Abstract Background Cardiovascular disease mortality is reduced in individuals with high daily consumption of dietary polyphenols. Optimal daily intakes, choice of polyphenol, and mechanism of action have yet to be fully defined. Pomegranate juice (PJ) reduces blood pressure and improves endothelial function. These effects are attributed to the high levels of polyphenols, primarily ellagitannins. Purpose The aims of these investigations were (1) to identify PJ polyphenol(s) that altered endothelial function and could potentially lower blood pressure, and (2) to compare these endothelial actions to oligomeric procyanidins (OPC) purified from apple polyphenol extracts. Methods PJ polyphenols were purified by Sephadex LH-20 chromatography and RP-HPLC, and identified by LC-MS/MS and NMR. Fractions were screened for biological activity using cultured bovine aortic endothelial cells by measuring the degree of inhibition of endothelin-1 synthesis. Endothelial actions were further assessed by measuring changes in intracellular Ca2+ using FLIPR Ca2+-6 assay, qRT-PCR (EDN1, eNOS and KLF2 mRNAs), and NO synthesis (nitrite). Results Six PJ polyphenols were isolated. These were identified as punicalin, four punicalagin isomers, and oenothein B (OTB, a cyclic dimeric ellagitannin; LC-MS [M-H]-= 1567.1). At concentrations ≤5 µg/ml only OTB inhibited ET-1 synthesis (IC50 1.5 µg/ml). The identity of OTB was confirmed by NMR, and by comparison with OTB purified from Epilobium species. Further characterisation of the actions of OTB on endothelial cells showed pre-incubation with 1.25, 2.5 and 5 µg/ml OTB increased binding of biotinylated-OPC by 1.7, 2.3 and 3.8 fold. Subsequent studies of the interactions between OTB and OPC showed synergistic effects for decreases in ET-1 synthesis, EDN1 mRNA, and increases in KLF2 mRNA, eNOS mRNA and NO release. The effect of combining OTB (1 µg/ml) and OPC (1 µg/ml) lasted for over 24 h (relative to control: ET-1 -57%, EDN1 mRNA -63%, eNOS mRNA +69%, KLF2 mRNA +356%), when individually these polyphenols no longer had any significant effect. Intracellular Ca2+ responses also showed synergistic interactions, however the profile of [Ca2+] changes for OTB and OPC alone differed, suggesting separate signalling pathways initiating these endothelial responses. Endothelium-dependent vasodilator effects of OTB were confirmed on isolated mouse aorta (EC50 0.27 µg/ml). Conclusions These effects of OTB may underlie previously reported decreases in blood pressure and improvements in endothelial function after pomegranate juice consumption. Detailed understanding of the mechanism of action of OTB, and its interactions with OPC could lead to new therapeutic modalities for treating endothelial dysfunction in a broad spectrum of people at risk of cardiovascular disease.

Purpose: Osteoarthritis (OA) is the leading cause of chronic disability worldwide, affecting 12% of the population, and yet we still do not have a disease-modifying treatment. Cartilage breakdown is the hallmark of OA, and patients suffer from pain and loss of joint function/independence, severely affecting quality of life. Therefore, there is a huge unmet clinical need. Receptor tyrosine kinase-like orphan receptor 2 (ROR2) is a non-canonical WNT receptor that regulates the planar cell polarity pathway, controlling limb outgrowth during development.

Osteoarthritis is characterized by the loss of the articular cartilage, bone remodeling, pain, and disability. No pharmacological intervention can currently halt progression of osteoarthritis. Here, we show that blocking receptor tyrosine kinase-like orphan receptor 2 (ROR2) improves cartilage integrity and pain in osteoarthritis models by inhibiting yes-associated protein (YAP) signaling. ROR2 was up-regulated in the cartilage in response to inflammatory cytokines and mechanical stress. The main ligand for ROR2, WNT5A, and the targets YAP and connective tissue growth factor were up-regulated in osteoarthritis in humans. In vitro, ROR2 overexpression inhibited chondrocytic differentiation. Conversely, ROR2 blockade triggered chondrogenic differentiation of C3H10T1/2 cells and suppressed the expression of the cartilage-degrading enzymes a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4 and ADAMTS-5. The chondrogenic effect of ROR2 blockade in the cartilage was independent of WNT signaling and was mediated by down-regulation of YAP signaling. ROR2 signaling induced G protein and Rho-dependent nuclear accumulation of YAP, and YAP inhibition was required but not sufficient for ROR2 blockade-induced chondrogenesis. ROR2 silencing protected mice from instability-induced osteoarthritis with improved structural outcomes, sustained pain relief, and without apparent side effects or organ toxicity. Last, ROR2 silencing in human articular chondrocytes transplanted in nude mice led to the formation of cartilage organoids with more and better differentiated extracellular matrix, suggesting that the anabolic effect of ROR2 blockade is conserved in humans. Thus, ROR2 blockade is efficacious and well tolerated in preclinical animal models of osteoarthritis.

