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Kumar R, Lee M, Kassa B, Fonseca Balladares D, Mickael C, Sanders L, Andruska A, Kumar M, Spiekerkoetter E, Bandeira A, Stenmark K, Tuder R, Graham B. Repetitive schistosoma exposure causes perivascular lung fibrosis and persistent pulmonary hypertension. Clin Sci (Lond) 2023; 137:617-631. [PMID: 37014925 PMCID: PMC10133871 DOI: 10.1042/cs20220642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) can occur as a complication of schistosomiasis. In humans, schistosomiasis-PH persists despite antihelminthic therapy and parasite eradication. We hypothesized that persistent disease arises as a consequence of exposure repetition. METHODS Following intraperitoneal sensitization, mice were experimentally exposed to Schistosoma eggs by intravenous injection, either once or three times repeatedly. The phenotype was characterized by right heart catheterization and tissue analysis. RESULTS Following intraperitoneal sensitization, a single intravenous Schistosoma egg exposure resulted in a PH phenotype that peaked at 7-14 days, followed by spontaneous resolution. Three sequential exposures resulted in a persistent PH phenotype. Inflammatory cytokines were not significantly different between mice exposed to one or three egg doses, but there was an increase in perivascular fibrosis in those who received three egg doses. Significant perivascular fibrosis was also observed in autopsy specimens from patients who died of this condition. CONCLUSIONS Repeatedly exposing mice to schistosomiasis causes a persistent PH phenotype, accompanied by perivascular fibrosis. Perivascular fibrosis may contribute to the persistent schistosomiasis-PH observed in humans with this disease.
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Affiliation(s)
- Rahul Kumar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, U.S.A
| | - Michael H. Lee
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, U.S.A
| | - Biruk Kassa
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, U.S.A
| | - Dara C. Fonseca Balladares
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, U.S.A
| | - Claudia Mickael
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, U.S.A
| | - Linda Sanders
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, U.S.A
| | - Adam Andruska
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Palo Alto, CA, U.S.A
| | - Maya Kumar
- Department of Pediatrics, Division of Pulmonary Medicine, Stanford University, Palo Alto, CA, U.S.A
| | - Edda Spiekerkoetter
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University, Palo Alto, CA, U.S.A
| | - Angela Bandeira
- PROCAPE, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Kurt R. Stenmark
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, U.S.A
| | - Rubin M. Tuder
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, U.S.A
| | - Brian B Graham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Lung Biology Center, Zuckerberg San Francisco General Hospital, San Francisco, California, U.S.A
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