Novel Targets of Drug Treatment for Pulmonary Hypertension

Am J Cardiovasc Drugs. 2015 Aug;15(4):225-34. doi: 10.1007/s40256-015-0125-4.

Abstract

Biomedical advances over the last decade have identified the central role of proliferative pulmonary arterial smooth muscle cells (PASMCs) in the development of pulmonary hypertension (PH). Furthermore, promoters of proliferation and apoptosis resistance in PASMCs and endothelial cells, such as aberrant signal pathways involving growth factors, G protein-coupled receptors, kinases, and microRNAs, have also been described. As a result of these discoveries, PH is currently divided into subgroups based on the underlying pathology, which allows focused and targeted treatment of the condition. The defining features of PH, which subsequently lead to vascular wall remodeling, are dysregulated proliferation of PASMCs, local inflammation, and apoptosis-resistant endothelial cells. Efforts to assess the relative contributions of these factors have generated several promising targets. This review discusses recent novel targets of therapies for PH that have been developed as a result of these advances, which are now in pre-clinical and clinical trials (e.g., imatinib [phase III]; nilotinib, AT-877ER, rituximab, tacrolimus, paroxetine, sertraline, fluoxetine, bardoxolone methyl [phase II]; and sorafenib, FK506, aviptadil, endothelial progenitor cells (EPCs) [phase I]). While substantial progress has been made in recent years in targeting key molecular pathways, PH still remains without a cure, and these novel therapies provide an important conceptual framework of categorizing patients on the basis of molecular phenotype(s) for effective treatment of the disease.

Publication types

  • Review

MeSH terms

  • Clinical Trials as Topic
  • Endothelial Progenitor Cells / physiology
  • Humans
  • Hypertension, Pulmonary / drug therapy*
  • Hypertension, Pulmonary / metabolism
  • Hypertension, Pulmonary / pathology
  • Immunosuppressive Agents / pharmacology*
  • MicroRNAs / pharmacology*
  • Myocytes, Smooth Muscle / drug effects
  • Myocytes, Smooth Muscle / metabolism
  • Protein Kinase Inhibitors / pharmacology*
  • Pulmonary Artery / metabolism
  • Pulmonary Artery / pathology
  • Selective Serotonin Reuptake Inhibitors / pharmacology*
  • Signal Transduction / drug effects
  • Therapies, Investigational / classification
  • Therapies, Investigational / methods
  • Vascular Remodeling / drug effects*

Substances

  • Immunosuppressive Agents
  • MicroRNAs
  • Protein Kinase Inhibitors
  • Serotonin Uptake Inhibitors