The severity of cardiac dysfunction predicts mortality in sepsis. Activation of transient receptor potential vanilloid receptor type (TRPV)-1, a predominantly neuronal nonselective cation channel, has been shown to improve outcome in sepsis and endotoxemia. However, the role of TRPV1 and the identity of its endogenous ligands in the cardiac dysfunction caused by sepsis and endotoxemia are unknown. Using TRPV1-/- and TRPV1+/+ mice, we showed that endogenous activation of cardiac TRPV1 during sepsis is key to limiting the ensuing cardiac dysfunction. Use of liquid chromatography-tandem mass spectrometry lipid analysis and selective inhibitors of arachidonic metabolism suggest that the arachidonate-derived TRPV1 activator, 20-hydroxyeicosateraenoic acid (20-HETE), underlies a substantial component of TRPV1-mediated cardioprotection in sepsis. Moreover, using selective antagonists for neuropeptide receptors, we show that this effect of TRPV1 relates to the activity of neuronally released cardiac calcitonin gene-related peptide (CGRP) and that, accordingly, administration of CGRP can rescue cardiac dysfunction in severe endotoxemia. In sum activation of TRPV1 by 20-HETE leads to the release of CGRP, which protects the heart against the cardiac dysfunction in endotoxemia and identifies both TRPV1 and CGRP receptors as potential therapeutic targets in endotoxemia.-Chen, J., Hamers, A. J. P., Finsterbusch, M., Massimo, G., Zafar, M., Corder, R., Colas, R. A., Dalli, J., Thiemermann, C., Ahluwalia, A. Endogenously generated arachidonate-derived ligands for TRPV1 induce cardiac protection in sepsis.

Endothelin-1 (ET-1) is involved in the pathogenesis of cardiac and renal diseases, and in the progression of tumour growth in cancer, but current diagnosis and treatment remain inadequate. Peptides derived from the 212 amino acid precursor preproendothelin-1 (ppET-1) may have utility as biomarkers, or cause biological effects that are unaffected by endothelin receptor antagonists. Here, we used specific immunoassays and LC-MS/MS to identify NT-proET-1 (ppET-1[18–50]), Endothelin-Like Domain Peptide (ELDP, ppET-1[93–166]) and CT-proET-1 (ppET-1[169–212]) in conditioned media from cultured endothelial cells. Synthesis of these peptides correlated with ET-1, and plasma ELDP and CT-proET-1 were elevated in patients with chronic heart failure. Clearance rates of NT-proET-1, ELDP and CT-proET-1 were determined after i.v. injection in anaesthetised rats. CT-proET-1 had the slowest systemic clearance, hence providing a biological basis for it being a better biomarker of ET-1 synthesis. ELDP contains the evolutionary conserved endothelin-like domain sequence, which potentially confers biological activity. On isolated arteries ELDP lacked direct vasoconstrictor effects. However, it enhanced ET-1 vasoconstriction and prolonged the increase in blood pressure in anaesthetised rats. ELDP may therefore contribute to disease pathogenesis by augmenting ET-1 responses.

