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Cascino TM, Desai AA, Kanthi Y. At a crossroads: coronavirus disease 2019 recovery and the risk of pulmonary vascular disease. Curr Opin Pulm Med 2021; 27:342-349. [PMID: 34127622 PMCID: PMC8373709 DOI: 10.1097/mcp.0000000000000792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary vasculature is considered a major driving force for morbidity and mortality. We set out to summarize current knowledge on the acute manifestations of pulmonary vascular disease (PVD) resulting from COVID-19 and prioritize long-term complications that may result in pulmonary hypertension (PH). RECENT FINDINGS Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism. Post COVID-19 survivors frequently report ongoing symptoms and may be at risk for the spectrum of PH, including group 1 pulmonary arterial hypertension, group 2 PH due to left heart disease, group 3 PH due to lung disease and/or hypoxia, and group 4 chronic thromboembolic PH. SUMMARY The impact of COVID-19 on the pulmonary vasculature is central to determining disease severity. Although the long-term PVD manifestations of COVID-19 are currently uncertain, optimizing the care of risk factors for PH and monitoring for the development of PVD will be critical to reducing long-term morbidity and improving the health of survivors.
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Affiliation(s)
- Thomas M Cascino
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ankit A Desai
- Department of Medicine, Indiana University, Indianapolis, Indiana
| | - Yogendra Kanthi
- Frankel Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
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Romanoski CE, Qi X, Sangam S, Vanderpool RR, Stearman RS, Conklin A, Gonzalez-Garay M, Rischard F, Ayon RJ, Wang J, Simonson T, Babicheva A, Shi Y, Tang H, Makino A, Kanthi Y, Geraci MW, Garcia JGN, Yuan JXJ, Desai AA. Transcriptomic profiles in pulmonary arterial hypertension associate with disease severity and identify novel candidate genes. Pulm Circ 2020; 10:2045894020968531. [PMID: 33343881 PMCID: PMC7727059 DOI: 10.1177/2045894020968531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/03/2020] [Indexed: 11/16/2022] Open
Abstract
Using RNAseq, we identified a 61 gene-based circulating transcriptomic profile most correlated with four indices of pulmonary arterial hypertension severity. In an independent dataset, 13/61 (21%) genes were differentially expressed in lung tissues of pulmonary arterial hypertension cases versus controls, highlighting potentially novel candidate genes involved in pulmonary arterial hypertension development.
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Affiliation(s)
- Casey E Romanoski
- Department of Cellular and Molecular Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Xinshuai Qi
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Shreya Sangam
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Rebecca R Vanderpool
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | | | - Austin Conklin
- Department of Cellular and Molecular Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Manuel Gonzalez-Garay
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Franz Rischard
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Ramon J Ayon
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Jian Wang
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, Guangzhou Medical University, Guangzhou, China.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Tatum Simonson
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Yinan Shi
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Haiyang Tang
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
| | - Ayako Makino
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,Department of Physiology, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Yogendra Kanthi
- Division of Intramural Research National Heart, Lung and Blood Institute Bethesda, Maryland, USA.,Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark W Geraci
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Joe G N Garcia
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,Department of Physiology, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Jason X-J Yuan
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA, USA.,Department of Physiology, College of Medicine, The University of Arizona, Tucson, AZ, USA
| | - Ankit A Desai
- Department of Medicine, College of Medicine, The University of Arizona, Tucson, AZ, USA.,Department of Medicine, Indiana University, Indianapolis, IN, USA
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Whitaker ME, Nair V, Sinari S, Dherange PA, Natarajan B, Trutter L, Brittain EL, Hemnes AR, Austin ED, Patel K, Black SM, Garcia JGN, Yuan Md PhD JX, Vanderpool RR, Rischard F, Makino A, Bedrick EJ, Desai AA. Diabetes Mellitus Associates with Increased Right Ventricular Afterload and Remodeling in Pulmonary Arterial Hypertension. Am J Med 2018; 131:702.e7-702.e13. [PMID: 29421689 PMCID: PMC5963998 DOI: 10.1016/j.amjmed.2017.12.