Abstract
Pulmonary arterial hypertension (PAH) is a disease of the pulmonary vasculature that is characterized by vascular obstruction and progressive right ventricular failure. One hallmark of clinical PAH is its very poor survival, with PAH mortality rates approximating those of many malignancies. The discovery that the fawn-hooded rat strain (FHR) spontaneously develops PAH has allowed for major insights into the pathophysiology of PAH. These findings have revealed that cancer and PAH not only share a similarly poor prognosis but also demonstrate similar resistance to apoptosis and activation of cell proliferation as a major pathophysiologic mechanism. One of the causes for the resistance to apoptosis and increased proliferation of pulmonary vascular smooth muscle cells in PAH is a cancer-like metabolic shift towards a glycolytic metabolism (Warburg effect) and down-regulation of mitochondrial glucose oxidation. This book chapter will review the role of such a metabolic shift in the pathophysiology of PAH and also highlight emerging anti-proliferative PAH therapies that correct the metabolic dysregulation in PAH.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Wigley FM, Lima JA, Mayes M, McLain D, Chapin JL, Ward-Able C (2005) The prevalence of undiagnosed pulmonary arterial hypertension in subjects with connective tissue disease at the secondary health care level of community-based rheumatologists (the UNCOVER study). Arthritis Rheum 52:2125-2132
Thenappan T, Shah SJ, Rich S, Gomberg-Maitland M (2007) A USA-based registry for pulmonary arterial hypertension: 1982-2006. Eur Respir J 30:1103-1110
Platoshyn O, Zhang S, McDaniel SS, Yuan JX-J (2002) Cytochrome c activates K+ channels before inducing apoptosis. Am J Physiol Cell Physiol 283:C1298-C1305
Pozeg ZI, Michelakis ED, McMurtry MS et al (2003) In vivo gene transfer of the O2-sensitive potassium channel Kv1.5 reduces pulmonary hypertension and restores hypoxic pulmonary vasoconstriction in chronically hypoxic rats. Circulation 107:2037-2044
Remillard CV, Yuan JX-J (2004) Activation of K+ channels: an essential pathway in programmed cell death. Am J Physiol Lung Cell Mol Physiol 286:L49-L67
Merklinger SL, Jones PL, Martinez EC, Rabinovitch M (2005) Epidermal growth factor receptor blockade mediates smooth muscle cell apoptosis and improves survival in rats with pulmonary hypertension. Circulation 112:423-431
Bonnet S, Archer SL, Allalunis-Turner J et al (2007) A mitochondria-K+ channel axis is suppressed in cancer and its normalization promotes apoptosis and inhibits cancer growth. Cancer Cell 11:37-51
Bonnet S, Michelakis ED, Porter CJ et al (2006) An abnormal mitochondrial-HIF-1-Kv channel pathway disrupts oxygen-sensing and triggers pulmonary arterial hypertension (PAH) in fawn-hooded rats: similarities to human PAH. Circulation 113:2630-2641
Yuan JX-J, Aldinger AM, Juhaszova M et al (1998) Dysfunctional voltage-gated K+ channels in pulmonary artery smooth muscle cells of patients with primary pulmonary hypertension. Circulation 98:1400-1406
Archer SL, Gomberg-Maitland M, Maitland ML, Rich S, Garcia JG, Weir EK (2008) Mitochondrial metabolism, redox signaling, and fusion: a mitochondria-ROS-HIF-1(-Kv1.5 O2-sensing pathway at the intersection of pulmonary hypertension and cancer. Am J Physiol Heart Circ Physiol 294:H570-H578
Ishikura K, Yamada N, Ito M et al (2006) Beneficial acute effects of rho-kinase inhibitor in patients with pulmonary arterial hypertension. Circ J 70:174-178
