Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by abnormally elevated pulmonary pressures and right heart failure. While the etiology of PAH is unknown, progressive loss and impaired regeneration of microvessels suggest that defective angiogenesis may be a major contributor to PAH pathogenesis. Control of angiogenesis is dependent on proper activation of the vascular endothelial growth factor (VEGF) pathway and while some studies show evidence of elevated VEGF pathway components within PAH vascular lesions, others demonstrate that pulmonary microvascular endothelial cells (PMVECs) from PAH patients form small and disorganized vascular networks under VEGF stimulation. Our inability to explain these observations is due in large part to an incomplete understanding of how response to VEGF signaling is regulated in PMVECs. We have discovered a novel link between VEGF and Wnt signaling where endothelial-derived Wnt7a, a Wnt ligand, is required to fully activate VEGF signaling in PMVECs via ROR2, a receptor belonging to the Wnt/PCP pathway. Failure of PAH PMVECs to respond to VEGF correlates with reduced Wnt7a production and is corrected by exogenous Wnt7a. Based on these studies, we propose that reduced angiogenesis in PAH is caused by lack of crosstalk between the VEGF and Wnt7a/ROR2 pathways, which prevents PMVECs from assuming a tip cell phenotype to direct vessel assembly. To establish this, we will apply analytical protein analysis and gene editing techniques to establish how VEGFR2- ROR2 receptor crosstalk modulates VEGF response in PMVECs (Aim 1) and will use live imaging 3D angiogenesis to study tip cell formation by PMVECs in response to VEGF and Wnt7a (Aim 2).
For Aim 3, we will use transgenic murine models to demonstrate that conditional deletion of Wnt7a and ROR2 levels in PMVECs can worsen hypoxia-induced small vessel loss and hemodynamics; we will also begin testing a novel nanoparticle-based therapeutic to determine whether restoring Wnt7a expression can improve these parameters in Sugen/hypoxia rats. Addressing how VEGF and Wnt orchestrate pulmonary angiogenesis will provide not only fundamental mechanistic insights into the regulation of angiogenesis but facilitate development of Wnt7a-based therapeutics that could prevent small vessel loss in PAH.

Public Health Relevance

Pulmonary hypertension is a life-threatening disease that affects predominantly females of childbearing age characterized by progressive small vessel loss and right heart failure. Most current therapies work by dilating blood vessels, but no treatments have been found that can restore angiogenesis and prevent loss of small vessels. The research project presented here aims at understanding how inappropriate cross talk of VEGF and Wnt signaling in pulmonary artery endothelial cells contributes to defective angiogenesis.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-CVRS-G (03)M)
Program Officer
Xiao, Lei
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Stanford University
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Zamanian, Roham T; Hedlin, Haley; Greuenwald, Paul et al. (2018) Features and Outcomes of Methamphetamine-associated Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 197:788-800
Frump, Andrea L; Bonnet, S├ębastien; de Jesus Perez, Vinicio A et al. (2018) Emerging role of angiogenesis in adaptive and maladaptive right ventricular remodeling in pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 314:L443-L460