wang, Hsiao, and Liu. Study supervision: Shun and Liu.

Financial Disclosure: None reported.

Funding/Support: This study was supported by grants NSC-94-2314-B-002-170 (Dr Lin) and NSC 94-2314-B-002-244 (Dr Liu) from the National Science Council, Taiwan.

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Hosemann  WGöde  UWagner  W Epidemiology, pathophysiology of nasal polyposis, and spectrum of endonasal sinus surgery. Am J Otolaryngol 1994;15 (2) 85- 98
PubMedArticle
2.
Lee  CHRhee  CSMin  YG Cytokine gene expression in nasal polyps. Ann Otol Rhinol Laryngol 1998;107 (8) 665- 670
PubMed
3.
Shun  CTLin  SKHong  CY  et al.  C-C chemokine ligand 2 gene expression in nasal polyp fibroblasts: possible implication in the pathogenesis of nasal polyposis. Ann Otol Rhinol Laryngol 2005;114 (11) 879- 885
PubMed
4.
Liu  CMHong  CYShun  CT  et al.  Inducible cyclooxygenase and interleukin-6 gene expressions in nasal polyposis. Arch Otolaryngol Head Neck Surg 2002;128 (8) 945- 951
PubMedArticle
5.
Carmeliet  PJain  RK Angiogenesis in cancer and other diseases. Nature 2000;407 (6801) 249- 257
PubMedArticle
6.
Folkman  J Angiogenesis in cancer, vascular, rheumatoid and other disease. Nat Med 1995;1 (1) 27- 31
PubMedArticle
7.
Ferrara  NGerber  HPLeCouter  J The biology of VEGF and its receptors. Nat Med 2003;9 (6) 669- 676
PubMedArticle
8.
Matsune  SSun  DOhori  J  et al.  Inhibition of vascular endothelial growth factor by macrolides in cultured fibroblasts from nasal polyps. Laryngoscope 2005;115 (11) 1953- 1956
PubMedArticle
9.
Sun  DMatsune  SOhori  JFukuiwa  TUshika  MKurono  Y TNF-α and endotoxin increase hypoxia-induced VEGF production by cultured human nasal fibroblasts in synergistic fashion. Auris Nasus Larynx 2005;32 (3) 243- 249
PubMedArticle
10.
Bunn  HFPoyton  KO Oxygen sensing and molecular adaptation to hypoxia. Physiol Rev 1996;76 (3) 839- 885
PubMed
11.
Semenza GL, HIF-1 and tumor progression: pathophysiology and therapeutics. Trends Mol Med 2002;8 (4) ((suppl 4)) S62- S67
PubMedArticle
12.
Balentine  DAWisweman  SABouwens  LC The chemistry of tea flavonoids. Crit Rev Food Sci Nutr 1997;37 (8) 693- 704
PubMedArticle
13.
Chung  JHHan  JHHwang  EJ  et al.  Dual mechanisms of green tea extract (EGCG)–induced cell survival in human epidermal keratinocytes. FASEB J 2003;17 (13) 1913- 1915
PubMed
14.
Pianetti  SGuo  SKavanagh  KTSonenshein  GE Green tea polyphenol epigallocatechin-3-gallate inhibits Her-2/Neu signaling, proliferation, and transformed phenotype of breast cancer cells. Cancer Res 2002;62 (3) 652- 655
PubMed
15.
Zhang  QTang  XLu  QZhang  ZRao  JLe  AD Green tea extract and (-)-epigallocatechin-3-gallate inhibit hypoxia- and serum-induced HIF-1alpha protein accumulation and VEGF expression in human cervical carcinoma and hepatoma cells. Mol Cancer Ther 2006;5 (5) 1227- 1238
PubMedArticle
16.
Liu  CMHong  CYShun  CT  et al.  Matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 gene expressions and their differential regulation by proinflammatory cytokines and prostaglandin in nasal polyp fibroblasts. Ann Otol Rhinol Laryngol 2001;110 (12) 1129- 1136
PubMed
17.
Lin  SKKok  SHYeh  FT  et al.  MEK/ERK and signal transducer and activator of transcription signaling pathways modulate oncostatin-M stimulated CCL2 expression in human osteoblasts through a common transcription factor. Arthritis Rheum 2004;50 (3) 785- 793
PubMedArticle
18.
Gong  YAgani  FH Oligomycin inhibits HIF-1α expression in hypoxic tumor cells. Am J Physiol Cell Physiol 2005;288 (5) C1023- C1029
PubMedArticle
19.
Brucker  PUIzzo  NJChu  CR Tonic activation of hypoxia-inducible factor-1α in avascular articular cartilage and implications for metabolic homeostasis. Arthritis Rheum 2005;52 (10) 3181- 3191
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