Avances en la genética de la hipertensión arterial pulmonar

La hipertensión arterial pulmonar (HAP) es un trastorno cardiopulmonar grave e incurable que conlleva una importante morbilidad y mortalidad. Se caracteriza por la oclusión y remodelación de las arteriolas pulmonares, insuficiencia respiratoria progresiva, disfunción ventricular derecha, insuficiencia cardíaca y muerte prematura. Puede presentarse en diferentes formas, entre ellas la idiopática (HAPI) en ausencia de una causa conocida y la hereditaria (HAPH) en caso de relacionarse con una alteración genética o si hay agregación familiar. Existen además de estas formas, otras causas de HAP asociadas a diversas condiciones médicas (drogas, toxinas, infección por virus de la inmunodeficiencia humana -VIH-, etc.). A pesar de los avances recientes sigue siendo una enfermedad difícil de diagnosticar y tratar. La investigación de las bases genéticas de la HAP ha contribuido significativamente a mejorar la comprensión de esta patología. Las alteraciones genéticas más frecuentes asociadas a la HAP son mutaciones inactivantes del gen que codifica el receptor de la proteína morfogenética ósea tipo 2 (BMPR2, bone morphogenic protein receptor type 2). Los pacientes con HAP y mutaciones en BMPR2 se presentan a una edad más temprana con una enfermedad más grave y tienen un mayor riesgo de muerte o trasplante, que aquellos sin mutaciones. Avances recientes han conducido al descubrimiento de nuevos genes relacionados con la HAP, tales como ACVRL1 (activin A receptor like type 1), ENG (endoglin), CAV1 (caveolin-1), KCNK3 (potassium channel subfamily K, member 3), entre otros. En este artículo de revisión resumimos el conocimiento sobre las variantes genéticas raras y comunes que subyacen al desarrollo y pronóstico de la HAP. Además, esbozamos la importancia de implementar el asesoramiento y el estudio genético en centros especializados. La comprensión de la genética de la HAP proporcionará nueva información sobre los mecanismos subyacentes a la patobiología, potencialmente, útiles para desarrollar nuevas estrategias terapéuticas en el marco de una medicina personalizada.

Pulmonary arterial hypertension (PAH) is a serious and incurable cardiopulmonary disorder with significant morbidity and mortality. It is characterized by the occlusion and remodeling of the pulmonary arterioles, progressive respiratory failure, right ventricular dysfunction, heart failure and premature death. PAH can occur in different forms, including idiopathic (IPAH) in absence of a known cause and hereditary (HPAH) if related to a genetic alteration or if there is familial aggregation. Besides these forms, there are other causes of PAH associated with various medical conditions (drugs, toxins, HIV infection, etc.). Despite recent advances in PAH, it remains a challenging disease to both diagnosis and management. Research about the genetic basis of PAH has contributed significantly to improve the understanding of this condition. The most common genetic alterations associated with PAH are inactivating mutations in the gene encoding a bone morphogenetic protein receptor type 2 (BMPR2). Patients with BMPR2 mutations present PAH at a younger age with more severe disease, and have an increased risk of death or transplantation, than those without mutations. Recent advances have led to the discovery of new genes related to PAH, such as ACVRL1 (activin A receptor like type 1), ENG (endoglin), CAV1 (caveolin-1), KCNK3 (potassium channel subfamily K, member 3), among others. In this review, we summarize the knowledge about rare and common genetic variants that underlie PAH development and prognosis. Additionally, we outline the importance of implementing genetic counseling and testing in specialized pulmonary hypertension centers. Understanding the genetics of PAH will provide new insights into the mechanisms underlying its pathobiology potentially useful for developing new therapeutic strategies within the scope of a personalized medicine.

