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Fonseca Balladares DC, Kassa B, Mickael C, Kumar R, Nolan K, Menezes TCF, Lee MH, Lau-Xiao AM, Molofsky AB, Wells E, Graham BB. Intrapulmonary T Cells Are Sufficient for Schistosoma-Induced Pulmonary Hypertension. Int J Mol Sci 2024; 25:9202. [PMID: 39273153 PMCID: PMC11395458 DOI: 10.3390/ijms25179202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/15/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Schistosomiasis is a parasitic infection that can cause pulmonary hypertension (PH). Th2 CD4 T cells are necessary for experimental Schistosoma-PH. However, if T cells migrate to the lung to initiate, the localized inflammation that drives vascular remodeling and PH is unknown. METHODS Mice were sensitized to Schistosoma mansoni eggs intraperitoneally and then challenged using tail vein injection. FTY720 was administered, which blocks lymphocyte egress from lymph nodes. T cells were quantified using flow cytometry, PH severity via heart catheterization, and cytokine concentration through ELISA. RESULTS FTY720 decreased T cells in the peripheral blood, and increased T cells in the mediastinal lymph nodes. However, FTY720 treatment resulted in no change in PH or type 2 inflammation severity in mice sensitized and challenged with S. mansoni eggs, and the number of memory and effector CD4 T cells in the lung parenchyma was also unchanged. Notably, intraperitoneal Schistosoma egg sensitization alone resulted in a significant increase in intravascular lymphocytes and T cells, including memory T cells, although there was no significant change in parenchymal cell density, IL-4 or IL-13 expression, or PH. CONCLUSION Blocking T cell migration did not suppress PH following Schistosoma egg challenge. Memory CD4 T cells, located in the lung intravascular space following egg sensitization, appear sufficient to cause type 2 inflammation and PH.
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Affiliation(s)
- Dara C Fonseca Balladares
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Biruk Kassa
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Claudia Mickael
- Program in Translational Lung Research, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rahul Kumar
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Kevin Nolan
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Thais C F Menezes
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo 04021-001, SP, Brazil
| | - Michael H Lee
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Anthony M Lau-Xiao
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
| | - Ari B Molofsky
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Elina Wells
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Brian B Graham
- Lung Biology Center, Division of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA 94110, USA
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Bobrovski VG, Pinheiro AL, de-Castro JAL, Rech EB, Zacarkim EV, Dos-S-Reis ES, Eger I. Schistosomiasis: A neglected cause of pulmonary arterial hypertension in Brazil. Curr Probl Cardiol 2024; 49:102340. [PMID: 38103813 DOI: 10.1016/j.cpcardiol.2023.102340] [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: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Schistosomiasis is a prevalent disease in Brazil whose etiological agent is Schistosoma mansoni, the main species associated with pulmonary arterial hypertension (PAH), a serious complication. It is estimated that this complication affects up to 15% of patients with the hepatosplenic form of the disease. Despite being an endemic country, Brazil does not have a screening scheme for cases of PAH associated with schistosomiasis (PAH-Sch), nor protocols for notification and treatment of this vascular complication. The objectives of this literature review are to gather knowledge about the pathophysiology, clinical manifestations, diagnosis and treatment of PAH-Sch and to highlight relevant aspects for the Brazilian reality. The pathophysiology, although lacking information, has proliferative vasculopathy as a central element. The clinical presentation of this disease can be asymptomatic or with nonspecific manifestations. Thus, complementary exams are essential for a confirmatory diagnosis, the gold standard being right heart catheterization, a scarce resource in endemic regions of the country. The treatment of PAH-Sch is similar to that performed for other causes of PAH, but the impact of anthelmintic therapy on the evolution of the vascular pathology is unknown. Therefore, Brazil needs to develop a screening plan for early diagnosis of PAH-Sch and new studies should be carried out to determine a more specific treatment.
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Affiliation(s)
- Vinícius G Bobrovski
- Department of Medicine, State University of Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, Paraná 84030-900, Brazil.
| | - Alisson L Pinheiro
- Department of Medicine, State University of Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, Paraná 84030-900, Brazil
| | - João A L de-Castro
- Department of Medicine, State University of Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, Paraná 84030-900, Brazil
| | - Eduardo B Rech
- Department of Medicine, State University of Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, Paraná 84030-900, Brazil
| | - Ezequiel V Zacarkim
- Department of General Biology, State University of Ponta Grossa, Paraná, Brazil
| | - Elise S Dos-S-Reis
- Department of Medicine, State University of Ponta Grossa, Avenida Carlos Cavalcanti, 4748, Ponta Grossa, Paraná 84030-900, Brazil
| | - Iriane Eger
- Department of General Biology, State University of Ponta Grossa, Paraná, Brazil
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Graham BB, Hilton JF, Lee MH, Kumar R, Balladares DF, Rahaghi FN, Estépar RSJ, Mickael C, Lima RLB, Loureiro CM, Lucena J, Oliveira RK, Corrêa RDA. Is pulmonary arterial hypertension associated with schistosomiasis distinct from pulmonary arterial hypertension associated with portal hypertension? JHLT OPEN 2023; 1:100007. [PMID: 38050478 PMCID: PMC10695267 DOI: 10.1016/j.jhlto.2023.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Pulmonary arterial hypertension associated with schistosomiasis (SchPAH) and pulmonary arterial hypertension associated with portal hypertension (PoPAH) are lung diseases that develop in the presence of liver diseases. However, mechanistic pathways by which the underlying liver conditions and other drivers contribute to the development and progression of pulmonary arterial hypertension (PAH) are unclear for both etiologies. In turn, these unknowns limit certainty of strategies to prevent, diagnose, and reverse the resultant PAH. Here we consider specific mechanisms that contribute to SchPAH and PoPAH, identifying those that may be shared and those that appear to be unique to each etiology, in the hope that this exploration will both highlight known causal drivers and identify knowledge gaps appropriate for future research. Overall, the key pathophysiologic differences that we identify between SchPAH and PoPAH suggest that they are not variants of a single condition.