Nagaoka T, Gebb SA, Karoor V et al (2006) Involvement of RhoA/Rho kinase signaling in pulmonary hypertension of the fawn-hooded rat. J Appl Physiol 100:996-1002
Parker TA, Roe G, Grover TR, Abman SH (2006) Rho kinase activation maintains high pulmonary vascular resistance in the ovine fetal lung. Am J Physiol Lung Cell Mol Physiol 291:L976-L982
Xing XQ, Gan Y, Wu SJ, Chen P, Zhou R, Xiang XD (2006) Rho-kinase as a potential therapeutic target for the treatment of pulmonary hypertension. Drug News Perspect 19:517-522
Dorfmuller P, Perros F, Balabanian K, Humbert M (2003) Inflammation in pulmonary arterial hypertension. Eur Respir J 22:358-363
Otterdal K, Andreassen AK, Yndestad A et al (2008) Raised LIGHT levels in pulmonary arterial hypertension: potential role in thrombus formation. Am J Respir Crit Care Med 177:202-207
Voelkel NF, Cool C, Lee SD, Wright L, Geraci MW, Tuder RM (1998) Primary pulmonary hypertension between inflammation and cancer. Chest 114:225S-230S
Herve P, Launay JM, Scrobohaci ML et al (1995) Increased plasma serotonin in primary pulmonary hypertension. Am J Med 99:249-254
Christman BW, McPherson CD, Newman JH et al (1992) An imbalance between the excretion of thromboxane and prostacyclin metabolites in pulmonary hypertension. N Engl J Med 327:70-75
Steudel W, Ichinose F, Huang PL et al (1997) Pulmonary vasoconstriction and hypertension in mice with targeted disruption of the endothelial nitric oxide synthase (NOS 3) gene. Circ Res 81:34-41
Stewart DJ, Levy RD, Cernacek P, Langleben D (1991) Increased plasma endothelin-1 in pulmonary hypertension: marker or mediator of disease? Ann Intern Med 114:464-469
Sakao S, Taraseviciene-Stewart L, Lee JD, Wood K, Cool CD, Voelkel NF (2005) Initial apoptosis is followed by increased proliferation of apoptosis-resistant endothelial cells. FASEB J 19(9):1178-1180
Cowan KN, Jones PL, Rabinovitch M (2000) Elastase and matrix metalloproteinase inhibitors induce regression, and tenascin-C antisense prevents progression, of vascular disease. J Clin Invest 105:21-34
Krick S, Platoshyn O, Sweeney M, Kim H, Yuan JX-J (2001) Activation of K+ channels induces apoptosis in vascular smooth muscle cells. Am J Physiol Cell Physiol 280:C970-C979
Ekhterae D, Platoshyn O, Krick S, Yu Y, McDaniel SS, Yuan JX-J (2001) Bcl-2 decreases voltage-gated K+ channel activity and enhances survival in vascular smooth muscle cells. Am J Physiol Cell Physiol 281:C157-C165
Michelakis ED, McMurtry MS, Wu X-C et al (2002) Dichloroacetate, a metabolic modulator, prevents and reverses chronic hypoxic pulmonary hypertension in rats: role of increased expression and activity of voltage-gated potassium channels. Circulation 105:244-250
McMurtry MS, Bonnet S, Wu X et al (2004) Dichloroacetate prevents and reverses pulmonary hypertension by inducing pulmonary artery smooth muscle cell apoptosis. Circ Res 95:830-840
McMurtry MS, Archer SL, Altieri DC et al (2005) Gene therapy targeting survivin selectively induces pulmonary vascular apoptosis and reverses pulmonary arterial hypertension. J Clin Invest 115:1479-1491
Morrell NW, Yang X, Upton PD et al (2001) Altered growth responses of pulmonary artery smooth muscle cells from patients with primary pulmonary hypertension to transforming growth factor-β1 and bone morphogenetic proteins. Circulation 104:790-795
McMurtry MS, Moudgil R, Hashimoto K, Bonnet S, Michelakis ED, Archer SL (2007) Overexpression of human bone morphogenetic protein receptor 2 does not ameliorate monocrotaline pulmonary arterial hypertension. Am J Physiol Lung Cell Mol Physiol 292:L872-L878
