G in Aortic Aneurysm and DissectionFigure 4. Notch FCCP signaling 
is activated in Stro-1+ stem cells in DTAAD patients. A) Immunofluorescence double staining showed that Jagged1 was expressed in Stro-1+ stem cells in the aortic media of both TAA and TAD tissues. B) Immunofluorescence double staining showed that NICD was highly expressed in Stro-1+ stem cells in the aortic media of both TAA and TAD tissues (scale bar = 25 mm). C) Immunofluorescence double staining showed that Hes1 was highly expressed in Stro-1+ stem cells in the aortic wall of both TAA and TAD tissues (scale bar = 50 mm). doi:10.1371/journal.pone.0052833.gthe Notch signaling pathway in Stro-1+ and CD34+ stem cells facilitates stem cell proliferation and differentiation into SMCs, contributing to aortic repair in DTAAD; further studies are needed to examine this potential mechanism. Fibroblasts are important components of the aortic wall and may play diverse roles in aortic repair, remodeling, and inflammation, but the role of fibroblasts in the pathogenesis and development of AAD is poorly understood. In the present study, we observed large numbers of fibroblasts in the aortic wall of DTAAD patients. Because fibroblasts can proliferate rapidly in response to injury and thus help significantly in cardiovascular repair [23,24,40], our finding of large numbers of fibroblasts may represent a response to aortic injury; this response may be an attempt to help maintain aortic strength and prevent aortic dilatation and rupture. However, uncontrolled proliferation of fibroblasts promotes fibrotic remolding [41] withdecreased contractile function and compliance. Additionally, fibroblasts produce cytokines and monocyte chemotactic protein-1 [42] and promote inflammatory cell recruitment/activation and aortic inflammation, all of which cause further 23977191 tissue damage. Thus, proper control of fibroblast homeostasis in the aortic wall is critical. Notch signaling induces fibroblast proliferation [24], and in the present study, we observed high levels of NICD and Hes1 in most fibroblasts in TAA and TAD tissues, indicating the activation of Notch signaling. This activation may contribute to fibroblast proliferation. Further studies are required to define the role of fibroblasts in aortic remodeling during AAD formation and progression and to identify how Notch signaling regulates the process. Macrophages play a destructive role in AAD 1326631 formation and progression. Previous studies have shown that AAA expansion is associated with macrophage accumulation in regions of medialNotch Signaling in Aortic Aneurysm and DissectionFigure 5. Notch signaling is activated in fibroblasts in DTAAD patients. A) ER-TR7 was used as the marker for fibroblasts in immunofluorescence double staining experiments. Significantly more fibroblasts were seen in the Lecirelin web adventitia of the aortic wall of TAA and TAD tissues than in control tissue (TAA vs. control, P,0.001; TAD vs. control, P,0.001), and NICD was detected in most fibroblasts in TAA and TAD tissues (TAA vs. control, P = 0.009; TAD vs. control, P = 0.02) (scale bar = 25 mm, insets 6.25 mm). Error bars indicate the standard deviation in the number of NICD+ fibroblasts. B) Immunofluorescence double staining showed that Hes1 was highly expressed in fibroblasts in the aortic wall of both TAA and TAD tissues (scale bar = 50 mm). doi:10.1371/journal.pone.0052833.gdisruption, predominantly on the adventitial aspect [43]. Moreover, macrophage-mediated vascular inflammation can.G in Aortic Aneurysm and DissectionFigure 4. Notch signaling is activated in Stro-1+ stem cells in DTAAD patients. A) Immunofluorescence double staining showed that Jagged1 was expressed in Stro-1+ stem cells in the aortic media of both TAA and TAD tissues. B) Immunofluorescence double staining showed that NICD was highly expressed in Stro-1+ stem cells in the aortic media of both TAA and TAD tissues (scale bar = 25 mm). C) Immunofluorescence double staining showed that Hes1 was highly expressed in Stro-1+ stem cells in the aortic wall of both TAA and TAD tissues (scale bar = 50 mm). doi:10.1371/journal.pone.0052833.gthe Notch signaling pathway in Stro-1+ and CD34+ stem cells facilitates stem cell proliferation and differentiation into SMCs, contributing to aortic repair in DTAAD; further studies are needed to examine this potential mechanism. Fibroblasts are important components of the aortic wall and may play diverse roles in aortic repair, remodeling, and inflammation, but the role of fibroblasts in the pathogenesis and development of AAD is poorly understood. In the present study, we observed large numbers of fibroblasts in the aortic wall of DTAAD patients. Because fibroblasts can proliferate rapidly in response to injury and thus help significantly in cardiovascular repair [23,24,40], our finding of large numbers of fibroblasts may represent a response to aortic injury; this response may be an attempt to help maintain aortic strength and prevent aortic dilatation and rupture. However, uncontrolled proliferation of fibroblasts promotes fibrotic remolding [41] withdecreased contractile function and compliance. Additionally, 
fibroblasts produce cytokines and monocyte chemotactic protein-1 [42] and promote inflammatory cell recruitment/activation and aortic inflammation, all of which cause further 23977191 tissue damage. Thus, proper control of fibroblast homeostasis in the aortic wall is critical. Notch signaling induces fibroblast proliferation [24], and in the present study, we observed high levels of NICD and Hes1 in most fibroblasts in TAA and TAD tissues, indicating the activation of Notch signaling. This activation may contribute to fibroblast proliferation. Further studies are required to define the role of fibroblasts in aortic remodeling during AAD formation and progression and to identify how Notch signaling regulates the process. Macrophages play a destructive role in AAD 1326631 formation and progression. Previous studies have shown that AAA expansion is associated with macrophage accumulation in regions of medialNotch Signaling in Aortic Aneurysm and DissectionFigure 5. Notch signaling is activated in fibroblasts in DTAAD patients. A) ER-TR7 was used as the marker for fibroblasts in immunofluorescence double staining experiments. Significantly more fibroblasts were seen in the adventitia of the aortic wall of TAA and TAD tissues than in control tissue (TAA vs. control, P,0.001; TAD vs. control, P,0.001), and NICD was detected in most fibroblasts in TAA and TAD tissues (TAA vs. control, P = 0.009; TAD vs. control, P = 0.02) (scale bar = 25 mm, insets 6.25 mm). Error bars indicate the standard deviation in the number of NICD+ fibroblasts. B) Immunofluorescence double staining showed that Hes1 was highly expressed in fibroblasts in the aortic wall of both TAA and TAD tissues (scale bar = 50 mm). doi:10.1371/journal.pone.0052833.gdisruption, predominantly on the adventitial aspect [43]. Moreover, macrophage-mediated vascular inflammation can.