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Affiliation(s)
- Brian B. Graham
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Michael H. Lee
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Rahul Kumar
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Dara Fonseca Balladares
- Lung Biology Center, University of California San Francisco, San Francisco, California
- Pulmonary Division, San Francisco General Hospital, San Francisco, California
| | - Farbod N. Rahaghi
- Pulmonary Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claudia Mickael
- Pulmonary and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Juliana Lucena
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Rudolf K.F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo de Amorim Corrêa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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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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Kadji Fassi JB, Boukeng Jatsa H, Membe Femoe U, Greigert V, Brunet J, Cannet C, Kenfack CM, Gipwe Feussom N, Tienga Nkondo E, Abou-Bacar A, Pfaff AW, Kamgang R, Kamtchouing P, Tchuem Tchuenté LA. Protein undernutrition reduces the efficacy of praziquantel in a murine model of Schistosoma mansoni infection. PLoS Negl Trop Dis 2022; 16:e0010249. [PMID: 35839247 PMCID: PMC9328564 DOI: 10.1371/journal.pntd.0010249] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/27/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background Undernutrition and schistosomiasis are public health problems and often occur in low and middle-income countries. Protein undernutrition can alter the host-parasite environment system and aggravate the course of schistosomiasis. This study aimed to assess the impact of a low-protein diet on the efficacy of praziquantel. Methodology/Principal findings Thirty-day-old mice were fed with a low-protein diet, and 40 days later, they were individually infected with fifty Schistosoma mansoni cercariae. A 28-day-treatment with praziquantel at 100 mg/kg for five consecutive days followed by distilled water begins on the 36th day post-infection. Mice were sacrificed on the 64th day post-infection. We determined the parasitological burden, liver and intestine histomorphometry, liver injury, and immunomodulation parameters. Praziquantel treatment of infected mice fed with a standard diet (IN-PZQ) resulted in a significant reduction of worm and egg burdens and a normalization of iron and calcium levels. The therapy also improved schistosomiasis-induced hepatopathy and oxidative stress. The anti-inflammatory and immunomodulatory activities of praziquantel were also significant in these mice. When infected mice receiving the low-protein diet were treated with praziquantel (ILP-PZQ), the body weight loss and hepatomegaly were not alleviated, and the worm and liver egg burdens were significantly higher than those of IN-PZQ mice (P < 0.001). The treatment did not reduce the increased activities of ALT and γ-GGT, the high malondialdehyde concentration, and the liver granuloma volume. The iron and calcium levels were not ameliorated and differed from those of IN-PZQ mice (P < 0.001 and P < 0.05). Moreover, in these mice, praziquantel treatment did not reverse the high level of IL-5 and the low mRNA expression of CCL3/MIP-1α and CXCL-10/IP-10 induced by S. mansoni infection. Conclusion/Significance These results demonstrated that a low-protein diet reduced the schistosomicidal, antioxidant, anti-inflammatory, and immunomodulatory activities of praziquantel. Almost 90% of people requiring schistosomiasis preventive chemotherapy in 2018 lived in sub-Saharan Africa. Besides, 205.3 million children under five years suffer and die of undernutrition in low- and middle-income countries. The physiopathology of schistosomiasis mansoni involves liver damage, oxidative stress, and perturbation of the immune response. These disturbances are intensified by undernutrition. Praziquantel is used to treat schistosomiasis, but its efficacy on the comorbidity of S. mansoni infection and undernutrition has not been investigated. We conducted this study to assess the effectiveness of praziquantel on S. mansoni infection in mice fed with a low-protein diet. We recorded growth retardation, hepatomegaly, and high worm and egg burdens in mice fed with a low-protein diet and treated with PZQ. Moreover, the treatment did not reverse the liver function injury, oxidative stress, high iron level, and low calcium level. The proinflammatory cytokine IL-5 was still high, and the gene expression of some macrophage-associated chemokines was reduced. Therefore, this study demonstrated that in a murine model of a low-protein diet, the efficacy of praziquantel on S. mansoni infection was reduced. It also underlines the importance of targeting protein deficiency and malnutrition in populations living in schistosomiasis endemic areas for efficient disease control.
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Affiliation(s)
- Joseph Bertin Kadji Fassi
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
| | - Hermine Boukeng Jatsa
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
- * E-mail:
| | - Ulrich Membe Femoe
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
- Institute of Parasitology and Tropical Diseases, Dynamic Host-Pathogen Interactions, University of Strasbourg, Strasbourg, France
| | - Valentin Greigert
- Institute of Parasitology and Tropical Diseases, Dynamic Host-Pathogen Interactions, University of Strasbourg, Strasbourg, France
| | - Julie Brunet
- Institute of Parasitology and Tropical Diseases, Dynamic Host-Pathogen Interactions, University of Strasbourg, Strasbourg, France
| | - Catherine Cannet
- Laboratory of Histomorphometry, Institute of Legal Medicine, University of Strasbourg, Strasbourg, France
| | - Christian Mérimé Kenfack
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
| | - Nestor Gipwe Feussom
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
| | - Emilienne Tienga Nkondo
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
| | - Ahmed Abou-Bacar
- Institute of Parasitology and Tropical Diseases, Dynamic Host-Pathogen Interactions, University of Strasbourg, Strasbourg, France
| | - Alexander Wilhelm Pfaff
- Institute of Parasitology and Tropical Diseases, Dynamic Host-Pathogen Interactions, University of Strasbourg, Strasbourg, France
| | - René Kamgang
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Pierre Kamtchouing
- Laboratory of Animal Physiology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Louis-Albert Tchuem Tchuenté
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
- Laboratory of Parasitology and Ecology, Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
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6
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Immune Cells in Pulmonary Arterial Hypertension. Heart Lung Circ 2022; 31:934-943. [PMID: 35361533 DOI: 10.1016/j.hlc.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 12/11/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a complex and serious cardiopulmonary disease; it is characterised by increased pulmonary arterial pressure and pulmonary vascular remodelling accompanied by disordered endothelial and smooth muscle cell proliferation within pulmonary arterioles and arteries. Although recent reports have suggested that dysregulated immunity and inflammation are key players in PAH pathogenesis, their roles in PAH progression remain unclear. Intriguingly, altered host immune cell distribution, number, and polarisation within the lung arterial vasculature have been linked to disease development. This review mainly focusses on the roles of different immune cells in PAH and discusses the underlying mechanisms.
