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Ivy D, Rosenzweig EB, Abman SH, Beghetti M, Bonnet D, Douwes JM, Manes A, Berger RMF. Embracing the challenges of neonatal and paediatric pulmonary hypertension. Eur Respir J 2024:2401345. [PMID: 39209483 DOI: 10.1183/13993003.01345-2024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024]
Abstract
Paediatric pulmonary arterial hypertension (PAH) shares common features with adult disease, but is associated with several additional disorders and challenges that require unique approaches. This article discusses recent advances, ongoing challenges and distinct approaches for caring for infants and children with PAH, as presented by the paediatric task force of the 7th World Symposium on Pulmonary Hypertension. We provide updates on diagnosing, classifying, risk-stratifying and treating paediatric pulmonary hypertension (PH) and identify critical knowledge gaps. An updated risk stratification tool and treatment algorithm is provided, now also including strategies for patients with associated cardiopulmonary conditions. Treatment of paediatric PH continues to be hindered by the lack of randomised controlled clinical trials. The challenging management of children failing targeted PAH therapy is discussed, including balloon atrial septostomy, lung transplantation and pulmonary-to-systemic shunt (Potts). A novel strategy using a multimodal approach for the management of PAH associated with congenital heart diseases with borderline pulmonary vascular resistance is included. Advances in diagnosing neonatal PH, especially signs and interpretation of PH by echocardiography, are highlighted. A team approach to the rapidly changing physiology of neonatal PH is emphasised. Challenges in drug approval are discussed, particularly the challenges of designing accurate paediatric clinical trials with age-appropriate end-points and adequate enrolment.
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Affiliation(s)
- Dunbar Ivy
- Pediatric Cardiology, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO, USA
| | - Erika B Rosenzweig
- Department of Pediatrics, Maria Fareri Children's Hospital at WMC Health and New York Medical College of Touro University, Valhalla, NY, USA
| | - Steven H Abman
- Department of Pediatrics, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, CO, USA
| | - Maurice Beghetti
- Paediatric Cardiology Unit, Department of Paediatrics, Gynecology and Obstetrics, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes, M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paediatric Cardiology, Paris, France
| | - Johannes Menno Douwes
- Center for Congenital Heart Diseases, Paediatric Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alessandra Manes
- Cardiology Unit IRCCS, S. Orsola University Hospital, Bologna, Italy
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Paediatric and Congenital Cardiology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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2
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Schlueter BC, Quanz K, Baldauf J, Petrovic A, Ruppert C, Guenther A, Gall H, Tello K, Grimminger F, Ghofrani HA, Weissmann N, Seeger W, Schermuly RT, Weiss A. The diverging roles of insulin-like growth factor binding proteins in pulmonary arterial hypertension. Vascul Pharmacol 2024; 155:107379. [PMID: 38762131 DOI: 10.1016/j.vph.2024.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/29/2023] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
Pulmonary hypertension (PH) is a progressive, severe and to date not curable disease of the pulmonary vasculature. Alterations of the insulin-like growth factor 1 (IGF-1) system are known to play a role in vascular pathologies and IGF-binding proteins (IGFBPs) are important regulators of the bioavailability and function of IGFs. In this study, we show that circulating plasma levels of IGFBP-1, IGFBP-2 and IGFBP-3 are increased in idiopathic pulmonary arterial hypertension (IPAH) patients compared to healthy individuals. These binding proteins inhibit the IGF-1 induced IGF-1 receptor (IGF1R) phosphorylation and exhibit diverging effects on the IGF-1 induced signaling pathways in human pulmonary arterial cells (i.e. healthy as well as IPAH-hPASMCs, and healthy hPAECs). Furthermore, IGFBPs are differentially expressed in an experimental mouse model of PH. In hypoxic mouse lungs, IGFBP-1 mRNA expression is decreased whereas the mRNA for IGFBP-2 is increased. In contrast to IGFBP-1, IGFBP-2 shows vaso-constrictive properties in the murine pulmonary vasculature. Our analyses show that IGFBP-1 and IGFBP-2 exhibit diverging effects on IGF-1 signaling and display a unique IGF1R-independent kinase activation pattern in human pulmonary arterial smooth muscle cells (hPASMCs), which represent a major contributor of PAH pathobiology. Furthermore, we could show that IGFBP-2, in contrast to IGFBP-1, induces epidermal growth factor receptor (EGFR) signaling, Stat-3 activation and expression of Stat-3 target genes. Based on our results, we conclude that the IGFBP family, especially IGFBP-1, IGFBP-2 and IGFBP-3, are deregulated in PAH, that they affect IGF signaling and thereby regulate the cellular phenotype in PH.
