Circ Res. 2019 Apr 26.
RATIONALE: Arterial remodeling, a hallmark of many cardiovascular pathologies including pulmonary arterial hypertension (PAH), is regulated by TGFβ1-TGFβ receptors and the antagonistic, vasoprotective BMPR2-PPARγ axis. However, it is unclear which factors drive detrimental TGFβ1 pathways in the hypertensive pulmonary vasculature.OBJECTIVE: We hypothesized that LDL receptor-related protein1 (LRP1) expression is decreased in PAH, leading to enhancement (disinhibition) of TGFβ1 signals, and that the PPARγ agonist pioglitazone can restore vascular homeostasis and prevent PAH resulting from LRP1 deletion in vascular smooth muscle cells (VSMC).
METHODS AND RESULTS: Targeted deletion of LRP1 in VSMC (smLRP1-/-) in mice disinhibited TGFβ1-CTGF signaling, leading to spontaneous PAH and distal pulmonary arterial muscularization as assessed by closed-chest cardiac catheterization and anti-αSMA staining. Pioglitazone inhibited the canonical TGFβ1-CTGF axis in human pulmonary artery SMC (HPASMC) and smLRP1-/- main pulmonary artery (CTGF, NOX4), and reversed PAH in smLRP1-/- mice. TGFβ1 boosted pSmad3 in PASMC from smLRP1-/- mice vs. controls. Pioglitazone-activated PPARγ binds to Smad3 in HPASMC (co-immunoprecipitation), thereby blocking its phosphorylation and overriding LRP1 deficiency. Finally, mRNA and protein expression of LRP1 was decreased in pulmonary plexiform lesions of patients with endstage idiopathic PAH (laser capture microdissection, qPCR, immunoblotting). Downregulation of LRP1 protein was also demonstrated in explanted PASMC from PAH patients and accompanied by enhanced TGFβ1-pSmad3-CTGF signaling and increased TGFβ1-induced PASMC proliferation that was prevented by pioglitazone.
CONCLUSIONS: Here, we identify LRP1 as an integrator of TGFβ1-mediated mechanisms that regulate vascular remodeling in mice and clinical PAH, and PPARγ as a therapeutic target that controls canonical TGFβ1 pathways. Hence, pharmacological PPARγ activation represents a promising new therapy for PAH patients who lack the vasoprotective LRP1 in VSMC.
Keywords: LDL receptor-related protein 1; LRP1; TGF-beta 1; vascular biology; vascular disease