Smooth muscle-specific HuR knockout attenuates vascular calcification

Vascular calcification is a common pathological feature of atherosclerosis, chronic kidney disease, vascular injury and aging. Human antigen R (HuR), a widely expressed RNA-binding protein, plays a key role in the regulation of homeostasis and pathological conditions such as cancer and cardiovascular disease, but its role in vascular calcification remains unclear. In this study, we generated smooth muscle-specific HuR knockout (HuR^SMKO) mice to investigate the function of HuR in vascular calcification. The HuR level increased under calcifying conditions, and high phosphate levels increased HuR expression via activating transcription factor 4 (ATF4). HuR overexpression exacerbated high phosphate-induced calcification, whereas HuR deficiency inhibited high phosphate-induced calcification in VSMCs. Smooth muscle-specific knockout of HuR protected against vascular calcification in vivo. Additionally, treatment with the HuR inhibitor CMLD-2 significantly attenuated calcification in mice. Mechanistically, HuR binds directly to Runt-related transcription factor 2 (Runx2) mRNA, increasing its stability and protein expression, which facilitates vascular calcification. These findings demonstrate that HuR plays a critical role in the regulation of vascular calcification through the posttranscriptional control of Runx2.