The pulmonary vasculature is unique in that it is subjected to a remarkable change in hemodynamic forces immediately after birth. Increase in oxygen tension with the first breath results in decreased pulmonary vascular resistance, which in conjunction with closure of the ductus arteriosus and foramen ovale, leads to marked increase in the blood flow through the pulmonary blood vessels. While the majority of infants can respond to such a change in hemodynamic forces via vascular stabilization and maturation, those in whom complications occur can succumb to respiratory failure and death. Neonatal pulmonary hemorrhage (NPH) is such a complication occurring in about 1 in 1000 births. We hypothesize that failure of proper maturation of the pulmonary arteries, involving disruption of flow induced ERK5 activation, is a key mechanism of NPH. Currently NPH lacks any well-defined etiology and conventional therapy remains mainly supportive. We propose to test the hypothesis that excess production of the growth factor Angiopoietin 2 (ANGPT2) in the lung, which results from disrupted ERK5 signaling, is a key therapeutically targetable mechanism in infants with NPH. Using a combination of mouse genetic and pharmacologic models and in vitro studies, we propose to test the relevant role of the ERK5-ANGPT2 pathway in promoting stabilization of the pulmonary vasculature in the pivotal newborn period. Our ultimate goal will be to develop new therapeutic strategies for NPH, which may be applicable to other contexts of pulmonary vascular instability.

Public Health Relevance

The birth of a newborn induces a dramatic increase in the amount of blood volume that traverses the blood vessels of the lungs, in response to which the lung blood vessels need to rapidly mature and stabilize to avoid detrimental outcomes. Neonatal pulmonary hemorrhage is a disruption of this maturation process that results in leakage of blood into the air space of the lungs, and results in detrimental clinical outcomes. We will investigate novel mechanisms which may be involved in this process, and identify potential therapeutic targets that can be used to restore normal pulmonary vascular development.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
High Priority, Short Term Project Award (R56)
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Lung Injury, Repair, and Remodeling Study Section (LIRR)
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Natarajan, Aruna R
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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Sofer, Avraham; Lee, Seyoung; Papangeli, Irinna et al. (2018) Therapeutic Engagement of the Histone Deacetylase IIA-Myocyte Enhancer Factor 2 Axis Improves Experimental Pulmonary Hypertension. Am J Respir Crit Care Med 198:1345-1348