A team of U.S. and Canadian researchers has shown that blocking production of NOGO-B in pulmonary arteries could prevent the deleterious vascular remodeling seen in pulmonary arterial hypertension. 1 If future studies demonstrate that NOGO-B inhibitors could treat disease that already is established, the compounds could become the first disease modifiers for pulmonary arterial hypertension, which currently is treated with vasodilators that alleviate disease symptoms but do not address underlying causes.In pulmonary arterial hypertension (PAH), increased proliferation and resistance to apoptosis in pulmonary vasculature-but not in systemic vasculature-results in obstruction of the pulmonary arteries, hypertension, right ventricular hypertrophy and eventual death.Last year, researchers from the University of Alberta and Metabolic Modulators Research Ltd. reported in Science Translational Medicine that in mouse models of hypoxia-induced PAH, a metabolic shift from glucose oxidation to glycolysis in pulmonary arterial cells drove the proliferative, antiapoptotic phenotype seen in PAH. 2 However, the team did not identify the mechanism underlying the change in metabolism.Evangelos Michelakis, who was corresponding author on both the 2010 study and the new paper, told SciBX the same metabolic shift occurs in nonhypoxic PAH models and human diseases such as idiopathic PAH, familial PAH associated with mutations in bone morphogenic protein receptor type II (BMPRII), scleroderma Figure 1. NOGO-B: on a stressful pathway to pulmonary arterial hypertension. in pulmonary artery smooth muscle cells, hypoxia induces endoplasmic reticulum (er) stress and expression of activating transcription factor 6 (atF6) [a], which upregulates the nOgO-B isoform of reticulon 4 (rtn4; nOgO; nOgO-a). increased levels of nOgO-B disrupt the spatial proximity and normal interactions between the er and mitochondria [b] to increase cytosolic glycolysis and decrease glucose oxidation [c], which promote cell proliferation and resistance to apoptosis [d], respectively, and lead to the deleterious vascular remodeling seen in pulmonary arterial hypertension (Pah). 2,10 Axerion Therapeutics Inc. has reticulon 4 receptor (rtn4r; ngr) decoys that bind nOgO and two other ngr ligands in preclinical development to treat spinal cord injury (sci).