Background Endothelin 1 (ET‐1) contributes to chronic kidney disease (CKD) development and progression, and endothelin receptor antagonists are being investigated as a novel therapy for CKD. The proET‐1 peptides, endothelin‐like domain peptide (ELDP) and C‐terminal pro‐ET‐1 (CT‐proET‐1), are both potential biomarkers of CKD and response to therapy with endothelin antagonists. Methods and Results We assessed plasma and urine ELDP and plasma CT‐proET‐1 in CKD patients with minimal comorbidity. Next, in a randomized double‐blind crossover study of 27 subjects with proteinuric CKD, we examined the effects of 6 weeks of treatment with placebo, sitaxentan (endothelin A antagonist), and nifedipine on these peptides alongside the primary end points of proteinuria, blood pressure, and arterial stiffness. Plasma ELDP and CT‐proET‐1 increased with CKD stage (both P <0.0001), correlating inversely with estimated glomerular filtration rate (both P <0.0001). Following intervention, placebo and nifedipine did not affect plasma and urine ELDP or plasma CT‐proET‐1. Sitaxentan increased both plasma ELDP and CT‐proET‐1 (baseline versus week 6±SEM: ELDP, 11.8±0.5 versus 13.4±0.6 fmol/mL; CT‐proET‐1, 20.5±1.2 versus 23.3±1.5 fmol/mL; both P <0.0001). Plasma ET‐1 was unaffected by any treatment. Following sitaxentan, plasma ELDP and CT‐proET‐1 correlated negatively with 24‐hour urinary sodium excretion. Conclusions ELDP and CT‐proET‐1 increase in CKD and thus are potentially useful biomarkers of renal injury. Increases in response to endothelin A antagonism may reflect EDN1 upregulation, which may partly explain fluid retention with these agents. Clinical Trial Registration URL: www.clinicalTrials.gov Unique identifier: NCT00810732

Regular consumption of chocolate and cocoa products has been linked to reduced cardiovascular mortality.This study compared the effects of high flavanol dark chocolate (HFDC; 1064mg flavanols/day for 6 weeks) and low flavanol dark chocolate (LFDC; 88mg flavanols/day for 6 weeks) on blood pressure, heart rate, vascular function and platelet aggregation in men with pre-hypertension or mild hypertension.Vascular function was assessed by pulse wave analysis using radial artery applanation tonometry in combination with inhaled salbutamol (0.4 mg) to assess changes due to endothelium-dependent vasodilatation.HFDC did not significantly reduce blood pressure compared to baseline or LFDC.Heart rate was increased by LFDC compared to baseline, but not by HFDC.Vascular responses to salbutamol tended to be greater after HFDC.Platelet aggregation induced by collagen or the thromboxane analogue U46619 was unchanged after LFDC or HFDC, whereas both chocolates reduced responses to ADP and the thrombin receptor activator peptide, SFLLRNamide (TRAP6), relative to baseline.Pre-incubation of platelets with theobromine also attenuated platelet aggregation induced by ADP or TRAP6.We conclude that consumption of HFDC confers modest improvements in cardiovascular function.Platelet aggregation is modulated by a flavanol-independent mechanism that is likely due to theobromine.

Poor prognosis in chronic heart failure (HF) is linked to endothelial dysfunction for which there is no specific treatment currently available. Previous studies have shown reproducible improvements in endothelial function with cocoa flavanols, but the clinical benefit of this effect in chronic HF has yet to be determined. Therefore, the aim of this study was to assess the potential therapeutic value of a high dose of cocoa flavanols in patients with chronic HF, by using reductions in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) as an index of improved cardiac function.

Insulin resistance and associated metabolic sequelae are common in chronic kidney disease (CKD) and are positively and independently associated with increased cardiovascular mortality. However, the pathogenesis has yet to be fully elucidated. 11β-Hydroxysteroid dehydrogenase type 1 (11βHSD1) catalyzes intracellular regeneration of active glucocorticoids, promoting insulin resistance in liver and other metabolic tissues. Using two experimental rat models of CKD (subtotal nephrectomy and adenine diet) which show early insulin resistance, we found that 11βHSD1 mRNA and protein increase in hepatic and adipose tissue, together with increased hepatic 11βHSD1 activity. This was associated with intrahepatic but not circulating glucocorticoid excess, and increased hepatic gluconeogenesis and lipogenesis. Oral administration of the 11βHSD inhibitor carbenoxolone to uremic rats for 2 wk improved glucose tolerance and insulin sensitivity, improved insulin signaling, and reduced hepatic expression of gluconeogenic and lipogenic genes. Furthermore, 11βHSD1(-/-) mice and rats treated with a specific 11βHSD1 inhibitor (UE2316) were protected from metabolic disturbances despite similar renal dysfunction following adenine experimental uremia. Therefore, we demonstrate that elevated hepatic 11βHSD1 is an important contributor to early insulin resistance and dyslipidemia in uremia. Specific 11βHSD1 inhibitors potentially represent a novel therapeutic approach for management of insulin resistance in patients with CKD.