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7
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Kassa B, Lee MH, Kumar R, Mickael C, Sanders L, Tuder RM, Mentink-Kane M, Graham BB. Experimental Schistosoma japonicum-induced pulmonary hypertension. PLoS Negl Trop Dis 2022; 16:e0010343. [PMID: 35417453 PMCID: PMC9037943 DOI: 10.1371/journal.pntd.0010343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/25/2022] [Accepted: 03/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosomiasis, a major cause of pulmonary arterial hypertension (PAH) worldwide, is most clearly described complicating infection by one species, Schistosoma mansoni. Controlled exposure of mice can be used to induce Type 2 inflammation-dependent S. mansoni pulmonary hypertension (PH). We sought to determine if another common species, S. japonicum, can also cause experimental PH. METHODS Schistosome eggs were obtained from infected mice, and administered by intraperitoneal sensitization followed by intravenous challenge to experimental mice, which underwent right heart catheterization and tissue analysis. RESULTS S. japonicum sensitized and challenged mice developed PH, which was milder than that following S. mansoni sensitization and challenge. The degree of pulmonary vascular remodeling and Type 2 inflammation in the lungs was similarly proportionate. Cross-sensitization revealed that antigens from either species are sufficient to sensitize for intravenous challenge with either egg, and the degree of PH severity depended on primarily the species used for intravenous challenge. Compared to a relatively uniform distribution of S. mansoni eggs, S. japonicum eggs were observed in clusters in the lungs. CONCLUSIONS S. japonicum can induce experimental PH, which is milder than that resulting from comparable S. mansoni exposure. This difference may result from the distribution of eggs in the lungs, and is independent of which species is used for sensitization. This result is consistent with the clearer association between S. mansoni infection and the development of schistosomiasis-associated PAH in humans.
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Affiliation(s)
- Biruk Kassa
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Michael H. Lee
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Linda Sanders
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Rubin M. Tuder
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | | | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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8
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Liang S, Desai AA, Black SM, Tang H. Cytokines, Chemokines, and Inflammation in Pulmonary Arterial Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1303:275-303. [PMID: 33788198 DOI: 10.1007/978-3-030-63046-1_15] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
According to the World Symposium Pulmonary Hypertension (WSPH) classification, pulmonary hypertension (PH) is classified into five categories based on etiology. Among them, Group 1 pulmonary arterial hypertension (PAH) disorders are rare but progressive and often, fatal despite multiple approved treatments. Elevated pulmonary arterial pressure in patients with WSPH Group 1 PAH is mainly caused by increased pulmonary vascular resistance (PVR), due primarily to sustained pulmonary vasoconstriction and excessive obliterative pulmonary vascular remodeling. Growing evidence indicates that inflammation plays a critical role in the development of pulmonary vascular remodeling associated with PAH. While the role of auto-immunity is unclear, infiltration of inflammatory cells in and around vascular lesions, including T- and B-cells, dendritic cells, macrophages, and mast cells have been observed in PAH patients. Serum and plasma levels of chemokines, cytokines, and autoantibodies are also increased in PAH patients; some of these circulating molecules are correlated with disease severity and survival. Preclinical experiments have reported a key role of the inflammation in PAH pathophysiology in vivo. Importantly, anti-inflammatory and immunosuppressive agents have further exhibited therapeutic effects. The present chapter reviews published experimental and clinical evidence highlighting the canonical role of inflammation in the pathogenesis of PAH and as a major target for the development of anti-inflammatory therapies in patients with PAH.
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Affiliation(s)
- Shuxin Liang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ankit A Desai
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Stephen M Black
- Division of Translational and Regenerative Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Haiyang Tang
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China. .,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangdong Key Laboratory of Vascular Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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9
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Sibomana JP, Campeche A, Carvalho-Filho RJ, Correa RA, Duani H, Pacheco Guimaraes V, Hilton JF, Kassa B, Kumar R, Lee MH, Loureiro CMC, Mazimba S, Mickael C, Oliveira RKF, Ota-Arakaki JS, Rezende CF, Silva LCS, Sinkala E, Ahmed HY, Graham BB. Schistosomiasis Pulmonary Arterial Hypertension. Front Immunol 2020; 11:608883. [PMID: 33362796 PMCID: PMC7758287 DOI: 10.3389/fimmu.2020.608883] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a disease of the lung blood vessels that results in right heart failure. PAH is thought to occur in about 5% to 10% of patients with hepatosplenic schistosomiasis, particularly due to S. mansoni. The lung blood vessel injury may result from a combination of embolization of eggs through portocaval shunts into the lungs causing localized Type 2 inflammatory response and vessel remodeling, triggering of autonomous pathology that becomes independent of the antigen, and high cardiac output as seen in portopulmonary hypertension. The condition is likely underdiagnosed as there is little systematic screening, and risk factors for developing PAH are not known. Screening is done by echocardiography, and formal diagnosis requires invasive right heart catheterization. Patients with Schistosoma-associated PAH show reduced functional capacity and can be treated with pulmonary vasodilators, which improves symptoms and may improve survival. There are animal models of this disease that might help in understanding disease pathogenesis and identify novel targets to screen and treatment. Pathogenic mechanisms include Type 2 immunity and activation and signaling in the TGF-β pathway. There are still major uncertainties regarding Schistosoma-associated PAH development, course and treatment.
