Wedgwood S, Lakshminrusimha S, Schumacker PT, Steinhorn RH. Cyclic stretch stimulates mitochondrial reactive oxygen species and Nox4 signaling in pulmonary artery smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 309: L196 -L203, 2015. First published May 29, 2015 doi:10.1152/ajplung.00097.2014.-This study was designed to determine whether cyclic stretch induces a persistent pulmonary hypertension of the newborn (PPHN) phenotype of increased NADPH oxidase (Nox) 4 signaling in control pulmonary artery smooth muscle cells (PASMC), and to identify the signal transduction molecules involved. To achieve this, PPHN was induced in lambs by antenatal ligation of the ductus arteriosus at 128 days gestation. After 9 days, lungs and PASMC were isolated from control (twin) and PPHN lambs. Control PASMC were exposed to cyclic stretch at 1 Hz and 15% elongation for 24 h. Stretch-induced Nox4 expression was attenuated by inhibition of mitochondrial complex III and NF-B, and stretch-induced protein thiol oxidation was attenuated by Nox4 small interfering RNA and complex III inhibition. NF-B activity was increased by stretch in a complex III-dependent fashion, and stretch-induced cyclin D1 expression was attenuated by complex III inhibition and Nox4 small interfering RNA. This is the first study to show that cyclic stretch increases Nox4 expression via mitochondrial complex III-induced activation of NF-B in fetal PASMC, resulting in ROS signaling and increased cyclin D1 expression. Targeting these signaling molecules may attenuate pulmonary vascular remodeling associated with PPHN. pulmonary hypertension; reactive oxygen species; NADPH oxidase AT BIRTH, PULMONARY VASCULAR resistance must rapidly decrease, to allow pulmonary blood flow to increase 10-fold and establish the lung as the organ of gas exchange. This fetal-tonewborn transition is regulated by complex physiological and biochemical processes, which are necessary to promote pulmonary artery (PA) vasodilation. Abnormalities in the transition at birth produce persistent pulmonary hypertension of the newborn (PPHN), a life-threatening clinical disorder of newborn infants (41). PPHN is characterized by elevated pulmonary vascular resistance (PVR), right-to-left extrapulmonary shunting of deoxygenated blood, and life-threatening hypoxemia. Pathological findings include pulmonary vascular remodeling and smooth muscle hyperplasia (20), and the severity of the disease correlates with the extent of vascular remodeling. However, the abnormal in utero events that trigger the development of PPHN are poorly understood.A lamb model involving antenatal ligation of the ductus arteriosus followed by delivery at near-term gestation has been used to simulate PPHN. These newborn lambs display pulmonary vascular remodeling, increased PA pressure, and other physiological changes consistent with clinical PPHN (33, 52). Ductal ligation initially induces a large increase in pulmonary blood flow followed by a return to baseline flow while PA pressure remains high (1). In vivo experiments s...