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Tamosiuniene R, Manouvakhova O, Mesange P, Saito T, Qian J, Sanyal M, Lin YC, Nguyen LP, Luria A, Tu AB, Sante JM, Rabinovitch M, Fitzgerald DJ, Graham BB, Habtezion A, Voelkel NF, Aurelian L, Nicolls MR. Dominant Role for Regulatory T Cells in Protecting Females Against Pulmonary Hypertension. Circ Res 2018; 122:1689-1702. [PMID: 29545367 DOI: 10.1161/circresaha.117.312058] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/18/2022]
Abstract
RATIONALE Pulmonary arterial hypertension (PH) is a life-threatening condition associated with immune dysregulation and abnormal regulatory T cell (Treg) activity, but it is currently unknown whether and how abnormal Treg function differentially affects males and females. OBJECTIVE To evaluate whether and how Treg deficiency differentially affects male and female rats in experimental PH. METHODS AND RESULTS Male and female athymic rnu/rnu rats, lacking Tregs, were treated with the VEGFR2 (vascular endothelial growth factor receptor 2) inhibitor SU5416 or chronic hypoxia and evaluated for PH; some animals underwent Treg immune reconstitution before SU5416 administration. Plasma PGI2 (prostacyclin) levels were measured. Lung and right ventricles were assessed for the expression of the vasoprotective proteins COX-2 (cyclooxygenase 2), PTGIS (prostacyclin synthase), PDL-1 (programmed death ligand 1), and HO-1 (heme oxygenase 1). Inhibitors of these pathways were administered to athymic rats undergoing Treg immune reconstitution. Finally, human cardiac microvascular endothelial cells cocultured with Tregs were evaluated for COX-2, PDL-1, HO-1, and ER (estrogen receptor) expression, and culture supernatants were assayed for PGI2 and IL (interleukin)-10. SU5416-treatment and chronic hypoxia produced more severe PH in female than male athymic rats. Females were distinguished by greater pulmonary inflammation, augmented right ventricular fibrosis, lower plasma PGI2 levels, decreased lung COX-2, PTGIS, HO-1, and PDL-1 expression and reduced right ventricular PDL-1 levels. In both sexes, Treg immune reconstitution protected against PH development and raised levels of plasma PGI2 and cardiopulmonary COX-2, PTGIS, PDL-1, and HO-1. Inhibiting COX-2, HO-1, and PD-1 (programmed death 1)/PDL-1 pathways abrogated Treg protection. In vitro, human Tregs directly upregulated endothelial COX-2, PDL-1, HO-1, ERs and increased supernatant levels of PGI2 and IL-10. CONCLUSIONS In 2 animal models of PH based on Treg deficiency, females developed more severe PH than males. The data suggest that females are especially reliant on the normal Treg function to counteract the effects of pulmonary vascular injury leading to PH.
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Affiliation(s)
- Rasa Tamosiuniene
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Olga Manouvakhova
- VA Palo Alto Health Care System, CA (O.M., Y.-C.L., A.L., A.B.T., J.M.S., M.R.N.)
| | - Paul Mesange
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Toshie Saito
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Jin Qian
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Mrinmoy Sanyal
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Yu-Chun Lin
- VA Palo Alto Health Care System, CA (O.M., Y.-C.L., A.L., A.B.T., J.M.S., M.R.N.)
| | - Linh P Nguyen
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Amir Luria
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.).,VA Palo Alto Health Care System, CA (O.M., Y.-C.L., A.L., A.B.T., J.M.S., M.R.N.)
| | - Allen B Tu
- VA Palo Alto Health Care System, CA (O.M., Y.-C.L., A.L., A.B.T., J.M.S., M.R.N.)
| | - Joshua M Sante
- VA Palo Alto Health Care System, CA (O.M., Y.-C.L., A.L., A.B.T., J.M.S., M.R.N.)
| | - Marlene Rabinovitch
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | | | - Brian B Graham
- University of Colorado Denver, School of Medicine, Department of Medicine, Aurora (B.B.G.)
| | - Aida Habtezion
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.)
| | - Norbert F Voelkel
- Virginia Commonwealth University School of Medicine, Department of Internal Medicine, Richmond (N.F.V.)
| | - Laure Aurelian
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.).,University of Maryland School of Medicine, Baltimore (L.A.)
| | - Mark R Nicolls
- From the Stanford University School of Medicine, Department of Medicine, CA (R.T., P.M., T.S., J.Q., M.S., L.P.N., A.L., M.R., A.H., L.A., M.R.N.) .,VA Palo Alto Health Care System, CA (O.M., Y.-C.L., A.L., A.B.T., J.M.S., M.R.N.)
