Background-Pulmonary arterial remodeling characterized by increased vascular smooth muscle proliferation is commonly seen in life-threatening disease, pulmonary arterial hypertension (PAH). Clinical studies have suggested a correlation between osteoprotegerin serum levels and PAH severity. Here, we aimed to invhestigate vascular osteoprotegerin expression and its effects on pulmonary arterial smooth muscle cell proliferation in vitro and in vivo, as well as examine the signal transduction pathways mediating its activity. Methods and Results-Serum osteoprotegerin levels were significantly elevated in patients with PAH and correlated with disease severity as determined by the World Health Organization (WHO) functional classifications and 6-minute walking distance tests. Similarly, increased osteoprotegerin expression was observed in the pulmonary arteries of hypoxia plus SU5416-and monocrotaline-induced PAH animal models. Moreover, osteoprotegerin disruption attenuated hypoxia plus SU5416-induced PAH progression by reducing pulmonary vascular remodeling, whereas lentiviral osteoprotegerin reconstitution exacerbated PAH by increasing pulmonary arterial smooth muscle cell proliferation. Furthermore, pathway analysis revealed that osteoprotegerin induced pulmonary arterial smooth muscle cell proliferation by interacting with integrin α v β 3 to elicit downstream focal adhesion kinase and AKT pathway activation. Conclusions-Osteoprotegerin facilitates PAH pathogenesis by regulating pulmonary arterial smooth muscle cell proliferation, suggesting that it may be a potential biomarker and therapeutic target in this disease.
Jia et al Osteoprotegerin in Pulmonary HypertensionIn addition, experimental results indicated that osteoprotegerin promotes the proliferation of various cancer cells and endothelial cells in a TRAIL-independent manner. 14,15 These data expand the functional significance of osteoprotegerin beyond its presumed role as a receptor activator of nuclear factor-κB ligand and TRAIL decoy receptor, and suggest that it may interact with integrins or fatty acid synthase. 8,14,15 This is greatly relevant because pulmonary arterial smooth muscle cells (PASMCs) express several integrin molecules that regulate pulmonary vascular remodeling and contribute to PAH progression. 16,17 Integrins are a large family of structurally related heterodimeric transmembrane receptors that regulate cell-cell and cell-matrix contacts. 18 Of the 18α and 8β subtypes identified, pulmonary vascular smooth muscles express α 1-5 , α 7 , α 8 , α v , β 1 , β 3 , and β 4 .17 On the basis of these observations, we hypothesize that osteoprotegerin may contribute to pulmonary vascular remodeling in an integrindependent manner.In this study, we demonstrated that osteoprotegerin expression was increased in both murine and human pulmonary arterial SMCs (mPASMCs and hPASMCs) in response to hypoxia and in the lung tissue and pulmonary arteries of hypoxia plus SU5416 (HySu)-induced PAH model mice. Moreover, integrin α 1 , α 8 , α v , and β 3 express...