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2014 ; 130
(14
): 1179-91
Nephropedia Template TP
Lathen C
; Zhang Y
; Chow J
; Singh M
; Lin G
; Nigam V
; Ashraf YA
; Yuan JX
; Robbins IM
; Thistlethwaite PA
Circulation
2014[Sep]; 130
(14
): 1179-91
PMID25062690
show ga
BACKGROUND: Pulmonary veno-occlusive disease is caused by excessive cell
proliferation and fibrosis, which obliterate the lumen of pulmonary venules,
leading to pulmonary hypertension, right ventricular failure, and death. This
condition has no effective treatment and a 5-year survival of <5%. Understanding
the mechanism of this disease and designing effective therapies are urgently
needed. METHODS AND RESULTS: We show that mice with homozygous deletion of the
Ets transcription factor Erg die between embryonic day 16.5 and 3 months of age
as a result of pulmonary veno-occlusive disease, capillary hemorrhage, and
pancytopenia. We demonstrate that Erg binds to and serves as a transcriptional
activator of the G-protein-coupled receptor gene Aplnr, the expression of which
is uniquely specific for venous endothelium and that knockout of either Erg or
Aplnr results in pulmonary venule-specific endothelial proliferation in vitro. We
show that mice with either homozygous-global or endothelium-directed deletion of
Aplnr manifest pulmonary veno-occlusive disease and right heart failure,
detectable at 8 months of age. Levels of pulmonary ERG and APLNR in patients with
pulmonary veno-occlusive disease undergoing lung transplantation were
significantly lower than those of control subjects. CONCLUSIONS: Our results
suggest that ERG and APLNR are essential for endothelial homeostasis in venules
in the lung and that perturbation in ERG-APLNR signaling is crucial for the
development of pulmonary veno-occlusive disease. We identify this pathway as a
potential therapeutic target for the treatment of this incurable disease.