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MESH Headings
- Humans
- Animals
- Receptor, IGF Type 1/metabolism
- Receptor, IGF Type 1/genetics
- Signal Transduction
- Pulmonary Artery/metabolism
- Pulmonary Artery/pathology
- Pulmonary Artery/physiopathology
- Insulin-Like Growth Factor Binding Protein 3/metabolism
- Insulin-Like Growth Factor Binding Protein 3/genetics
- Insulin-Like Growth Factor Binding Protein 2/metabolism
- Insulin-Like Growth Factor Binding Protein 2/genetics
- Insulin-Like Growth Factor I/metabolism
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Cells, Cultured
- Male
- Insulin-Like Growth Factor Binding Protein 1/metabolism
- Insulin-Like Growth Factor Binding Protein 1/genetics
- Phosphorylation
- Disease Models, Animal
- STAT3 Transcription Factor/metabolism
- Case-Control Studies
- Mice, Inbred C57BL
- Familial Primary Pulmonary Hypertension/metabolism
- Familial Primary Pulmonary Hypertension/physiopathology
- Familial Primary Pulmonary Hypertension/pathology
- Familial Primary Pulmonary Hypertension/genetics
- Female
- ErbB Receptors/metabolism
- Middle Aged
- Vascular Remodeling
- Adult
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
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Affiliation(s)
- Beate Christiane Schlueter
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Karin Quanz
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Julia Baldauf
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Aleksandar Petrovic
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Clemens Ruppert
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Andreas Guenther
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; Agaplesion Lung Clinic Waldhof-Elgershausen, Greifenstein 35753, Germany
| | - Henning Gall
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Khodr Tello
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Friedrich Grimminger
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Hossein-Ardeschir Ghofrani
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Norbert Weissmann
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Werner Seeger
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany; Max Planck Institute (MPI) for Heart and Lung Research, Parkstrasse 1, Bad Nauheim 61231, Germany; University Hospital Giessen and Marburg (UKGM), Giessen 35392, Germany
| | - Ralph Theo Schermuly
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany
| | - Astrid Weiss
- Justus-Liebig-University Giessen (JLU), Aulweg 130, Giessen 35392, Germany; Universities of Giessen and Marburg Lung Center (UGMLC), Giessen 35392, Germany; Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Giessen 35392, Germany; Member of the German Center for Lung Research (DZL), Giessen 35392, Germany.
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Sakarin S, Rungsipipat A, Roytrakul S, Jaresitthikunchai J, Phaonakrop N, Charoenlappanit S, Thaisakun S, Surachetpong SD. Proteomic analysis of the serum in dogs with pulmonary hypertension secondary to myxomatous mitral valve disease: the preliminary study. Front Vet Sci 2024; 11:1327453. [PMID: 38596466 PMCID: PMC11002142 DOI: 10.3389/fvets.2024.1327453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/01/2024] [Indexed: 04/11/2024] Open
Abstract
Background Pulmonary hypertension (PH) is a common complication in dogs with myxomatous mitral valve disease (MMVD), characterized by elevated blood pressure in pulmonary artery. Echocardiography is a reliable technique for PH diagnosis in veterinary medicine. However, it is limited to use as an early detection method. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) has found extensive application in the discovery of serum protein biomarkers for various diseases. The objective of this study was to identify serum proteins in healthy control dogs and MMVD dogs both with and without PH using LC-MS/MS. Materials and methods In this research, a total of 81 small-breed dogs participated, and they were categorized into three groups: the control (n = 28), MMVD (n = 24) and MMVD+PH (n = 29) groups. Serum samples were collected and analyzed by LC-MS/MS. Results Differentially expressed proteins were identified, and the upregulated and downregulated proteins in MMVD+PH group including Myomesin 1 (MYOM1) and Histone deacetylase 7 (HDAC7), Pleckstrin homology domain containing M3 (PLEKHM3), Diacylglycerol lipase alpha (DAGLA) and Tubulin tyrosine ligase like 6 (TTLL6) were selected as proteins of interest in MMVD dogs with PH. Conclusion Different types of proteins have been identified in healthy dogs and MMVD dogs with and without PH. Additional studies are needed to investigate the potential of these proteins as biomarkers for PH in dogs with MMVD.
