Hypoxic
pulmonary hypertension (HPH) is characterized by pulmonary
vascular sustained constriction and progressive remodeling, which
are initiated by hypoxia then with hypoxia-induced additive factors
including pulmonary vascular endothelium injury, intrapulmonary angiotension
system imbalance, and inflammation. Now HPH is still an intractable
disease lacking effective treatments. Gene therapy has a massive potential
for HPH but is hindered by a lack of efficient targeted delivery and
hypoxia-responsive regulation systems for transgenes. Herein, we constructed
the hypoxia-responsive plasmid of angiotensin-converting enzyme 2
(ACE2) with endothelial-specific promoter Tie2 and a hypoxia response
element and next prepared its biomimetic nanoparticle delivery system,
named ACE2-CS-PRT@PM, by encapsulating the plasmid of ACE2 with protamine
and chondroitin sulfate as the core then coated it with a platelet
membrane as a shell for targeting the injured pulmonary vascular endothelium.
ACE2-CS-PRT@PM has a 194.3 nm diameter with a platelet membrane-coating
core–shell structure and a negatively charged surface, and
it exhibits higher delivery efficiency targeting to pulmonary vascular
endothelium and hypoxia-responsive overexpression of ACE2 in endothelial
cells in a hypoxia environment. In vitro, ACE2-CS-PRT@PM significantly
inhibited the hypoxia-induced proliferation of pulmonary smooth muscle
cells. In vivo, ACE2-CS-PRT@PM potently ameliorated the hemodynamic
dysfunction and morphological abnormality and largely reversed HPH
via inhibiting the hypoxic proliferation of pulmonary artery smooth
muscle cells, reducing pulmonary vascular remodeling, restoring balance
to the intrapulmonary angiotension system, and improving the inflammatory
microenvironment without any detectable toxicity. Therefore, ACE2-CS-PRT@PM
is promising for the targeted gene therapy of HPH.