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Affiliation(s)
- Jean Pierre Sibomana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Medicine, Butare University Teaching Hospital, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aloma Campeche
- Division of Gastroenterology, Department of Medicine, Santa Casa Hospital, Salvador, Bahia, Brazil
| | - Roberto J. Carvalho-Filho
- Division of Gastroenterology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ricardo Amorim Correa
- Internal Medicine/Pulmonary Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Duani
- Internal Medicine/Infectious Diseases Division, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Virginia Pacheco Guimaraes
- Pulmonary Department, Hospital Júlia Kubistchek, Fundação Hospitalar of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Joan F. Hilton
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Biruk Kassa
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Rahul Kumar
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Michael H. Lee
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | | | - Sula Mazimba
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Claudia Mickael
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rudolf K. F. Oliveira
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jaquelina S. Ota-Arakaki
- Division of Respiratory Diseases, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Camila Farnese Rezende
- Pulmonary Medicine, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciana C. S. Silva
- Internal Medicine Department, Medical School, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Edford Sinkala
- Hepatology Clinic, Department of Medicine, University of Zambia Teaching Hospital, Lusaka, Zambia
| | - Hanan Yusuf Ahmed
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Tikur Anbessa Specialized Hospital, College of Health Sciences, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Brian B. Graham
- Department of Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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10
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Knafl D, Gerges C, King CH, Humbert M, Bustinduy AL. Schistosomiasis-associated pulmonary arterial hypertension: a systematic review. Eur Respir Rev 2020; 29:29/155/190089. [DOI: 10.1183/16000617.0089-2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022] Open
Abstract
Schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) is a life-threatening complication of chronic hepatosplenic schistosomiasis. It is suggested to be the leading cause of pulmonary arterial hypertension (PAH) worldwide. However, pathophysiological data on Sch-PAH are scarce. We examined the hypothesis that there are pronounced similarities in pathophysiology, haemodynamics, and survival of Sch-PAH and idiopathic PAH (iPAH).This systematic review and meta-analysis was registered in the PROSPERO database (identifier CRD42018104066). A systematic search and review of the literature was performed according to PRISMA guidelines for studies published between 01 January 1990 and 29 June 2018.For Sch-PAH, 18 studies evaluating pathophysiological mechanisms, eight studies on haemodynamics (n=277), and three studies on survival (n=191) were identified. 16 clinical registries reporting data on haemodynamics and survival including a total of 5792 patients with iPAH were included for comparison. Proinflammatory molecular pathways are involved in both Sch-PAH and iPAH. The transforming growth factor (TGF)-β signalling pathway is upregulated in Sch-PAH and iPAH. While there was no difference in mean pulmonary artery pressure (54±17 mmHg versus 55±15 mmHg, p=0.29), cardiac output (4.4±1.3 L·min−1versus 4.1±1.4 L·min−1, p=0.046), and cardiac index (2.6±0.7 L·min−1·m−2versus 2.3±0.8 L·min−1·m−2, p<0.001) were significantly higher in Sch-PAH compared to iPAH, resulting in a lower pulmonary vascular resistance in Sch-PAH (10±6 Woods units versus 13±7 Woods units, p<0.001). 1- and 3-year survival were significantly better in the Sch-PAH group (p<0.001).Sch-PAH and iPAH share common pathophysiological mechanisms related to inflammation and the TGF-β signalling pathway. Patients with Sch-PAH show a significantly better haemodynamic profile and survival than patients with iPAH.
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11
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Kumar R, Mickael C, Kassa B, Sanders L, Koyanagi D, Hernandez‐Saavedra D, Freeman S, Morales‐Cano D, Cogolludo A, McKee AS, Fontenot AP, Butrous G, Tuder RM, Graham BB. Th2 CD4 + T Cells Are Necessary and Sufficient for Schistosoma-Pulmonary Hypertension. J Am Heart Assoc 2019; 8:e013111. [PMID: 31339057 PMCID: PMC6761627 DOI: 10.1161/jaha.119.013111] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
Background Inflammation underlies many forms of pulmonary hypertension (PH), including that resulting from Schistosoma infection, a major cause of PH worldwide. Schistosomiasis-associated PH is proximately triggered by embolization of parasite eggs into the lungs, resulting in localized type 2 inflammation. However, the role of CD4+ T cells in this disease is not well defined. Methods and Results We used a mouse model of schistosomiasis-associated PH, induced by intraperitoneal egg sensitization followed by intravenous egg challenge, with outcomes including right ventricle systolic pressure measured by cardiac catheterization, and cell density and phenotype assessed by flow cytometry. We identified that embolization of Schistosoma eggs into lungs of egg-sensitized mice increased the perivascular density of T-helper 2 (Th2) CD4+ T cells by recruitment of cells from the circulation and triggered type 2 inflammation. Parabiosis confirmed that egg embolization is required for localized type 2 immunity. We found Th2 CD4+ T cells were necessary for Schistosoma-induced PH, given that deletion of CD4+ T cells or inhibiting their Th2 function protected against type 2 inflammation and PH following Schistosoma exposure. We also observed that adoptive transfer of Schistosoma-sensitized CD4+ Th2 cells was sufficient to drive type 2 inflammation and PH. Conclusions Th2 CD4+ T cells are a necessary and sufficient component for the type 2 inflammation-induced PH following Schistosoma exposure.
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Affiliation(s)
- Rahul Kumar
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Claudia Mickael
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Biruk Kassa
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Linda Sanders
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Dan Koyanagi
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | | | - Scott Freeman
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Daniel Morales‐Cano
- Department of Pharmacology and ToxicologySchool of MedicineUniversity Complutense of MadridInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM)MadridSpain
- Ciber Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Angel Cogolludo
- Department of Pharmacology and ToxicologySchool of MedicineUniversity Complutense of MadridInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM)MadridSpain
- Ciber Enfermedades Respiratorias (CIBERES)MadridSpain
| | - Amy S. McKee
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
- Department of Microbiology and ImmunologyUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Andrew P. Fontenot
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
- Department of Microbiology and ImmunologyUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Ghazwan Butrous
- Pharmaceutical SciencesUniversity of KentCanterburyUnited Kingdom
| | - Rubin M. Tuder
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Brian B. Graham
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraCO
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12
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Abstract
PURPOSE OF REVIEW To understand the global distribution of different forms of pulmonary hypertension. RECENT FINDINGS Different registries have explored the epidemiological characteristics of pulmonary hypertension. Interestingly, there is a clear difference in the prevalence of different forms of pulmonary hypertension in developed regions in comparison with less developed countries. This finding suggests not only that extrapolation of data should be avoided but also that the known prevalence of pulmonary hypertension might be underestimated. SUMMARY Pulmonary hypertension might be more prevalent than what is currently believed. Specific forms of pulmonary hypertension distributed worldwide might characterize an unrecognized burden that still have to be properly approached. This highlights the heterogeneity of pulmonary hypertension around the world. It is clear that more epidemiological data are still needed as well as studies addressing management alternatives in these specific regions.
