P ulmonary arterial hypertension (PAH) is a progressive disorder characterized by abnormally high blood pressure in the pulmonary artery, right ventricular (RV) overload, and, eventually, right heart failure leading to death. The estimated median survival of patients diagnosed with idiopathic PAH is <3 years. 1 The only treatment option that has been shown to increase the survival rate is the continuous systemic administration of prostacyclin 2 ; the median survival rate increases from 2.8 years in untreated patients to 5 years in treated patients. 3,4 However, systemic prostacyclin therapy has serious limitations, including a short halflife and the need for a permanent intravenous catheter. Other treatment options are needed. One alternative being studied is cell-based gene therapy using bone marrow-derived endothelial-like progenitor cells (ELPCs) that express endothelial nitric oxide synthase (eNOS). 5 However, unlike synthetic prostacyclin and its analogs, eNOS treatment is not an established therapeutic approach and has not been included in the PAH treatment algorithm used by clinicians. 2 In the present study, we hypothesize that prostacyclin-producing ELPCs, delivered via the jugular vein, may provide sustained therapeutic effects without the limitations associated with systemic delivery of prostacyclin. Because prostacyclin is produced from arachidonic acid in a serial fashion by the enzymes cyclooxygenase (COX) and prostacyclin synthase (PGIS), we have generated a nonviral vector expressing a human COX isoform 1-PGIS fusion protein. 6 The fusion enzyme is anchored across the membrane of the endoplasmic Background-Intravenous prostacyclin is approved for treating pulmonary arterial hypertension (PAH), but it has a short half-life and must be delivered systemically via an indwelling intravenous catheter. We hypothesize that localized jugular vein delivery of prostacyclin-producing cells may provide sustained therapeutic effects without the limitations of systemic delivery. Methods and Results-We generated a vector expressing a human cyclooxygenase isoform 1 and prostacyclin synthase fusion protein that produces prostacyclin from arachidonic acid. Endothelial-like progenitor cells (ELPCs) were transfected with the cyclooxygenase isoform 1-prostacyclin synthase plasmid and labeled with lentivirus expressing nuclear-localized red fluorescent protein (nuRFP). The engineered ELPCs (expressing cyclooxygenase isoform 1-prostacyclin synthase and nuRFP) were tested in rats with monocrotaline (MCT)-induced PAH. In PAH prevention studies, treatment with engineered ELPCs or control ELPCs (expressing nuRFP alone) attenuated MCT-induced right ventricular systolic pressure increase, right ventricular hypertrophy, and pulmonary vessel wall thickening. Engineered ELPCs were more effective than control ELPCs in all variables evaluated. In PAH reversal studies, engineered ELPCs or control ELPCs increased the survival rate of rats with established PAH and decreased right ventricular hypertrophy. Engineered ELPCs provided ...