The effects of oligomeric procyanidins (OPC) on vascular endothelial function provide a plausible explanation for the reduced incidence of coronary heart disease in red wine drinkers. Grape variety is an important influence on the amounts of OPC in wines. Red wines made from Aglianico, Sagrantino or Tannat grapes typically have higher OPC levels. The endothelial response to OPC induces atheroprotective changes in vascular function, which are likely mediated via oxidant signalling mechanisms originating from the mitochondrial electron transport chain.

Background: ET-1 is strongly implicated in cardiac and renal pathologies both as a potent vasoconstrictor, and as an inducer of tissue remodeling and fibrosis. However, in experimental and human studies ET antagonists are often ineffective. ET-1 biosynthesis occurs via a 212 amino acid peptide preproendothelin-1 (ppET-1); hence other peptides from this precursor may contribute to the biological effects of EDN1 gene expression. Methods: Specific immunoassays were used to identify the peptide products of ppET-1 in conditioned media samples from EA.hy 926 and A549 cell lines. Secretion of proET-1 peptides was also investigated using primary cultures of human aortic endothelial (HAEC) and smooth muscle cells (HAVSMC), and cardiomyocytes (HCM). Synthetic proET-1 peptides were used to study their rate of clearance from the circulation in anaesthetized rats, and effects on ET-1 induced vasoconstrictor and blood pressure responses. Results: Using specific antibodies 3 peptides were identified: NT-proET-1 (ppET-1[18-50]), MP-proET-1 (ppET-1[93-166]) and CT-proET-1 (ppET-1[169-212]). Specific sandwich ELISAs for these three peptides showed that they were secreted from all cell types studied with levels of release correlating with ET-1. Arterial blood measurements after i.v. administration (1 nmol/kg) of peptide showed markedly different elimination rates. NT-proET-1 had the most rapid clearance (<5 min) and CT-proET-1 the slowest (8% of initial values 40 min after injection). On rat mesenteric resistance arteries MP-proET-1 alone showed no significant vasoconstrictor effect up to 10 nM, but after pre-treatment with ET-1 (1 - 3 nM) it produced a concentration dependent vasoconstriction. Pre-incubation of rat mesenteric resistance arteries with 10 nM MP-proET-1 increased the response of 1 nM ET-1 by 5 fold (P <0.002). MP-proET-1 alone (3 nmol/kg) had no effect on blood pressure in anaesthetised rats, but it significantly increased the duration of the pressor response to ET-1 (0.3 nmol/kg, P <0.02). Conclusions: ProET-1 derived peptides may play an important role in vascular pathologies by modulating ET-1 responses, or the actions of other mediators. The slower systemic clearance of CT-proET-1 favors its use as a biomarker of EDN1-linked pathologies.

Background: Endothelial dysfunction in patients with heart failure (HF) has been linked to a worse prognosis. High flavanol cocoa products improve endothelial function, but it has yet to be established whether such changes are sufficient to confer medical benefit. We investigated whether high flavanol dark chocolate (HFDC) reduces the severity of HF by measuring changes in amino-terminal pro-B type natriuretic peptide (NT-proBNP). Methods: Patients with HF and a history of ischemic heart disease (n = 32), stable on optimal medication according to standard guidelines, were randomized to consume 50 g per day of either HFDC or low flavanol dark chocolate (LFDC) for 4 weeks, and then crossed over to consume the alternative dark chocolate for a further 4 week. The flavanol contents of the HFDC and LFDC were 1094 and 95 mg/50 g. NT-proBNP, blood pressure, and aortic pulse waveform derived from radial artery applanation tonometry were assessed at baseline, after each 4-week treatment phase, and at follow-up 4 weeks after completion of chocolate consumption. Results: 24 subjects completed the study. After 4 weeks consumption of HFDC, NT-proBNP was significantly lower compared to baseline (P = 0.016), LFDC (P = 0.019) and at follow-up (P = 0.004). After HFDC, diastolic blood pressure (DBP) was decreased compared to LFDC (mean decrease ± SD; -7 ± 10 mmHg, P = 0.003 and compared to baseline measurements (-4 ± 9 mmHg, P = 0.047). Figure 1 shows a comparison of mean changes in DBP and NT-proBNP after HFDC compared to baseline, LFDC and follow-up values. Mean decrease in NT-proBNP was >30% in 12 patients. Conclusions: Reductions in NT-proBNP and blood pressure after HFDC are consistent with a decrease in vascular resistance resulting in reduced left ventricular afterload. Post treatment reductions of NT-proBNP >30% have previously been associated with improved outcome in patients with HF. Hence, long-term benefits of high flavanol interventions in HF merit further investigation.

