A genetic polymorphism in the human gene encoding connexin37 (CX37, encoded by GJA4, also known as CX37) has been reported as a potential prognostic marker for atherosclerosis. The expression of this gap-junction protein is altered in mouse and human atherosclerotic lesions: it disappears from the endothelium of advanced plaques but is detected in macrophages recruited to the lesions. The role of CX37 in atherogenesis, however, remains unknown. Here we have investigated the effect of deleting the mouse connexin37 (Cx37) gene (Gja4, also known as Cx37) on atherosclerosis in apolipoprotein E-deficient (Apoe(-/-)) mice, an animal model of this disease. We find that Gja4(-/-)Apoe(-/-) mice develop more aortic lesions than Gja4(+/+)Apoe(-/-) mice that express Cx37. Using in vivo adoptive transfer, we show that monocyte and macrophage recruitment is enhanced by eliminating expression of Cx37 in these leukocytes but not by eliminating its expression in the endothelium. We further show that Cx37 hemichannel activity in primary monocytes, macrophages and a macrophage cell line (H36.12j) inhibits leukocyte adhesion. This antiadhesive effect is mediated by release of ATP into the extracellular space. Thus, Cx37 hemichannels may control initiation of the development of atherosclerotic plaques by regulating monocyte adhesion. H36.12j macrophages expressing either of the two CX37 proteins encoded by a polymorphism in the human GJA4 gene show differential ATP-dependent adhesion. These results provide a potential mechanism by which a polymorphism in CX37 protects against atherosclerosis.

Background-Endothelial dysfunction is the initiating event of atherosclerosis. The expression of connexin40 (Cx40), an endothelial gap junction protein, is decreased during atherogenesis. In the present report, we sought to determine whether Cx40 contributes to the development of the disease. Methods and Results-Mice with ubiquitous deletion of Cx40 are hypertensive, a risk factor for atherosclerosis. Consequently, we generated atherosclerosis-susceptible mice with endothelial-specific deletion of Cx40 (Cx40del mice). Cx40del mice were indeed not hypertensive. The progression of atherosclerosis was increased in Cx40del mice after 5 and 10 weeks of a high-cholesterol diet, and spontaneous lesions were observed in the aortic sinuses of young mice without such a diet. These lesions showed monocyte infiltration into the intima, increased expression of vascular cell adhesion molecule-1, and decreased expression of the ecto-enzyme CD73 in the endothelium. The proinflammatory phenotype of Cx40del mice was confirmed in another model of induced leukocyte recruitment from the lung microcirculation. Endothelial CD73 is known to induce antiadhesion signaling via the production of adenosine. We found that reducing Cx40 expression in vitro with small interfering RNA or antisense decreased CD73 expression and activity and increased leukocyte adhesion to mouse endothelial cells. These effects were reversed by an adenosine receptor agonist. Key Words: atherosclerosis Ⅲ connexins Ⅲ endothelium Ⅲ gap junctions Ⅲ inflammation C ardiovascular diseases currently constitute the major cause of death in developed countries. 1 Atherosclerosis, an inflammatory disease of large and medium-sized arteries, 2 is the most important cause of cardiovascular diseases. The main consequences of atherosclerosis are myocardial infarction, cerebral infarction, and aortic aneurysm. 3 Conclusions-Cx40-mediated Clinical Perspective on p 131Atherosclerosis involves the formation of intimal lesions that are characterized by a dysfunctional endothelium, inflammation, lipid accumulation, cell death, and fibrosis. 2,3 The distribution of atherosclerotic plaques is highly characteristic in humans; the lesions develop predominantly near side branches of arteries where blood flow is disturbed. 4 A variety of substances mediating intercellular communication, including cytokines, chemokines, and growth factors, have been identified to induce, amplify, and modify the atherosclerotic inflammatory process. 5,6 In this context, connexins, a large family of proteins that form hemichannels and gap junction channels enabling transmembrane and intercellular coordination of tissue activity, 7,8 have been involved in atherogenesis. Three connexins are expressed in the vascular wall, namely connexin (Cx)37, Cx40, and Cx43, and important changes in their expression pattern have been reported in Received March 20, 2009; accepted October 28, 2009. From the Division of Cardiology (C.E.C., I.R., B.F., B.R.K.) and Department of Pediatrics (K.E.L.S., M.Z.R.S., M.B., B.F., T.D....