Eddahibi S, Raffestin B, Hamon M, Adnot S (2002) Is the serotonin transporter involved in the pathogenesis of pulmonary hypertension? J Lab Clin Med 139:194-201
Guignabert C, Izikki M, Tu LI et al (2006) Transgenic mice overexpressing the 5-hydroxytryptamine transporter gene in smooth muscle develop pulmonary hypertension. Circ Res 98:1323-1330
Schermuly RT, Dony E, Ghofrani HA et al (2005) Reversal of experimental pulmonary hypertension by PDGF inhibition. J Clin Invest 115:2811-2821
Archer SL, Souil E, Dinh-Xuan AT et al (1998) Molecular identification of the role of voltage-gated K+ channels, Kv1.5 and Kv2.1, in hypoxic pulmonary vasoconstriction and control of resting membrane potential in rat pulmonary artery myocytes. J Clin Invest 101:2319-2330
Archer SL, Wu X-C, Thébaud B et al (2004) Preferential expression and function of voltage-gated, O2-sensitive K+ channels in resistance pulmonary arteries explains regional heterogeneity in hypoxic pulmonary vasoconstriction. ionic diversity in smooth muscle cells. Circ Res 95:308-318
Yuan XJ, Wang J, Juhaszova M, Gaine SP, Rubin LJ (1998) Attenuated K+ channel gene transcription in primary pulmonary hypertension. Lancet 351:726-727
Reeve HL, Michelakis E, Nelson DP, Weir EK, Archer SL (2001) Alterations in a redox oxygen sensing mechanism in chronic hypoxia. J Appl Physiol 90:2249-2256
Young KA, Ivester C, West J, Carr M, Rodman DM (2006) BMP signaling controls PASMC KV channel expression in vitro and in vivo. Am J Physiol Lung Cell Mol Physiol 290:L841-L848
Landsberg JW, Yuan JX-J (2004) Calcium and TRP channels in pulmonary vascular smooth muscle cell proliferation. News Physiol Sci 19:44-50
Bonnet S, Rochefort G, Sutendra G et al (2007) The nuclear factor of activated T cells in pulmonary arterial hypertension can be therapeutically targeted. Proc Natl Acad Sci USA 104:11418-11423
Davie NJ, Crossno JT, Jr., Frid MG et al (2004) Hypoxia-induced pulmonary artery adventitial remodeling and neovascularization: contribution of progenitor cells. Am J Physiol Lung Cell Mol Physiol 286:L668-L678
Deng Z, Morse JH, Slager SL et al (2000) Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-II gene. Am J Hum Genet 67:737-744
Thomson JR, Machado RD, Pauciulo MW et al (2000) Sporadic primary pulmonary hypertension is associated with germline mutations of the gene encoding BMPR-II, a receptor member of the TGF-β family. J Med Genet 37:741-745
West J, Fagan K, Steudel W et al (2004) Pulmonary hypertension in transgenic mice expressing a dominant-negative BMPRII gene in smooth muscle. Circ Res 94:1109-1114
Ricciardi MJ, Knight BP, Martinez FJ, Rubenfire M (1998) Inhaled nitric oxide in primary pulmonary hypertension: a safe and effective agent for predicting response to nifedipine. J Am Coll Cardiol 32:1068-1073
Sitbon O, Humbert M, Jagot JL et al (1998) Inhaled nitric oxide as a screening agent for safely identifying responders to oral calcium-channel blockers in primary pulmonary hypertension. Eur Respir J 12:265-270
West J, Cogan J, Geraci M et al (2008) Gene expression in BMPR2 mutation carriers with and without evidence of pulmonary arterial hypertension suggests pathways relevant to disease penetrance. BMC Med Genomics 1:45
Kentera D, Susic D, Veljkovic V, Tucakovic G, Koko V (1988) Pulmonary artery pressure in rats with hereditary platelet function defect. Respiration 54:110-114
Cowley AW, Jr., Liang M, Roman RJ, Greene AS, Jacob HJ (2004) Consomic rat model systems for physiological genomics. Acta Physiol Scand 181:585-592
Sato K, Webb S, Tucker A et al (1992) Factors influencing the idiopathic development of pulmonary hypertension in the fawn hooded rat. Am Rev Respir Dis 145:793-797