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Affiliation(s)
- Siriwan Sakarin
- Faculty of Veterinary Science, Department of Veterinary Medicine, Center of Excellence for Companion Animal Cancer, Chulalongkorn University, Bangkok, Thailand
| | - Anudep Rungsipipat
- Faculty of Veterinary Science, Department of Pathology, Chulalongkorn University, Bangkok, Thailand
| | - Sittiruk Roytrakul
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Janthima Jaresitthikunchai
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Narumon Phaonakrop
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Sawanya Charoenlappanit
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Siriwan Thaisakun
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Sirilak Disatian Surachetpong
- Faculty of Veterinary Science, Department of Veterinary Medicine, Center of Excellence for Companion Animal Cancer, Chulalongkorn University, Bangkok, Thailand
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4
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Torres G, Lancaster AC, Yang J, Griffiths M, Brandal S, Damico R, Vaidya D, Simpson CE, Martin LJ, Pauciulo MW, Nichols WC, Ivy DD, Austin ED, Hassoun PM, Everett AD. Low-affinity insulin-like growth factor binding protein 7 and its association with pulmonary arterial hypertension severity and survival. Pulm Circ 2023; 13:e12284. [PMID: 37674873 PMCID: PMC10477418 DOI: 10.1002/pul2.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Insulin-like growth factor (IGF) binding proteins (IGFBPs) are a family of growth factor modifiers, some of which are known to be independently associated with pulmonary arterial hypertension (PAH) survival. IGF factor binding protein 7 (IGFBP7) is a unique low-affinity IGFBP that, independent of IGF, stimulates prostacyclin production. This study proposed to establish associations between IGFBP7 and PAH severity and survival, using enrollment and longitudinal samples. Serum IGFBP7 levels were significantly elevated in patients with PAH compared to controls. After adjusting for age and sex, logarithmic increases in IGFBP7 were associated with a 20 m shorter six-minute walk distance (6MWD; p < 0.001), a 2-3 mmHg higher mean right atrial pressure (p < 0.001 and 0.02), and a higher likelihood of a greater REVEAL 2.0 risk category placement (p < 0.001). Kaplan-Meier analysis demonstrated significantly decreased survival with IGFBP7 above the median and Cox multivariable analysis adjusted for age and sex, demonstrated higher serum IGFBP7 was an independent predictor of survival. Though the exact mechanism is still unknown, given IGFBP7's role as a prostacyclin stimulant, it has potential use as a therapeutic target for disease modulation.
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Affiliation(s)
- Guillermo Torres
- Department of Pediatrics, Division of Pediatric CardiologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Jun Yang
- Department of Pediatrics, Division of Pediatric CardiologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Megan Griffiths
- Department of Pediatrics, Division of Pediatric CardiologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Stephanie Brandal
- Department of Pediatrics, Division of Pediatric CardiologyJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Rachel Damico
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Dhananjay Vaidya
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of General Internal MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Catherine E. Simpson
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Lisa J. Martin
- Department of Pediatrics, Division of Human Genetics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Michael W. Pauciulo
- Department of Pediatrics, Division of Human Genetics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - William C. Nichols
- Department of Pediatrics, Division of Human Genetics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - David D. Ivy
- Department of Pediatric CardiologyChildren's Hospital ColoradoDenverColoradoUSA
| | - Eric D. Austin
- Department of Pediatrics, Division of Allergy, Immunology, and Pulmonary MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Paul M. Hassoun
- Department of Medicine, Division of Pulmonary and Critical Care MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Allen D. Everett
- Department of Pediatrics, Division of Pediatric CardiologyJohns Hopkins UniversityBaltimoreMarylandUSA
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5
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Hu H, Cai J, Qi D, Li B, Yu L, Wang C, Bajpai AK, Huang X, Zhang X, Lu L, Liu J, Zheng F. Identification of Potential Biomarkers for Group I Pulmonary Hypertension Based on Machine Learning and Bioinformatics Analysis. Int J Mol Sci 2023; 24:ijms24098050. [PMID: 37175757 PMCID: PMC10178909 DOI: 10.3390/ijms24098050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023] Open
Abstract
A number of processes and pathways have been reported in the development of Group I pulmonary hypertension (Group I PAH); however, novel biomarkers need to be identified for a better diagnosis and management. We employed a robust rank aggregation (RRA) algorithm to shortlist the key differentially expressed genes (DEGs) between Group I PAH patients and controls. An optimal diagnostic model was obtained by comparing seven machine learning algorithms and was verified in an independent dataset. The functional roles of key DEGs and biomarkers were analyzed using various in silico methods. Finally, the biomarkers and a set of key candidates were experimentally validated using patient samples and a cell line model. A total of 48 key DEGs with preferable diagnostic value were identified. A gradient boosting decision tree algorithm was utilized to build a diagnostic model with three biomarkers, PBRM1, CA1, and TXLNG. An immune-cell infiltration analysis revealed significant differences in the relative abundances of seven immune cells between controls and PAH patients and a correlation with the biomarkers. Experimental validation confirmed the upregulation of the three biomarkers in Group I PAH patients. In conclusion, machine learning and a bioinformatics analysis along with experimental techniques identified PBRM1, CA1, and TXLNG as potential biomarkers for Group I PAH.