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4
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Saito T, Miyagawa K, Chen SY, Tamosiuniene R, Wang L, Sharpe O, Samayoa E, Harada D, Moonen JRAJ, Cao A, Chen PI, Hennigs JK, Gu M, Li CG, Leib RD, Li D, Adams CM, Del Rosario PA, Bill M, Haddad F, Montoya JG, Robinson WH, Fantl WJ, Nolan GP, Zamanian RT, Nicolls MR, Chiu CY, Ariza ME, Rabinovitch M. Upregulation of Human Endogenous Retrovirus-K Is Linked to Immunity and Inflammation in Pulmonary Arterial Hypertension. Circulation 2017; 136:1920-1935. [PMID: 28935667 DOI: 10.1161/circulationaha.117.027589] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/31/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Immune dysregulation has been linked to occlusive vascular remodeling in pulmonary arterial hypertension (PAH) that is hereditary, idiopathic, or associated with other conditions. Circulating autoantibodies, lung perivascular lymphoid tissue, and elevated cytokines have been related to PAH pathogenesis but without a clear understanding of how these abnormalities are initiated, perpetuated, and connected in the progression of disease. We therefore set out to identify specific target antigens in PAH lung immune complexes as a starting point toward resolving these issues to better inform future application of immunomodulatory therapies. METHODS Lung immune complexes were isolated and PAH target antigens were identified by liquid chromatography tandem mass spectrometry, confirmed by enzyme-linked immunosorbent assay, and localized by confocal microscopy. One PAH antigen linked to immunity and inflammation was pursued and a link to PAH pathophysiology was investigated by next-generation sequencing, functional studies in cultured monocytes and endothelial cells, and hemodynamic and lung studies in a rat. RESULTS SAM domain and HD domain-containing protein 1 (SAMHD1), an innate immune factor that suppresses HIV replication, was identified and confirmed as highly expressed in immune complexes from 16 hereditary and idiopathic PAH versus 12 control lungs. Elevated SAMHD1 was localized to endothelial cells, perivascular dendritic cells, and macrophages, and SAMHD1 antibodies were prevalent in tertiary lymphoid tissue. An unbiased screen using metagenomic sequencing related SAMHD1 to increased expression of human endogenous retrovirus K (HERV-K) in PAH versus control lungs (n=4). HERV-K envelope and deoxyuridine triphosphate nucleotidohydrolase mRNAs were elevated in PAH versus control lungs (n=10), and proteins were localized to macrophages. HERV-K deoxyuridine triphosphate nucleotidohydrolase induced SAMHD1 and proinflammatory cytokines (eg, interleukin 6, interleukin 1β, and tumor necrosis factor α) in circulating monocytes, pulmonary arterial endothelial cells, and also activated B cells. Vulnerability of pulmonary arterial endothelial cells (PAEC) to apoptosis was increased by HERV-K deoxyuridine triphosphate nucleotidohydrolase in an interleukin 6-independent manner. Furthermore, 3 weekly injections of HERV-K deoxyuridine triphosphate nucleotidohydrolase induced hemodynamic and vascular changes of pulmonary hypertension in rats (n=8) and elevated interleukin 6. CONCLUSIONS Our study reveals that upregulation of the endogenous retrovirus HERV-K could both initiate and sustain activation of the immune system and cause vascular changes associated with PAH.
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Affiliation(s)
- Toshie Saito
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Kazuya Miyagawa
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Shih-Yu Chen
- Department of Microbiology and Immunology (S.-Y.C., W.J.F., G.P.N.).,Baxer Laboratory for Stem Cell Biology (S.-Y.C., W.J.F., G.P.N.)
| | - Rasa Tamosiuniene
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Lingli Wang
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Orr Sharpe
- Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Erik Samayoa
- Stanford University School of Medicine, CA. Department of Laboratory Medicine and Medicine/Infectious Diseases (E.S., C.Y.C.), and Viral Diagnostics and Discovery Center University of California, San Francisco (E.S., C.Y.C.)
| | - Daisuke Harada
- Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Jan-Renier A J Moonen
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Aiqin Cao
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Pin-I Chen
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Jan K Hennigs
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Mingxia Gu
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | - Caiyun G Li
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | | | - Dan Li
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
| | | | - Patricia A Del Rosario
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Matthew Bill
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Francois Haddad
- Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Jose G Montoya
- Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - William H Robinson
- Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Wendy J Fantl
- Department of Microbiology and Immunology (S.-Y.C., W.J.F., G.P.N.).,Baxer Laboratory for Stem Cell Biology (S.-Y.C., W.J.F., G.P.N.).,Vincent Coates Foundation Mass Spectrometry Laboratory (R.D.L., C.M.A.), and Department of Obstetrics and Gynecology (W.J.F.)
| | - Garry P Nolan
- Department of Microbiology and Immunology (S.-Y.C., W.J.F., G.P.N.).,Baxer Laboratory for Stem Cell Biology (S.-Y.C., W.J.F., G.P.N.)
| | - Roham T Zamanian
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Mark R Nicolls
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.).,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Medicine (R.T., O.S., D.H., P.A.d.R., M.B., F.H., J.G.M., W.H.R., R.T.Z., M.R.N.)
| | - Charles Y Chiu
- Stanford University School of Medicine, CA. Department of Laboratory Medicine and Medicine/Infectious Diseases (E.S., C.Y.C.), and Viral Diagnostics and Discovery Center University of California, San Francisco (E.S., C.Y.C.)
| | - Maria E Ariza
- Department of Cancer Biology and Genetics, The Ohio State University Wexner Medical Center, Columbus, OH (M.E.A.)
| | - Marlene Rabinovitch
- Vera Moulton Wall Center for Pulmonary Vascular Disease (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., P.A.d.R., M.B., R.T.Z., M.R.N., M.R.), .,Cardiovascular Institute (T.S., K.M., R.T., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., F.H., R.T.Z., M.R.N., M.R.).,Department of Pediatrics (T.S., K.M., L.W., J.-R.A.J.M., A.C., P.-I.C., J.K.H., M.G., C.G.L., D.L., M.R.)
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