Ashmore RC, Rodman DM, Sato K et al (1991) Paradoxical constriction to platelets by arteries from rats with pulmonary hypertension. Am J Physiol 260:H1929-H1934
Bowers R, Cool C, Murphy RC et al (2004) Oxidative stress in severe pulmonary hypertension. Am J Respir Crit Care Med 169:764-769
Tuder RM, Chacon M, Alger L et al (2001) Expression of angiogenesis-related molecules in plexiform lesions in severe pulmonary hypertension: evidence for a process of disordered angiogenesis. J Pathol 195:367-374
Burke-Wolin T, Wolin MS (1989) H2O2 and cGMP may function as an O2 sensor in the pulmonary artery. J Appl Physiol 66:167-170
Michelakis ED, Hampl V, Nsair A et al (2002) Diversity in mitochondrial function explains differences in vascular oxygen sensing. Circ Res 90:1307-1315
Wolin MS, Burke TM (1987) Hydrogen peroxide elicits activation of bovine pulmonary arterial soluble guanylate cyclase by a mechanism associated with its metabolism by catalase. Biochem Biophys Res Commun 143:20-25
Michelakis ED, Rebeyka I, Wu X et al (2002) O2 sensing in the human ductus arteriosus: regulation of voltage-gated K+ channels in smooth muscle cells by a mitochondrial redox sensor. Circ Res 91:478-486
Guo G, Yan-Sanders Y, Lyn-Cook BD et al (2003) Manganese superoxide dismutase-mediated gene expression in radiation-induced adaptive responses. Mol Cell Biol 23:2362-2378
Redout EM, Wagner MJ, Zuidwijk MJ et al (2007) Right-ventricular failure is associated with increased mitochondrial complex II activity and production of reactive oxygen species. Cardiovasc Res 75:770-781
Liu JQ, Zelko IN, Erbynn EM, Sham JSK, Folz RJ (2006) Hypoxic pulmonary hypertension: role of superoxide and NADPH oxidase (gp91phox). Am J Physiol Lung Cell Mol Physiol 290:L2-L10
Nozik-Grayck E, Suliman HB, Majka S et al (2008) Lung EC-SOD overexpression attenuates hypoxic induction of Egr-1 and chronic hypoxic pulmonary vascular remodeling. Am J Physiol Lung Cell Mol Physiol 295:L422-L430
Li N, Oberley TD, Oberley LW, Zhong W (1998) Overexpression of manganese superoxide dismutase in DU145 human prostate carcinoma cells has multiple effects on cell phenotype. Prostate 35:221-233
Bravard A, Sabatier L, Hoffschir F, Ricoul M, Luccioni C, Dutrillaux B (1992) SOD2: a new type of tumor-suppressor gene? Int J Cancer 51:476-480
Hodge DR, Xiao W, Peng B, Cherry JC, Munroe DJ, Farrar WL (2005) Enforced expression of superoxide dismutase 2/manganese superoxide dismutase disrupts autocrine interleukin-6 stimulation in human multiple myeloma cells and enhances dexamethasone-induced apoptosis. Cancer Res 65:6255-6263
Hurt EM, Thomas SB, Peng B, Farrar WL (2007) Molecular consequences of SOD2 expression in epigenetically silenced pancreatic carcinoma cell lines. Br J Cancer 97:1116-1123
Hurt EM, Thomas SB, Peng B, Farrar WL (2007) Integrated molecular profiling of SOD2 expression in multiple myeloma. Blood 109:3953-3962
Hitchler MJ, Oberley LW, Domann FE (2008) Epigenetic silencing of SOD2 by histone modifications in human breast cancer cells. Free Radic Biol Med 45(11):1573-1580
Fuks F, Hurd PJ, Deplus R, Kouzarides T (2003) The DNA methyltransferases associate with HP1 and the SUV39H1 histone methyltransferase. Nucleic Acids Res 31:2305-2312
Fuks F, Hurd PJ, Wolf D, Nan X, Bird AP, Kouzarides T (2003) The methyl-CpG-binding protein MeCP2 links DNA methylation to histone methylation. J Biol Chem 278:4035-4040
Archer SL, Huang J, Henry T, Peterson D, Weir EK (1993) A redox-based O2 sensor in rat pulmonary vasculature. Circ Res 73:1100-1112
