Title: HMGB1 and gender difference in pulmonary arterial hypertension Abstract: Pulmonary arterial hypertension (PAH) is a fatal disease characterized by increased pulmonary vascular resistance (PVR) and right ventricle (RV) hypertrophy. Despite recent progress, there is still inadequate treatment for this disease, with medial survival for the patients with Functional Class III and IV as low as 2.5 years and 6 months. There is a well-established sexual dimorphism in regard to PAH, especially idiopathic PAH, with females generally being associated with higher susceptibility to PAH, while males possessing lower survival rate and predisposition to develop RV failure. Our recently published research highlights two distinct gender-associated phenotypes of PAH: an excessive level of pulmonary vascular remodeling associated with the female gender, and an inflammation of pulmonary vascular wall and RV fibrosis in males. The pro-inflammatory signaling has been inextricably linked to initiation and progression of PAH. High mobility group box 1 (HMGB1) is a nuclear factor released during cell death that stimulates immune cell activation via p PRR), including toll-like receptor 4 (TLR4) and the receptor for advanced glycation endproducts (RAGE). TLR4 activation increases pro-inflammatory immune cell activation. In contrast, RAGE, while involved in inflammation, can limit an immune response and activate pro-surviving process. A recent publication reveals that males and females are prone to different types of the cell death in response to initial damage, with male cells more likely to die by necrosis, and females ? by apoptosis. As HMGB1 needs to be in a reduced state to bind to TLR4, we hypothesize that the reduced environment created by necrotic cell death promotes HMGB1 mediated TLR4 activation and inflammation in males, while in females, apoptotic cells release HMGB1 in oxidized state, leading to activation of RAGE and proliferative response. e have designed peptides to selectively inhibit necrosis-mediated TLR4 activation or the apoptosis-mediated RAGE activation by prevention of their interaction with HMGB1. We will further investigate the therapeutic potential of these peptides by testing them in a rodent model of PAH for the ability to inhibit TLR4 or RAGE and, thus, evaluate the particular contribution of these pathways in PAH of either sex. attern recognition receptors ( W

Public Health Relevance

Pulmonary arterial hypertension (PAH) is a rare but incurable disease that ultimately leads to death. The insufficient understanding of the particular pathological events driving the PAH is the primary reason for low life expectancy and high mortality of the patients with PAH. In the proposed study, we will investigate the gender-specific damage-mediated signaling pathways and test peptide-based therapeutics aimed to prevent the development and progression of PAH in both genders.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
1R01HL133085-01
Application #
9157135
Study Section
Respiratory Integrative Biology and Translational Research Study Section (RIBT)
Program Officer
Xiao, Lei
Project Start
2016-08-01
Project End
2021-06-30
Budget Start
2016-08-01
Budget End
2017-06-30
Support Year
1
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Arizona
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
806345617
City
Tucson
State
AZ
Country
United States
Zip Code
85721