Pulmonary arterial hypertension (PAH) is a severe disease characterized by excessive proliferation of apoptosis-resistant pulmonary artery endothelial cells (PAEC) and smooth muscle cells (PASMC), progressive pulmonary arterial (PA) stiffening, and ultimately right heart failure and death. Recent studies suggest that increased PA stiffness contributes significantly to increased right ventricular after-load and is associated with increased mortality in PAH patients, however the role of PA stiffening in the pathogenesis of PAH has not yet been fully elucidated. We have used atomic force microscopy (AFM) micro-indentation to mechanically characterize the stiffness of pulmonary arteries at an unprecedented micro-scale level in experimental PAH. Our preliminary findings demonstrate that distal pulmonary arteries develop significant increases in matrix stiffness by more than three-fold in the rat models of SU5416/hypoxia and monocrotaline (MCT)-induced PAH. Furthermore, human PASMC and PAEC grown on polyacrylamide substrates with the stiffness of remodeled pulmonary arteries develop a striking hyper-proliferative phenotype, decreased expression of cyclooxygenase (COX)-2, reduced prostaglandin I2 synthesis, and increased secretion of endothelin-1. Taken together, our findings suggest that matrix remodeling in the PA wall fundamentally biases cellular behavior towards progressive vascular remodeling via previously unrecognized effects of matrix stiffening. We hypothesize that increases in PA stiffness are not merely a consequence of pathological alterations in the vessel wall, but rather that increases in matrix stiffness trigger a """"""""remodeling phenotype"""""""" characterized by enhanced cellular proliferation and matrix deposition in pulmonary arteries, promoting mechano-biological feedback amplification of vascular remodeling. To test our hypothesis, we propose three specific aims.
In Specific Aim 1, we will investigate the temporal and spatial increases in PA stiffness and reversibility of mechanical changes during experimental PAH. We will utilize AFM micro-indentation to characterize the local mechanical environment of distal pulmonary arteries at the micron spatial scale in the rat models of SU5416/hypoxia and MCT-induced PAH.
In Specific Aim 2, we will determine whether increases in matrix stiffness trigger a """"""""remodeling phenotype"""""""" in human PASMC and PAEC and investigate the role of COX-2 in orchestrating these stiffness- dependent cellular alterations. We will investigate the molecular mechanisms by which stiffness modulates COX-2 expression and test whether stiffness-dependent regulation of COX-2-derived prostanoids drives feedback amplification of vascular remodeling.
In Specific Aim 3, we will elucidate how stiffness modulates gene expression and identify key transcription factors involved in stiffness-dependent gene regulation in human PASMC and PAEC. We will use transcriptional profiling and bioinformatic approaches, along with a novel dynamic stiffening hydrogel system, to perform an unbiased analysis of temporal gene expression during the stiffness-driven emergence of the hyper-proliferative cellular phenotype.

Public Health Relevance

Pulmonary arterial hypertension (PAH) is a severe disease characterized by abnormal growth of cells within the pulmonary artery wall, which may lead to irreversible vascular remodeling, stiffening of the pulmonary arteries, failure of the right side o the heart, and death. We hypothesize that increases in pulmonary artery stiffness trigger a """"""""remodeling phenotype"""""""" in the cells of the vessel wall which promotes further vascular remodeling. The goal of our proposed studies is to perform a rigorous analysis of the stiffness-dependent """"""""switch"""""""" which causes pulmonary artery cells to behave abnormally and lead to pulmonary vascular remodeling. Our research has the potential to discover new pathways for targeted therapy to prevent irreversible vascular remodeling, right heart failure, and death in patients with PAH.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Respiratory Integrative Biology and Translational Research Study Section (RIBT)
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Moore, Timothy M
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Brigham and Women's Hospital
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