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 12/28/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Diabetes mellitus is associated with left ventricular hypertrophy and dysfunction. Parallel studies have also reported associations between diabetes mellitus and right ventricular dysfunction and reduced survival in patients with pulmonary arterial hypertension. However, the impact of diabetes mellitus on the pulmonary vasculature has not been well characterized. We hypothesized that diabetes mellitus and hyperglycemia could specifically influence right ventricular afterload and remodeling in patients with Group I pulmonary arterial hypertension, providing a link to their known susceptibility to right ventricular dysfunction. METHODS Using an adjusted model for age, sex, pulmonary vascular resistance, and medication use, associations of fasting blood glucose, glycated hemoglobin, and the presence of diabetes mellitus were evaluated with markers of disease severity in 162 patients with pulmonary arterial hypertension. RESULTS A surrogate measure of increased pulmonary artery stiffness, elevated pulmonary arterial elastance (P = .012), along with reduced log(pulmonary artery capacitance) (P = .006) were significantly associated with the presence of diabetes mellitus in patients with pulmonary arterial hypertension in a fully adjusted model. Similar associations between pulmonary arterial elastance and capacitance were noted with both fasting blood glucose and glycated hemoglobin. Furthermore, right ventricular wall thickness on echocardiography was greater in pulmonary arterial hypertension patients with diabetes, supporting the link between right ventricular remodeling and diabetes. CONCLUSION Cumulatively, these data demonstrate that an increase in right ventricular afterload, beyond pulmonary vascular resistance alone, may influence right ventricular remodeling and provide a mechanistic link between the susceptibility to right ventricular dysfunction in patients with both diabetes mellitus and pulmonary arterial hypertension.
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Affiliation(s)
- Morgan E Whitaker
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Vineet Nair
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Shripad Sinari
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Parinita A Dherange
- Department of Medicine, Banner-University Medical Center South, Tucson, Ariz
| | - Balaji Natarajan
- Department of Medicine, Banner-University Medical Center South, Tucson, Ariz
| | - Lindsey Trutter
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Evan L Brittain
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Anna R Hemnes
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Eric D Austin
- Division of Pediatric Pulmonary, Allergy, and Immunology, Vanderbilt University, Nashville, Tenn
| | - Kumar Patel
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Stephen M Black
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Joe G N Garcia
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Jason X Yuan Md PhD
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | | | - Franz Rischard
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Ayako Makino
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Edward J Bedrick
- The University of Arizona Health Sciences, The University of Arizona, Tucson
| | - Ankit A Desai
- The University of Arizona Health Sciences, The University of Arizona, Tucson.
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Identification of multiple ACVRL1 mutations in patients with pulmonary arterial hypertension by targeted exome capture. Clin Sci (Lond) 2016; 130:1559-69. [PMID: 27316748 DOI: 10.1042/cs20160247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/17/2016] [Indexed: 11/17/2022]
Abstract
Pulmonary artery hypertension (PAH) is characterized as sustained elevation of pressure in the pulmonary vascular system that is attributable to a variety of causes. More than a dozen genes have previously been proposed as being associated with PAH. To examine potential mutations of these genes in patients with PAH, we developed a targeted exome kit containing 22 PAH-associated genes for genetic screens of 80 unrelated patients with PAH. As a result, we identified 16 different mutations in the BMPR2 gene and four different mutations in ACVRL1, the gene for activin receptor-like kinase-1 (ACVRL1). However, no deleterious mutations were found in the remaining 20 genes. In the present study, we provided detailed characterization of the ACVRL1 mutations in four pedigrees, including two novel missense mutations (c.676G>A, p.V226M; c.955G>C, p.G319R) and two recurrent mutations (c.1231C>T, p.R411W; c.1450C>T, p.R484W). Furthermore, we showed that markedly reduced Smad1/5 phosphorylation levels and reduced activities of luciferase reporters in each of the four ACVRL1 mutant-transfected NIH-3T3 cells. Therefore, our findings demonstrated that missense mutations of ACVRL1 identified in the present study significantly affected the bone morphogenetic protein 9 (BMP-9) pathway, implicating PAH pathogenesis. Detailed genotype–phenotype correlation analysis revealed initial symptoms of hereditary haemorrhagic telangiectasia (HHT) in some of the patients, suggesting the importance of sequencing molecular markers for early identification and intervention of individuals at risk for PAH and potential HHT. We developed a customized exome sequencing system to identify mutations in these PAH-associated genes, and found two novel missense mutations and two recurrent mutations in the ACVRL1 gene in four unrelated Chinese families; we also determined hypomorphic alleles using functional studies.
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