Schroder E, Eaton P (2008) Hydrogen peroxide as an endogenous mediator and exogenous tool in cardiovascular research: issues and considerations. Curr Opin Pharmacol 8:153-159
Archer SL, Will JA, Weir EK (1986) Redox status in the control of pulmonary vascular tone. Herz 11:127-141
Archer SL, Nelson DP, Weir EK (1989) Simultaneous measurement of O2 radicals and pulmonary vascular reactivity in rat lung. J Appl Physiol 67:1903-1911
Archer SL, Weir EK, Reeve HL, Michelakis E (2000) Molecular identification of O2 sensors and O2-sensitive potassium channels in the pulmonary circulation. Adv Exp Med Biol 475:219-240
Archer SL, Michelakis ED, Thebaudt B et al (2006) A central role for oxygen-sensitive K+ channels and mitochondria in the specialized oxygen-sensing system. Novartis Found Symp 272:157-171; discussion 71-75, 214-217
Cadenas E, Davies KJ (2000) Mitochondrial free radical generation, oxidative stress, and aging. Free Radic Biol Med 29:222-230
Semenza GL (2004) O2-regulated gene expression: transcriptional control of cardiorespiratory physiology by HIF-1. J Appl Physiol 96:1173-1177; discussion 0-2
Kim JW, Tchernyshyov I, Semenza GL, Dang CV (2006) HIF-1-mediated expression of pyruvate dehydrogenase kinase: a metabolic switch required for cellular adaptation to hypoxia. Cell Metab 3:177-185
Shimoda LA, Manalo DJ, Sham JSK, Semenza GL, Sylvester JT (2001) Partial HIF-1α deficiency impairs pulmonary arterial myocyte electrophysiological responses to hypoxia. Am J Physiol Lung Cell Mol Physiol 281:L202-L208
Huang LE, Arany Z, Livingston DM, Bunn HF (1996) Activation of hypoxia-inducible transcription factor depends primarily upon redox-sensitive stabilization of its alpha subunit. J Biol Chem 271:32253-32259
Wang GL, Jiang BH, Semenza GL (1995) Effect of altered redox states on expression and DNA-binding activity of hypoxia-inducible factor 1. Biochem Biophys Res Commun 212:550-556
Roche TE, Baker JC, Yan X et al (2001) Distinct regulatory properties of pyruvate dehydrogenase kinase and phosphatase isoforms. Prog Nucleic Acid Res Mol Biol 70:33-75
Mayers RM, Leighton B, Kilgour E (2005) PDH kinase inhibitors: a novel therapy for Type II diabetes? Biochem Soc Trans 33:367-370
Freeman BA, Crapo JD (1981) Hyperoxia increases oxygen radical production in rat lungs and lung mitochondria. J Biol Chem 256:10986-10992
Morrell JA, Orme J, Butlin RJ, Roche TE, Mayers RM, Kilgour E (2003) AZD7545 is a selective inhibitor of pyruvate dehydrogenase kinase 2. Biochem Soc Trans 31:1168-1170
Silverman LR, Mufti GJ (2005) Methylation inhibitor therapy in the treatment of myelodysplastic syndrome. Nat Clin Pract Oncol 2(Suppl 1):S12-S23
Acknowledgments
This work is supported by the Harold Hines Jr. Chair in Medicine and NIH-RO1-HL071115.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Humana Press, a part of Springer Science+Business Media, LLC
About this paper
Cite this paper
Rehman, J., Archer, S.L. (2010). A Proposed Mitochondrial–Metabolic Mechanism for Initiation and Maintenance of Pulmonary Arterial Hypertension in Fawn-Hooded Rats: The Warburg Model of Pulmonary Arterial Hypertension. In: Yuan, JJ., Ward, J. (eds) Membrane Receptors, Channels and Transporters in Pulmonary Circulation. Advances in Experimental Medicine and Biology, vol 661. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-500-2_11
Download citation
DOI: https://doi.org/10.1007/978-1-60761-500-2_11
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-60761-499-9
Online ISBN: 978-1-60761-500-2
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)