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Abstract
Abstract
Background
Interleukin (IL)-13 is a regulatory factor of tissue remodeling and is involved in the pathogenesis of pulmonary artery hypertension (PAH). However, the implications of IL-13 in PAH remains uncertain. This article aims to describe the current knowledge on production and function of IL-13 and its receptors in the mechanisms of PAH.
Content
The study materials of this article were based on comprehensive literature retrieval of publications of IL-13 in PAH. These study materials were carefully reviewed, analyzed and discussed.
Summary
IL-13 levels in blood and lung tissue were elevated in both animal models of PAH and patients with PAH in comparison to non-PAH controls. Types I and II IL-13 receptors participate in pulmonary artery remodeling through signal transducer and activator of transcription (STAT)6 or through phosphatidylinositol 3-kinase (PI3K), STAT3 and mitogen activated protein kinase (MAPK) pathways. Oxidant, arginase 2 (Arg2) and hypoxia-inducible factor 1α are involved in the proliferation of pulmonary artery smooth muscle cells.
Outlook
Types I and II IL-13 receptors play an important role in the IL-13 signaling by STAT6 via Janus kinase kinases, and by PI3K, STAT3 and MAPK pathways, respectively. Alternative pathways, including oxidant, Arg2 and hypoxia-inducible factor 1α might be also involved in the pathological process of PAH development. Investigational therapies by inflammatory suppression or thrombolytic and anticoagulant agents could inhibit intimal hyperplasia of the pulmonary arteries and suppress pulmonary vasculature remodeling. Drug research and development oriented by this hypothesis would confer benefits to the treatment of PAH.
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14
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Mickael CS, Graham BB. The Role of Type 2 Inflammation in Schistosoma-Induced Pulmonary Hypertension. Front Immunol 2019; 10:27. [PMID: 30733718 PMCID: PMC6353826 DOI: 10.3389/fimmu.2019.00027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Approximately 5% of individuals chronically infected with Schistosoma mansoni develop pulmonary hypertension (PH). The disease is progressive and often fatal, and treatment options are palliative, not curative. Recent studies have unraveled major players of the Th2 inflammation axis in the Schistosoma-induced PH pathology using murine models and studying human samples. TGF-β signaling is a link between the Type 2 inflammation and vascular remodeling, and specifically Thrombospondin-1 (TSP-1) is upregulated by the inflammation and activates TGF-β. Overall, the current model for the pathogenesis of Schistosoma-induced PH is that deposition of Schistosoma mansoni eggs in the pulmonary vasculature results in localized Th2 inflammation, leading to TGF-β activation by TSP-1, and the active TGF-β then results in vascular remodeling and PH.
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Affiliation(s)
- Claudia S Mickael
- Program in Translational Lung Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brian B Graham
- Program in Translational Lung Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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15
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MicroRNA-96 Promotes Schistosomiasis Hepatic Fibrosis in Mice by Suppressing Smad7. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2018; 11:73-82. [PMID: 30406154 PMCID: PMC6214875 DOI: 10.1016/j.omtm.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/05/2018] [Indexed: 01/05/2023]
Abstract
Infection with Schistosoma causes aberrant expression of host microRNAs (miRNAs), and normalizing the levels of dysregulated miRNAs can attenuate pathology. Here, we show that the host miRNA, miR-96, is markedly upregulated during the progression of hepatic schistosomiasis. We demonstrate that elevation of miR-96 induces hepatic fibrosis in infected mice by suppressing the expression of its target gene, Smad7. We show that infection with Schistosoma induces the expression of transforming growth factor β1 (TGF-β1), which in turn upregulates the expression of miR-96 through SMAD2/3-DROSHA-mediated post-transcriptional regulation. Furthermore, inhibition of miR-96 with recombinant adeno-associated virus 8 (rAAV8)-mediated delivery of Tough Decoy RNAs in mice attenuated hepatic fibrosis and prevented lethality following schistosome infection. Taken together, our data highlight the potential for rAAV8-mediated inhibition of miR-96 as a therapeutic strategy to treat hepatic schistosomiasis.
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16
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TGF-β activation by bone marrow-derived thrombospondin-1 causes Schistosoma- and hypoxia-induced pulmonary hypertension. Nat Commun 2017; 8:15494. [PMID: 28555642 PMCID: PMC5459967 DOI: 10.1038/ncomms15494] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 04/03/2017] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is an obstructive disease of the precapillary pulmonary arteries. Schistosomiasis-associated PAH shares altered vascular TGF-β signalling with idiopathic, heritable and autoimmune-associated etiologies; moreover, TGF-β blockade can prevent experimental pulmonary hypertension (PH) in pre-clinical models. TGF-β is regulated at the level of activation, but how TGF-β is activated in this disease is unknown. Here we show TGF-β activation by thrombospondin-1 (TSP-1) is both required and sufficient for the development of PH in Schistosoma-exposed mice. Following Schistosoma exposure, TSP-1 levels in the lung increase, via recruitment of circulating monocytes, while TSP-1 inhibition or knockout bone marrow prevents TGF-β activation and protects against PH development. TSP-1 blockade also prevents the PH in a second model, chronic hypoxia. Lastly, the plasma concentration of TSP-1 is significantly increased in subjects with scleroderma following PAH development. Targeting TSP-1-dependent activation of TGF-β could thus be a therapeutic approach in TGF-β-dependent vascular diseases. Thrombospondin-1 (TSP-1) activates latent TGF-β in the extracellular matrix. Here the authors show that inappropriate activation of latent TGF-β in murine, bovine and human lung by monocyte-produced TSP-1 causes pulmonary hypertension, and that interference with the activation process prevents disease development.
