Mitofusin 2 Downregulation Triggers Pulmonary Artery Smooth Muscle Cell Proliferation and Apoptosis Imbalance in Rats With Hypoxic Pulmonary Hypertension Via the PI3K/Akt and Mitochondrial Apoptosis Pathways.

During hypoxia-induced pulmonary hypertension (HPH), pulmonary artery smooth muscle cells (PASMCs) proliferate as part of the characteristic pulmonary vascular remodeling. We investigated the expression of mitofusin 2(Mfn2) and its role in maintaining the balance between PASMC proliferation and apoptosis during hypoxia. In an experimental model of HPH, we exposed rats to hypoxia (10% ± 0.5% O2) or room air for 4 weeks. We found that Mfn2 messenger RNA and protein levels were reduced and that proliferating cell nuclear antigen protein expression was upregulated in HPH rat lung tissues. We also exposed primary cultured PASMCs from rat pulmonary arterioles to normoxia (21% O2/5% CO2) or hypoxia (2.5% O2/5% CO2) for 24 hours. We found that PASMC proliferation increased under hypoxic conditions and that more hypoxic cells than normoxic cells entered the S + G2/M phase. Additionally, phosphorylated Akt and proliferating cell nuclear antigen expression increased, whereas Mfn2 expression, cleaved caspase 9 expression, and the ratio of mitochondrial to cytosolic cytochrome C expression each decreased. These hypoxia-induced effects were reversed in PASMCs by Mfn2 overexpression and by phosphatidylinositide 3-kinases (PI3K) inhibition. Our results indicate that downregulation of Mfn2 in HPH may activate the PI3K/Akt pathway, thereby causing more cells to enter the S + G2/M phase of the cell cycle and inhibiting the mitochondrial apoptosis pathway.