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Affiliation(s)
- Hui Hu
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jie Cai
- Department of Cardial Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430060, China
| | - Daoxi Qi
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Boyu Li
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Li Yu
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Chen Wang
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Akhilesh K Bajpai
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Xiaoqin Huang
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Xiaokang Zhang
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Lu Lu
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA
| | - Jinping Liu
- Department of Cardial Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430060, China
| | - Fang Zheng
- Center for Gene Diagnosis, Department of Clinical Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Torres G, Yang J, Griffiths M, Brandal S, Damico R, Vaidya D, Simpson CE, Pauciulo MW, Nichols WC, Ivy DD, Austin ED, Hassoun PM, Everett AD. Insulin-like growth factor binding Protein-4: A novel indicator of pulmonary arterial hypertension severity and survival. Pulm Circ 2023; 13:e12235. [PMID: 37152104 PMCID: PMC10156920 DOI: 10.1002/pul2.12235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 05/09/2023] Open
Abstract
Proteomic analysis of patients with pulmonary arterial hypertension (PAH) has demonstrated significant abnormalities in the insulin-like growth factor axis (IGF). This study proposed to establish associations between a specific binding protein, insulin-like growth factor binding protein 4 (IGFBP4), and PAH severity as well as survival across varying study cohorts. In all cohorts studied, serum IGFBP4 levels were significantly elevated in PAH compared to controls (p < 0.0001). IGFBP4 concentration was also highest in the connective tissue-associated PAH (CTD-PAH) and idiopathic PAH subtypes (876 and 784 ng/mL, median, respectively). After adjustment for age and sex, IGFBP4 was significantly associated with worse PAH severity as defined by a decreased 6-min walk distance (6MWD), New York heart association functional class (NYHA-FC), REVEAL 2.0 score and higher right atrial pressures. In longitudinal analysis provided by one of the study cohorts, IGFBP4 was prospectively significantly associated with a shorter 6MWD, worse NYHA-FC classification, and decreased survival. Cox multivariable analysis demonstrated higher serum IGFBP4 as an independent predictor of survival in the overall PAHB cohort. Therefore, this study established that higher circulating IGFBP4 levels were significantly associated with worse PAH severity, decreased survival and disease progression. Dysregulation of IGF metabolism/growth axis may play a significant role in PAH cardio-pulmonary pathobiology.
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Affiliation(s)
- Guillermo Torres
- Division of Pediatric Cardiology, Department of PediatricsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jun Yang
- Division of Pediatric Cardiology, Department of PediatricsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Megan Griffiths
- Division of Pediatric Cardiology, Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Stephanie Brandal
- Division of Pediatric Cardiology, Department of PediatricsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Rachel Damico
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Dhananjay Vaidya
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Division of General Internal MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Catherine E. Simpson
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Michael W. Pauciulo
- Division of Human Genetics, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - William C. Nichols
- Division of Human Genetics, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - David D. Ivy
- Department of Pediatric CardiologyChildren's Hospital ColoradoDenverColoradoUSA
| | - Eric D. Austin
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Paul M. Hassoun
- Division of Pulmonary and Critical Care Medicine, Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Allen D. Everett
- Division of Pediatric Cardiology, Department of PediatricsJohns Hopkins UniversityBaltimoreMarylandUSA
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