A hipertensão arterial pulmonar (HAP) é um distúrbio cardiopulmonar grave e incurável, com morbidade e mortalidade significativas. É caracterizada pela oclusão e remodelação das arteríolas pulmonares, insuficiência respiratória progressiva, disfunção ventricular direita, insuficiência cardíaca e morte prematura. Pode acontecer em diferentes formas, incluindo a idiopática (HAPI) na ausência de uma causa conhecida e a hereditária (HAPH) no caso de estar associada a uma anomalia genética ou quando há agregação familiar. Adicionalmente a estas formas, existem outras causas de HAP associadas a várias condições médicas (toxinas, drogas, infecção por HIV, etc.). Apesar dos avanços recentes, continua a ser uma doença difícil de diagnosticar e tratar. A pesquisa sobre a base genética da HAP contribuiu significativamente para melhorar a compreensão desta doença. As alterações genéticas mais comuns associadas à HAP são as mutações no gene que codifica o receptor da proteína morfogenética óssea tipo 2 (BMPR2, bone morphogenic protein receptor type 2). Pacientes com HAP e mutações BMPR2 se apresentam em idade mais jovem com doença mais grave e têm maior risco de morte ou transplante do que aqueles sem mutações. Avanços recentes levaram à descoberta de novos genes relacionados à HAP, tais como ACVRL1 (activin A receptor like type 1), ENG (endoglin), CAV1 (caveolin-1), KCNK3 (potassium channel subfamily K, member 3), entre outros. Neste artigo de revisão resumimos o conhecimento sobre as variantes genéticas raras e comuns associadas à etiologia e prognóstico da HAP. Ademais, destacamos a importância de implementar o aconselhamento genético e o estudo genético em centros especializados. A compreensão da genética da HAP vai proporcionar novo informação sobre os mecanismos subjacentes à patobiologia potencialmente úteis para o desenvolvimento de novas estratégias terapêuticas no âmbito da medicina personalizada.

LDN-193189 inhibits progression and induces apoptosis in human dedifferentiated chondrosarcoma cell line NDCS-1 / 中国肿瘤临床

Objective:To clarify the effects of the BMP receptor inhibitor LDN-193189 in the dedifferentiated chondrosarcoma (DDCS) cell line NDCS-1 and to explore the anti-tumor mechanism of LDN-193189 in DDCS. Methods:NDCS-1 was treated with 5 nmol/L of LDN-193189. MTT assay and clone formation experiments were used to verify that LDN-193189 suppressed cel proliferation. Transwel and wound healing tests were performed to demonstrate that LDN-193189 inhibited cell invasion. Western blot detection was used to show that LDN-193189 inhibited the suppression of BMPR2, p-Smad1/5, and RUNX2 protein expression. Results:The BMPR2 signaling pathway was inhibited by LDN-193189;thus, cell viability and invasion were significantly suppressed. Conclusion:LDN-193189 induces the inhibition of progression in vitro via the BMPR2-p-Smad1/5-RUNX2 signaling pathway in the human DDCS cell line NDCS-1.

Research progress on role of immuno-inflammatory response in pulmonary artery hypertension / 中国药理学通报

Abstrcat:Pulmonary artery hypertension ( PAH) is a cardiopul-monary disease with extensive obliterative changes in the small to midsized pulmonary arterioles. This review summarizes the al-tered inflammation and immune processes underlying the devel-opment of PAH, and discusses inflammatory factors, immune cells, Rho kinase and gene implicated in PAH. Preclinical stud-ies have provided the basis for abnormal immune response in ani-mal models of the PAH, and this paper, based on inflammatory/immune response mechanisms, proposes PAH potential therapeu-tic targets.

Genetics in heritable pulmonary arterial hypertension / 대한내과학회지

Pulmonary arterial hypertension is caused by vascular remodeling including muscularization of arteries, loss of small precapillary arteries, and formation of neointima and plexiform lesion, resulting in a progressive increase in pulmonary vascular resistance. About 70% of heritable pulmonary arterial hypertension and 10% to 40% of idiopathic pulmonary arterial hypertension patients possess mutations in bone morphogenetic protein receptor, type 2 (BMPR2), which is a type II receptor of TGF-beta superfamily. Very rarely, mutations in another receptors of TGF-beta superfamily, activin-like kinase-type 1 (ALK1) and endoglin (ENG) are found in pulmonary arterial hypertension patients with hereditary hemorrhagic telangiectasia. Genetic screening is useful to identify family members who are mutation carriers in heritable pulmonary arterial hypertension families.