Benoît Ranchoux1, Fabrice Antigny1, Catherine Rucker-Martin1, Aurélie Hautefort1, Christine Péchoux1, Harm Jan Bogaard1, Peter Dorfmüller1, Séverine Remy1, Florence Lecerf1, Sylvie Planté1, Sophie Chat1, Elie Fadel1, Amal Houssaini1, Ignacio Anegon1, Serge Adnot1, Gerald Simonneau1, Marc Humbert1, Sylvia Cohen-Kaminsky1, Frédéric Perros2. 1. From Univ. Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France (B.R., F.A., C.R.-M., A.H., P.D., F.L., E.F., G.S., M.H., S.C.-K., F.P.); AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (B.R., F.A., C.R.-.M., A.H., P.D., F.L., G.S., M.H., S.C.-K., F.P.); INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France (B.R., F.A., C.R.-M., A.H., P.D., F.L., E.F., G.S., M.H., S.C.-K., F.P.); INRA U1196, Génomique et Physiologie de la Lactation - Plateau de Microscopie Electronique à Transmission, Jouy-en-Josas, France (C.P., S.C.); Service de Chirurgie Thoracique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France (E.F.); Service d'Anatomie Pathologique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (P.D., S.P.); Department of Pulmonary Medicine, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (H.J.B.); INSERM UMR 1064-Center for Research in Transplantation and Immunology-ITUN et Transgenic Rats and Immunophenomic Platform, Nantes, France (S.R., I.A.); and INSERM U955, Département de Physiologie and Service de Cardiologie, Hôpital Henri Mondor, AP-HP, Université Paris-Est Créteil (UPEC), Créteil, France (A.H., S.A.). 2. From Univ. Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, France (B.R., F.A., C.R.-M., A.H., P.D., F.L., E.F., G.S., M.H., S.C.-K., F.P.); AP-HP, DHU TORINO, Centre de Référence de l'Hypertension Pulmonaire Sévère, Service de Pneumologie et Réanimation Respiratoire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (B.R., F.A., C.R.-.M., A.H., P.D., F.L., G.S., M.H., S.C.-K., F.P.); INSERM UMR-S 999, Labex LERMIT, Hypertension Artérielle Pulmonaire: Physiopathologie et Innovation Thérapeutique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France (B.R., F.A., C.R.-M., A.H., P.D., F.L., E.F., G.S., M.H., S.C.-K., F.P.); INRA U1196, Génomique et Physiologie de la Lactation - Plateau de Microscopie Electronique à Transmission, Jouy-en-Josas, France (C.P., S.C.); Service de Chirurgie Thoracique, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France (E.F.); Service d'Anatomie Pathologique, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France (P.D., S.P.); Department of Pulmonary Medicine, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (H.J.B.); INSERM UMR 1064-Center for Research in Transplantation and Immunology-ITUN et Transgenic Rats and Immunophenomic Platform, Nantes, France (S.R., I.A.); and INSERM U955, Département de Physiologie and Service de Cardiologie, Hôpital Henri Mondor, AP-HP, Université Paris-Est Créteil (UPEC), Créteil, France (A.H., S.A.). frederic.perros@inserm.fr.
Abstract
BACKGROUND: The vascular remodeling responsible for pulmonary arterial hypertension (PAH) involves predominantly the accumulation of α-smooth muscle actin-expressing mesenchymal-like cells in obstructive pulmonary vascular lesions. Endothelial-to-mesenchymal transition (EndoMT) may be a source of those α-smooth muscle actin-expressing cells. METHODS AND RESULTS: In situ evidence of EndoMT in human PAH was obtained by using confocal microscopy of multiple fluorescent stainings at the arterial level, and by using transmission electron microscopy and correlative light and electron microscopy at the ultrastructural level. Findings were confirmed by in vitro analyses of human PAH and control cultured pulmonary artery endothelial cells. In addition, the mRNA and protein signature of EndoMT was recognized at the arterial and lung level by quantitative real-time polymerase chain reaction and Western blot analyses. We confirmed our human observations in established animal models of pulmonary hypertension (monocrotaline and SuHx). After establishing the first genetically modified rat model linked to BMPR2 mutations (BMPR2(Δ140Ex1/+) rats), we demonstrated that EndoMT is linked to alterations in signaling of BMPR2, a gene that is mutated in 70% of cases of familial PAH and in 10% to 40% of cases of idiopathic PAH. We identified molecular actors of this pathological transition, including twist overexpression and vimentin phosphorylation. We demonstrated that rapamycin partially reversed the protein expression patterns of EndoMT, improved experimental PAH, and decreased the migration of human pulmonary artery endothelial cells, providing the proof of concept that EndoMT is druggable. CONCLUSIONS: EndoMT is linked to alterations in BPMR2 signaling and is involved in the occlusive vas cular remodeling of PAH, findings that may have therapeutic implications.
BACKGROUND: The vascular remodeling responsible for pulmonary arterial hypertension (PAH) involves predominantly the accumulation of α-smooth muscle actin-expressing mesenchymal-like cells in obstructive pulmonary vascular lesions. Endothelial-to-mesenchymal transition (EndoMT) may be a source of those α-smooth muscle actin-expressing cells. METHODS AND RESULTS: In situ evidence of EndoMT in human PAH was obtained by using confocal microscopy of multiple fluorescent stainings at the arterial level, and by using transmission electron microscopy and correlative light and electron microscopy at the ultrastructural level. Findings were confirmed by in vitro analyses of human PAH and control cultured pulmonary artery endothelial cells. In addition, the mRNA and protein signature of EndoMT was recognized at the arterial and lung level by quantitative real-time polymerase chain reaction and Western blot analyses. We confirmed our human observations in established animal models of pulmonary hypertension (monocrotaline and SuHx). After establishing the first genetically modified rat model linked to BMPR2 mutations (BMPR2(Δ140Ex1/+) rats), we demonstrated that EndoMT is linked to alterations in signaling of BMPR2, a gene that is mutated in 70% of cases of familial PAH and in 10% to 40% of cases of idiopathic PAH. We identified molecular actors of this pathological transition, including twist overexpression and vimentin phosphorylation. We demonstrated that rapamycin partially reversed the protein expression patterns of EndoMT, improved experimental PAH, and decreased the migration of human pulmonary artery endothelial cells, providing the proof of concept that EndoMT is druggable. CONCLUSIONS: EndoMT is linked to alterations in BPMR2 signaling and is involved in the occlusive vas cular remodeling of PAH, findings that may have therapeutic implications.
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