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17
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Decreased Endoglin expression in the pulmonary vasculature of nitrofen-induced congenital diaphragmatic hernia rat model. Pediatr Surg Int 2017; 33:263-268. [PMID: 27822781 DOI: 10.1007/s00383-016-4004-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY Pulmonary hypertension (PH) remains a therapeutical challenge in neonates born with congenital diaphragmatic hernia (CDH). Endoglin (Eng), an auxiliary receptor component of the transforming growth factor β (TGFβ) signalling pathway, is expressed mainly by endothelial cells and has been found to be involved in angiogenesis and vascular remodelling. Genetic studies have linked TGFβ and Eng mutations to human arterial PH and other cardiovascular syndromes. Eng interacts with the TGFβ receptors 1 and 2 (Tgfβr1, Tgfβr2). We designed this study to investigate the hypothesis that Eng is altered in the pulmonary vasculature of rats with nitrofen-induced CDH subjected to its interdependency with Tgfβr1 and Tgfβr2. METHODS After ethical approval (Rec 913b), time-pregnant Sprague-Dawley rats received either nitrofen or olive oil on gestational day (D9). The foetuses (n = 22) were sacrificed and divided into CDH and control group on D21. Gene and protein expressions of Eng, Tgfβr1 and Tgfβr2 were assessed via qRT-PCR and western blotting. Immunofluorescence staining for Eng was combined with CD34 to evaluate Eng expression in the pulmonary vasculature. MAIN RESULTS Relative mRNA levels of Eng, Tgfβr1 and Tgfβr2 were significantly downregulated in CDH lungs compared to controls (Eng CDH 0.341 ± 0.022, Eng Ctrl 0.471 ± 0.031, p = 0.0015; Tgfβr1 CDH 0.161 ± 0.008, Tgfβr1 Ctrl 0.194 ± 0.01, p = 0.0114; Tgfβr2 CDH 0.896 ± 0.099, Tgfβr2 Ctrl 1.379 ± 0.081, p = 0.0006) Western blotting confirmed the reduced pulmonary protein expression of these three proteins in the CDH lungs. A markedly diminished endothelial expression of Eng in the pulmonary vasculature of nitrofen-exposed foetuses compared to controls was seen in laser scanning confocal-microscopy. CONCLUSION This study demonstrates for the first time a reduced expression of Endoglin in the pulmonary vasculature of nitrofen-induced CDH. Abnormal Eng/Tgfβr1/Tgfβr2 signalling may contribute to impaired vascular remodelling and development of PH in this CDH animal model.
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18
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Xiao T, Xie L, Huang M, Shen J. Differential expression of microRNA in the lungs of rats with pulmonary arterial hypertension. Mol Med Rep 2016; 15:591-596. [PMID: 28000863 PMCID: PMC5364860 DOI: 10.3892/mmr.2016.6043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/03/2016] [Indexed: 01/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a chronic disorder of the small pulmonary arteries, and the efficacy of the therapies and the prognosis remain poor. The pathobiology of PAH is complex, and needs to be elucidated by multiple approaches. The present study used a monocrotaline-induced PAH rat model to perform a comprehensive microRNA (miRNA) microarray screening in the lungs and identified 16 downregulated miRNAs in the lungs from PAH rats. High-enrichment gene ontology (GO) analysis identified several sets of genes, and established the miRNA-mRNA network by outlining the interactions of miRNA and GO-associated genes. Three downregulated miRNAs [miRNA 125-3p (miR-125-3p), miR-148-3p and miR-193] displayed the most marked regulatory function, and miR-148-3p and miR-193 were observed to have the highest number of target mRNAs. Signaling pathway analysis demonstrated 26 signal transduction pathways, with MAPK, TGF-β and cell cycle signaling as the most prominent. In addition, 342 genes were identified as the potential targets of these 16 miRNAs. Thus, a set of miRNAs in the lungs from rats with PAH and novel associations between biological events and PAH pathogenesis were identified, providing potential therapeutic targets for this disorder.
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Affiliation(s)
- Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Min Huang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, P.R. China
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19
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Elsakkar MG, Eissa MM, Hewedy WA, Nassra RM, Elatrebi SF. Sodium valproate, a histone deacetylase inhibitor, with praziquantel ameliorates Schistosoma mansoni-induced liver fibrosis in mice. Life Sci 2016; 162:95-101. [PMID: 27528511 DOI: 10.1016/j.lfs.2016.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/07/2016] [Accepted: 08/10/2016] [Indexed: 11/17/2022]
Abstract
AIMS This study explores the potential antifibrotic effect of sodium valproate (SV), an inhibitor of class I histone deacetylase (HDAC) enzymes, and/or praziquantel (PZQ) on Schistosoma mansoni (S. mansoni)-induced liver fibrosis in mice. MAIN METHODS Male Swiss albino mice were divided into nine groups: group I- normal control (NC); group II- uninfected gum mucilage (GM) treated; group III- uninfected PZQ- treated; group IV- uninfected SV-treated; group V- control S. mansoni infected mice; group VI- infected GM-treated; group VII- infected PZQ-treated; group VIII- infected SV-treated; group IX- infected PZQ+SV treated. All SV administrations were 300mg/kg/day orally and administered for five weeks beginning on the 5th week post infection (WPI). All PZQ administrations were 500mg/kg/day orally and administered for 2 consecutive days beginning on the 7th WPI. Serum transforming growth factor-beta 1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), hepatic hydroxyproline (Hyp) content, and liver function tests (AST and ALT) were determined. Specimens of the hepatic tissues were examined histologically. KEY FINDINGS Treatment of S. mansoni-infected mice with SV significantly decreased the serum levels of ALT, TGF-β1 and TNF-α, and the liver tissue hydroxyproline content compared with the S. mansoni infected untreated groups. Histologically, treatment with SV revealed regression of the granulomatous inflammatory reaction. Combined treatment with PZQ and SV produces more favorable biochemical results, and aborted granulomatous reaction compared with either drug alone. SIGNIFICANCE Sodium valproate is a promising anti-fibrotic agent. It demonstrated an anti-fibrotic effect in early stages of S. mansoni infection through downregulation of profibrogenic cytokines, and collagen deposition.