Background: Epicardial adipose tissue (EAT), a metabolically active visceral fat depot surrounding the heart, has been implicated in the pathogenesis of coronary artery disease (CAD) through possible paracrine interaction with the coronary arteries. We examined the association of EAT with metabolic syndrome and the prevalence and progression of coronary artery calcium (CAC) burden.Methods: CAC scan was performed in 333 asymptomatic diabetic patients without prior history of CAD (median age 54 years, 62% males), followed by a repeat scan after 2.7 +/- 0.3 years. CAC progression was defined as > 2.5mm(3) increase in square root transformed volumetric CAC scores. EAT and intra-thoracic fat volumes were quantified using a dedicated software (QFAT), and were examined in relation to the metabolic syndrome, baseline CAC scores and CAC progression.Results: Both epicardial and intra-thoracic fat were associated with metabolic syndrome after adjustment for conventional cardiovascular risk factors, but the association was attenuated after additional adjustment for body mass index. EAT, but not intra-thoracic fat, showed significant association with baseline CAC scores (odds ratio [ OR] 1.13, 95% confidence interval [CI] 1.04-1.22, p = 0.04) and CAC progression (OR 1.12, 95% CI 1.05-1.19, p < 0.001) after adjustment for conventional measures of obesity and risk factors.Conclusion: EAT volume measured on non-contrast CT is an independent marker for the presence and severity of coronary calcium burden and also identifies individuals at increased risk of CAC progression. EAT quantification may thus add to the prognostic value of CAC imaging. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Consumption of a fructose-rich diet leads to insulin resistance and dyslipidemia in part due to elevated gluconeogenesis and lipogenesis. SIRT1, an NAD(+)-dependent protein deacetylase, can induce gluconeogenesis and lipogenesis. The aim of this study was to determine whether fructose increased hepatic SIRT1, leading to induction of gluconeogenesis and lipogenesis. Rat hepatocytes were incubated with fructose (1-5 mM). SIRT1 protein, SIRT1 activity, and NAD(+)/NADH ratio were measured. The effects of SIRT1 inhibitors (EX-527 and nicotinamide) and activators (SIRT1 activator 3 and SRT1720) and the mitochondrial complex I inhibitor rotenone were examined on fructose-induced increases in gluconeogenesis and lipogenesis. Fructose increased SIRT1 protein, SIRT1 activity, and NAD(+)/NADH ratio. Fructose also induced gluconeogenesis, with increases in peroxisome proliferator-activated receptor coactivator 1-alpha (PGC1 alpha) and phosphoenolpyruvate carboxykinase (PEPCK; gene code Pck1) gene expression, PEPCK activity, and hepatocyte glucose production. In addition, levels of 3-hydroxy-3-methylglutaryl coenzyme A reductase (Hmgcr) and acetyl-coA carboxylase (Acc) mRNA, and intracellular cholesterol were increased. Increases in gluconeogenesis, Hmgcr, Acc, and cholesterol were abolished by SIRT1 inhibitors and rotenone, while SIRT1 activators increased gluconeogenesis, Hmgcr, Acc, Pgc1 beta, and sterol regulatory element-binding protein 1c (Srebp1c) gene expression. In conclusion, fructose induces gluconeogenesis and lipogenesis through a SIRT1-dependent mechanism, suggesting that induction of hepatic SIRT1 could play a pivotal role in the metabolic changes observed in humans and animals consuming a fructose-rich diet. These results highlight the need for a greater understanding of the role of SIRT1 in metabolic regulation and indicate the potential for adverse effects of SIRT1 activators if used therapeutically. Journal of Endocrinology (2011) 208, 273-283

