Abstract 4920: Endothelial-Targeted BMPR2 Loss-of-Function Mutations Cause Increased Apoptosis and Pulmonary Arterial Hypertension
Introduction: Pulmonary arterial hypertension (PAH) is a rare and fatal disease caused by excessive remodelling of small pulmonary arterioles. Heterozygous loss-of-function mutations in the bone morphogenetic protein receptor 2 (BMPR2) have recently been implicated in patients with familial and idiopathic PAH. However, how mutations in this ubiquitously expressed receptor result in a specific abnormality of the lung microcirculation is unknown. We hypothesized that mutations in BMPR2 lead to PAH by increasing the susceptibility of ECs to apoptosis, particularly within fragile pulmonary arterioles. Aims: To examine the effect of endothelial targeted overexpression of a BMPR2 deletional mutation on EC apoptosis, pulmonary hemodynamics and arteriolar remodelling.
Methods: We developed an endothelial-specific binary transgenic (BT) mouse model in which the driver mice express the tetracycline transactivator under the control of the endothelial-restricted V-cadherin promoter and the responder mice harbour a BMPR2 transgene containing an arginine-to-stop mutation in the receptor’s C-terminal domain driven by a tetracycline responsive promoter. Pulmonary artery pressure was evaluated by measuring right ventricular systolic pressure (RVSP). Fluorescent microangiography (FMA) was performed to visualize the 3D architecture of the pulmonary microcirculation.
Results: RVSP was significantly increased in BT mice compared to non binary controls (p < 0.05; n = 9), associated with increased muscularization of small pulmonary arterioles detected by α -smooth muscle actin immunostaining. In addition, FMA revealed decreased perfusion and distal pre-capillary discontinuity in BT mice. TUNEL staining also demonstrated a significant increase in the number of apoptotic cells in BT mice compared to non binary controls (5.8 ± 1.1, 1.0 ± 0.7 positive cells/HPF, respectively; p < 0.05; n = 4).
Conclusions: These data suggest that BMPR2 mutations increase the susceptibility to apoptosis, possibly leading to EC loss and pre-capillary arteriolar discontinuity. This new model will help elucidate the pathophysiological events leading to the development of PAH and provide a unique tool to evaluate novel potential treatments for this disease.