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Affiliation(s)
- Mohamed G Elsakkar
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Maha M Eissa
- Department of Medical Parasitology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Wafaa A Hewedy
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rasha M Nassra
- Department of Medical Biochemistry, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Soha F Elatrebi
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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20
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Xiang S, Zeng Y, Xiong B, Qin Y, Huang X, Jiang Y, Luo W, Sooranna SR, Pinhu L. Transforming growth factor beta 1 induced endothelin-1 release is peroxisome proliferator-activated receptor gamma dependent in A549 cells. JOURNAL OF INFLAMMATION-LONDON 2016; 13:19. [PMID: 27293383 PMCID: PMC4902962 DOI: 10.1186/s12950-016-0128-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/07/2016] [Indexed: 01/30/2023]
Abstract
Background Endothelin-1 (ET-1) is involved in pulmonary vascular remodeling. The aim of this study was to investigate the biochemical interactions between PPAR-γ, TGF-β1 and ET-1 in vitro. Methods A549 cells were pre-treated with S2505 (10 μM), S2871 (10 μM) with/without SB203580 (10 μM) for 60 min following 2 h treatment with 10 ng/mL TGF-β1. A549 cells were also transfected with positive or negative PPAR-γ plasmids for comparison. RT-PCR, ELISA, western blotting and confocal laser scanning microscopy (CLSM) were used to measure the relevant expression of mRNA, protein, mediators of pathways and nuclear factor translocation. Results SB203580 inhibited TGF-β1 induced ET-1 expression in A549 cells. S2871 decreased PPAR-γ mRNA and increase TGF-β1-induced ET-1 expression. S2871 increased phosphorylation of p38 MAPK and Smad2. Cells transfected with PPAR-γ negative plasmid increased TGF-β1 induced ET-1 expression, and increased the expression of phospho-p38 MAPK and phospho-Smad2. S2505 increased PPAR-γ mRNA expression, suppressed the increased TGF-β1-induced expression of ET-1. S2505 inhibited TGF-β1 induced phosphorylation of p38 MAPK and Smad2, also the nuclear translocation of Smad2. Cells transfected with PPAR-γ positive plasmid reduced TGF-β1-induced ET-1 expression, and inhibited the expression of phospho-p38 MAPK and phospho-Smad2. Conclusions TGF-β1 induced release of endothelin-1 is PPAR-γ dependent in cultured A549 cells.
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Affiliation(s)
- Shulin Xiang
- The First Clinical Medical College of Jinan University, Guangzhou, 510630 Guangdong Province China.,Department of Intensive Care Unit, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021 China
| | - Yi Zeng
- Department of Central Laboratory, Youjiang Medical University for Nationalities, Baise, 533000 Guangxi Zhuang Autonomous Region China
| | - Bin Xiong
- Department of Intensive Care Unit, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021 China
| | - Yueqiu Qin
- Department of Digestive Medicine, Youjiang Medical University for Nationalities, Baise, 533000 Guangxi Zhuang Autonomous Region China
| | - Xia Huang
- The First Clinical Medical College of Jinan University, Guangzhou, 510630 Guangdong Province China.,Department of Respiratory Medicine, Youjiang Medical University for Nationalities, Baise, 533000 Guangxi Zhuang Autonomous Region China
| | - Yujie Jiang
- The First Clinical Medical College of Jinan University, Guangzhou, 510630 Guangdong Province China.,Department of Respiratory Medicine, Youjiang Medical University for Nationalities, Baise, 533000 Guangxi Zhuang Autonomous Region China
| | - Weigui Luo
- Department of Respiratory Medicine, Youjiang Medical University for Nationalities, Baise, 533000 Guangxi Zhuang Autonomous Region China
| | - Suren R Sooranna
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, SW10 9NH UK
| | - Liao Pinhu
- Department of Intensive Care Medicine, Youjiang Medical University for Nationalities, Baise, 533000 Guangxi Zhuang Autonomous Region China
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21
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Kumar R, Mickael C, Chabon J, Gebreab L, Rutebemberwa A, Garcia AR, Koyanagi DE, Sanders L, Gandjeva A, Kearns MT, Barthel L, Janssen WJ, Mauad T, Bandeira A, Schmidt E, Tuder RM, Graham BB. The Causal Role of IL-4 and IL-13 in Schistosoma mansoni Pulmonary Hypertension. Am J Respir Crit Care Med 2016; 192:998-1008. [PMID: 26192556 DOI: 10.1164/rccm.201410-1820oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
RATIONALE The etiology of schistosomiasis-associated pulmonary arterial hypertension (PAH), a major cause of PAH worldwide, is poorly understood. Schistosoma mansoni exposure results in prototypical type-2 inflammation. Furthermore, transforming growth factor (TGF)-β signaling is required for experimental pulmonary hypertension (PH) caused by Schistosoma exposure. OBJECTIVES We hypothesized type-2 inflammation driven by IL-4 and IL-13 is necessary for Schistosoma-induced TGF-β-dependent vascular remodeling. METHODS Wild-type, IL-4(-/-), IL-13(-/-), and IL-4(-/-)IL-13(-/-) mice (C57BL6/J background) were intraperitoneally sensitized and intravenously challenged with S. mansoni eggs to induce experimental PH. Right ventricular catheterization was then performed, followed by quantitative analysis of the lung tissue. Lung tissue from patients with schistosomiasis-associated and connective tissue disease-associated PAH was also systematically analyzed. MEASUREMENTS AND MAIN RESULTS Mice with experimental Schistosoma-induced PH had evidence of increased IL-4 and IL-13 signaling. IL-4(-/-)IL-13(-/-) mice, but not single knockout IL-4(-/-) or IL-13(-/-) mice, were protected from Schistosoma-induced PH, with decreased right ventricular pressures, pulmonary vascular remodeling, and right ventricular hypertrophy. IL-4(-/-)IL-13(-/-) mice had less pulmonary vascular phospho-signal transducer and activator of transcription 6 (STAT6) and phospho-Smad2/3 activity, potentially caused by decreased TGF-β activation by macrophages. In vivo treatment with a STAT6 inhibitor and IL-4(-/-)IL-13(-/-) bone marrow transplantation also protected against Schistosoma-PH. Lung tissue from patients with schistosomiasis-associated and connective tissue disease-associated PAH had evidence of type-2 inflammation. CONCLUSIONS Combined IL-4 and IL-13 deficiency is required for protection against TGF-β-induced pulmonary vascular disease after Schistosoma exposure, and targeted inhibition of this pathway is a potential novel therapeutic approach for patients with schistosomiasis-associated PAH.