OBJECTIVE:Advanced glycation end products (AGE) have been implicated in diabetic vascular complications through activation of pro-inflammatory genes. AGE-modified proteins are also targeted by the immune system resulting in the generation of AGE-specific autoantibodies, but the association of these immune responses with diabetic vasculopathy remains to be fully elucidated. The aim of this study was to determine whether antibodies against apolipoprotein B100 modified by methylglyoxal (MGO-apoB100) are associated with coronary atherosclerosis in patients with type 2 diabetes. METHODS:We measured antibodies against MGO-apoB100 in plasma from 497 type 2 diabetic patients without clinical signs of cardiovascular disease. Severity of coronary disease was assessed as coronary artery calcium (CAC) imaging. Immunoglobulin (Ig)M and IgG levels recognizing MGO-apoB100 were determined by enzyme-linked immunosorbent assay. RESULTS:Anti-MGO-apoB100 IgM antibody levels were higher in subjects with a low to moderate CAC score (≤400 Agatston units) than in subjects with a high score (>400 Agatston units; 136.8±4.4 vs. 101.6± 7.4 arbitrary units (AU), P<0.0001) and in subjects demonstrating no progression of CAC during 30 months of follow-up (136.4±5.7 vs. 113.9 ± 6.2 AU in subjects with progression, P<0.0001). Subjects with a family history of premature myocardial infarction had lower levels of anti-MGO-apoB100 IgM. Female subjects had higher levels of anti-MGO-apoB100 antibodies and lower CAC than men. Accordingly, high levels of IgM against MGO-apoB100 are associated with less severe and a lower risk of progression of coronary disease in subjects with type 2 diabetes. CONCLUSIONS:Although conclusions regarding causal relationships based on epidemiological observations need to be made with caution, our findings suggest the possibility that anti-MGO-apoB100 IgM may be protective in diabetic vasculopathy.

Abnormal elevation of hepatic gluconeogenesis is central to the onset of hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). Metformin corrects hyperglycaemia through inhibition of gluconeogenesis, but its mechanism of action is yet to be fully described. SIRT1 and GCN5 (listed as KAT2A in the MGI Database) have recently been identified as regulators of gluconeogenic gene expression through modulation of levels and activity of the coactivators cAMP-response element binding protein-regulated transcription coactivator 2 (TORC2 or CRTC2 as listed in the MGI Database) and peroxisome proliferator-activated receptor-gamma coactivator-1alpha (PGC1alpha or PPARGC1A as listed in the MGI Database). We report that in db/db mice, metformin (250 mg/kg per day; 7 days) increases hepatic levels of GCN5 protein and mRNA compared with the untreated db/db mice, as well as increases levels of SIRT1 protein and activity relative to controls and untreated db/db mice. These changes were associated with reduced TORC2 protein level and decreased gene expression and activation of the PGC1alpha gene target phosphoenolpyruvate carboxykinase, and lower plasma glucose and insulin. Inhibition of SIRT1 partially blocked the effects of metformin on gluconeogenesis. SIRT1 was increased through an AMP-activated protein kinase-mediated increase in gene expression of nicotinamide phosphoribosyltransferase, the rate-limiting enzyme of the salvage pathway for NAD(+). Moreover, levels of GCN5 were dramatically reduced in db/db mice compared with the controls. This indicates that loss of GCN5-mediated inhibition of gluconeogenesis appears to constitute a major mechanism for the onset of abnormally elevated hepatic glucose production in db/db mice. In conclusion, induction of GCN5 and SIRT1 potentially represents a critical mechanism of action of metformin. In addition, these data identify induction of hepatic GCN5 as a potential therapeutic strategy for treatment of T2DM.

Flavonoid-rich diets are associated with a lower mortality from cardiovascular disease. This has been linked to improvements in endothelial function. However, the specific flavonoids, or biologically active metabolites, conferring these beneficial effects have yet to be fully defined. In this experimental study of the effect of flavonoids on endothelial function cultured endothelial cells have been used as a bioassay with endothelin-1 (ET-1) synthesis being measured an index of the response. Evaluation of the relative effects of extracts of cranberry juice compared to apple, cocoa, red wine, and green tea showed inhibition of ET-1 synthesis was dependent primarily on their oligomeric procyanidin content. Procyanidin-rich extracts of cranberry juice triggered morphological changes in endothelial cells with reorganization of the actin cytoskeleton and increased immunostaining for phosphotyrosine residues. These actions were independent of antioxidant activity. Comparison of the effects of apple procyanidin monomers through heptamer showed a clear structure-activity relationship. Although monomer, dimer, and trimer had little effect on ET-1 synthesis, procyanidin tetramer, pentamer, hexamer, and heptamer produced concentration-dependent decreases with IC(50) values of 5.4, 1.6, 0.9, and 0.7 microM, respectively. Levels of ET-1 mRNA showed a similar pattern of decreases, which were inversely correlated with increased expression of Kruppel-like factor 2 (KLF2), a key endothelial transcription factor with a broad range of antiatherosclerotic actions including suppression of ET-1 synthesis. Future investigations of procyanidin-rich products should assess the role KLF2 induction plays in the beneficial vascular effects of high flavonoid consumption.