Pulmonary hypertension is a severe and progressive disease, a key feature of which is pulmonary vascular remodeling. Several growth factors, including EGF, PDGF, and TGF-β1, are involved in pulmonary vascular remodeling during pulmonary hypertension. However, increased knowledge of the downstream signaling cascades is needed if effective clinical interventions are to be developed. In this context, calpain provides an interesting candidate therapeutic target, since it is activated by EGF and PDGF and has been reported to activate TGF-β1. Thus, in this study, we examined the role of calpain in pulmonary vascular remodeling in two rodent models of pulmonary hypertension. These data showed that attenuated calpain activity in calpain-knockout mice or rats treated with a calpain inhibitor resulted in prevention of increased right ventricular systolic pressure, right ventricular hypertrophy, as well as collagen deposition and thickening of pulmonary arterioles in models of hypoxia-and monocrotaline-induced pulmonary hypertension. Additionally, inhibition of calpain in vitro blocked intracellular activation of TGF-β1, which led to attenuated Smad2/3 phosphorylation and collagen synthesis. Finally, smooth muscle cells of pulmonary arterioles from patients with pulmonary arterial hypertension showed higher levels of calpain activation and intracellular active TGF-β. Our data provide evidence that calpain mediates EGF-and PDGF-induced collagen synthesis and proliferation of pulmonary artery smooth muscle cells via an intracrine TGF-β1 pathway in pulmonary hypertension.
IntroductionPulmonary hypertension is a severe and progressive disease characterized by increased pulmonary vascular resistance leading to right heart failure and death (1-3). Pulmonary vascular remodeling is an important common pathological feature of all categories of pulmonary hypertension. Accumulation of extracellular matrix, including collagen, and vascular smooth muscle cell proliferation and hypertrophy contribute to medial hypertrophy and muscularization, leading to obliteration of precapillary pulmonary arteries and sustained elevation of pulmonary arterial pressure (3, 4).Several growth factors, including EGF, PDGF, and TGF-β1, participate in the process of pulmonary vascular remodeling in patients with pulmonary hypertension and in animal models (2,(5)(6)(7)(8). For example, expression of EGF or its receptor EGFR are increased in animal models of monocrotaline-(MCT-) and hypoxia-induced pulmonary hypertension and in humans with pulmonary hypertension (8-10). Blockade of EGFR results in reductions in pulmonary pressure, right ventricular hypertrophy, and distal arterial muscularization in MCT-induced pulmonary hypertension (11). Moreover, PDGF and its receptor are upregulated in pulmonary arteries of patients with pulmonary hypertension (12, 13) and rodents exposed to chronic hypoxia and MCT (7,14,15). PDGF receptor antagonists not only prevent, but also reverse, increased