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Affiliation(s)
- Rahul Kumar
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Claudia Mickael
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Jacob Chabon
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Liya Gebreab
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Alleluiah Rutebemberwa
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Alexandra Rodriguez Garcia
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Daniel E Koyanagi
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Linda Sanders
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Aneta Gandjeva
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Mark T Kearns
- 2 Department of Medicine, National Jewish Health, Denver, Colorado
| | - Lea Barthel
- 2 Department of Medicine, National Jewish Health, Denver, Colorado
| | | | - Thais Mauad
- 3 Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil; and
| | - Angela Bandeira
- 4 Department of Medicine, Memorial S. Jose Hospital, Universidade de Pernambuco, Recife, Brazil
| | - Eric Schmidt
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Rubin M Tuder
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Brian B Graham
- 1 Program in Translational Lung Research, Department of Medicine, Anschutz Medical Campus, Aurora, Colorado
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22
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Courtney CL, Ethun KF, Villinger F, Ruprecht RM, Byrareddy SN. Massive occlusive thrombosis of the pulmonary artery in pigtailed macaques chronically infected with R5-tropic simian-human immunodeficiency virus. J Med Primatol 2015; 44:35-9. [PMID: 25174584 PMCID: PMC4293324 DOI: 10.1111/jmp.12142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) has been identified as a serious complication of HIV infection. METHODS AND RESULTS Here, we report sudden death in two pigtailed macaques (Macaca nemestrina) chronically infected (~1-2 years post-infection) with an R5 SHIV strain. At necropsy, total occlusion of the pulmonary artery by a large fibrin thrombus was present in both animals. CONCLUSION This report describes pulmonary vascular lesions similar to PAH in R5 SHIV-infected pigtail macaques.
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Affiliation(s)
- Cynthia L Courtney
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Kelly F Ethun
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Francois Villinger
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
| | - Ruth M. Ruprecht
- Texas Biomedical Research Institute, TX, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Siddappa N. Byrareddy
- Department of Pathology & Laboratory Medicine, School of Medicine, and Emory Vaccine Center, Emory University, Atlanta, GA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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23
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Gidwani S, Nair A. The burden of pulmonary hypertension in resource-limited settings. Glob Heart 2014; 9:297-310. [PMID: 25667181 DOI: 10.1016/j.gheart.2014.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 12/11/2022] Open
Abstract
Pulmonary vascular disease (PVD) is a significant global health problem and accounts for a substantial portion of cardiovascular disease in the developing world. Although there have been considerable advances in therapeutics for pulmonary arterial hypertension, over 97% of the disease burden lies within the developing world where there is limited access to health care and pharmaceuticals. The causes of pulmonary arterial hypertension differ between industrialized and developing nations. Infectious diseases-including schistosomiasis human immunodeficiency virus, and rheumatic fever-are common causes of PVD, as are hemoglobinopathies, and untreated congenital heart disease. High altitude and exposure to household air pollutants also contribute to a significant portion of PVD cases. Although diagnosis of pulmonary arterial hypertension requires the use of imaging and invasive hemodynamics, access to equipment may be limited. PVD therapies may be prohibitively expensive and limited to a select few. Prevention is therefore important in limiting the global PVD burden.
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Affiliation(s)
| | - Ajith Nair
- Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA.
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24
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Macrophage P2X7 receptor function is reduced during schistosomiasis: putative role of TGF- β1. Mediators Inflamm 2014; 2014:134974. [PMID: 25276050 PMCID: PMC4158569 DOI: 10.1155/2014/134974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/14/2014] [Accepted: 08/04/2014] [Indexed: 12/05/2022] Open
Abstract
Schistosomiasis is a chronic inflammatory disease whose macrophages are involved in immunopathology modulation. Although P2X7 receptor signaling plays an important role in inflammatory responses mediated by macrophages, no reports have examined the role of P2X7 receptors in macrophage function during schistosomiasis. Thus, we evaluated P2X7 receptor function in peritoneal macrophages during schistosomiasis using an ATP-induced permeabilization assay and measurements of the intracellular Ca2+ concentration. ATP treatment induced significantly less permeabilization in macrophages from S. mansoni-infected mice than in control cells from uninfected animals. Furthermore, P2X7-mediated increases in intracellular Ca2+ levels were also reduced in macrophages from infected mice. TGF-β1 levels were increased in the peritoneal cavity of infected animals, and pretreatment of control macrophages with TGF-β1 reduced ATP-induced permeabilization, mimicking the effect of S. mansoni infection. Western blot and qRT-PCR data showed no difference in P2X7 protein and mRNA between uninfected, infected, and TGF-β1-treated groups. However, immunofluorescence analysis revealed reduced cell surface localization of P2X7 receptors in macrophages from infected and TGF-β1-treated mice compared to controls. Therefore, our data suggest that schistosomiasis reduces peritoneal macrophage P2X7 receptor signaling. This effect is likely due to the fact that infected mice have increased levels of TGF-β1, which reduces P2X7 receptor cell surface expression.
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