骨形态发生蛋白9在门静脉性肺动脉高压中的作用机制
DOI: 10.3969/j.issn.1001-5256.2022.03.037
-
摘要: 门静脉性肺动脉高压(POPH)是在门静脉高压基础上出现的肺动脉压力升高。骨形态发生蛋白9(BMP9) 作为BMP家族成员之一,除了具有成骨活性外,还具有保护内皮完整性及维持血管稳态的作用。本文通过回顾POPH发病机制、BMP9生理表达及作用,以及BMP9信号通路及其参与肺动脉高压肺血管重塑的相关研究进展,探讨其成为POPH新型生物标志物的可能,进而协助POPH诊断。Abstract: Portopulmonary hypertension (POPH) is an increase in pulmonary artery pressure that occurs on the basis of portal hypertension. As a member of the BMP family, bone morphogenetic protein 9 (BMP9) not only has the osteogenic activity, but can also protect endothelial integrity and maintain vascular homeostasis. This article reviews the pathogenesis of POPH, the physiological expression and role of BMP9, and related research advances in the BMP9 signaling pathway and its involvement in pulmonary hypertension and vascular remodeling, thereby exploring the possibility of BMP9 as a new biomarker for POPH to assist in the diagnosis of POPH.
-
图 1 BMP9结构[5]
注:BMP9合成429个氨基酸前体,包含22个信号肽,297个前结构域和110个成熟蛋白,该前体被丝氨酸内切蛋白酶切割产生成熟蛋白质二聚体,该二聚体与两个前结构域保持非共价结合,形成100 kD复合物。
-
[1] TUDER RM, ARCHER SL, DORFMVLLER P, et al. Relevant issues in the pathology and pathobiology of pulmonary hypertension[J]. J Am Coll Cardiol, 2013, 62(25 Suppl): D4-D12. DOI: 10.1016/j.jacc.2013.10.025. [2] THENAPPAN T, ORMISTON ML, RYAN JJ, et al. Pulmonary arterial hypertension: Pathogenesis and clinical management[J]. BMJ, 2018, 360: j5492. DOI: 10.1136/bmj.j5492. [3] EVANS JD, GIRERD B, MONTANI D, et al. BMPR2 mutations and survival in pulmonary arterial hypertension: An individual participant data meta-analysis[J]. Lancet Respir Med, 2016, 4(2): 129-137. DOI: 10.1016/S2213-2600(15)00544-5. [4] XU XQ, JING ZC. The 6th world symposium on pulmonary hypertension: Focus on updates on definition and clinical classification of pulmonary hypertension[J]. Med J Peking Union Med Coll Hosp, 2018, 9(3): 197-201. DOI: 10.3969/j.issn.1674-9081.2018.03.002.徐希奇, 荆志成. 第六届世界肺高血压会议: 聚焦肺高血压定义与诊断分类更新[J]. 协和医学杂志, 2018, 9(3): 197-201. DOI: 10.3969/j.issn.1674-9081.2018.03.002. [5] BIDART M, RICARD N, LEVET S, et al. BMP9 is produced by hepatocytes and circulates mainly in an active mature form complexed to its prodomain[J]. Cell Mol Life Sci, 2012, 69(2): 313-324. DOI: 10.1007/s00018-011-0751-1. [6] LIU YJ, LI T. An excerpt of international liver transplant society Practice guidelines: Diagnosis and management of hepatopulmonary hypertension[J]. J Clin Hepatol, 2016, 32(10): 1838-1842. DOI: 10.3969/j.issn.1001-5256.2020.01.051.刘以俊, 李涛. 《2016年国际肝移植学会实践指南: 肝肺综合征与门脉性肺动脉高压的诊断与管理》摘译[J]. 临床肝胆病杂志, 2016, 32(10): 1838-1842. DOI: 10.3969/j.issn.1001-5256.2020.01.051. [7] MANTZ FA Jr, CRAIGE E. Portal axis thrombosis with spontaneous portacaval shunt and resultant cor pulmonale[J]. AMA Arch Pathol, 1951, 52(1): 91-97. http://www.ncbi.nlm.nih.gov/pubmed/14837570 [8] BADESCH DB, RASKOB GE, ELLIOTT CG, et al. Pulmonary arterial hypertension: Baseline characteristics from the REVEAL Registry[J]. Chest, 2010, 137(2): 376-387. DOI: 10.1378/chest.09-1140. [9] MANCUSO L, SCORDATO F, PIERI M, et al. Management of portopulmonary hypertension: New perspectives[J]. World J Gastroenterol, 2013, 19(45): 8252-8257. DOI: 10.3748/wjg.v19.i45.8252. [10] SAVALE L, SATTLER C, COILLY A, et al. Long-term outcome in liver transplantation candidates with portopulmonary hypertension[J]. Hepatology, 2017, 65(5): 1683-1692. DOI: 10.1002/hep.28990. [11] RODRÍGUEZ-VILARRUPLA A, FERNÍNDEZ M, BOSCH J, et al. Current concepts on the pathophysiology of portal hypertension[J]. Ann Hepatol, 2007, 6(1): 28-36. http://www.annalsofhepatology.com/PDF/vol6n1/Hp071-05.pdf [12] SHENODA B, BOSELLI J. Vascular syndromes in liver cirrhosis[J]. Clin J Gastroenterol, 2019, 12(5): 387-397. DOI: 10.1007/s12328-019-00956-0. [13] RAEVENS S, GEERTS A, van STEENKISTE C, et al. Hepatopulmonary syndrome and portopulmonary hypertension: Recent knowledge in pathogenesis and overview of clinical assessment[J]. Liver Int, 2015, 35(6): 1646-1660. DOI: 10.1111/liv.12791. [14] TERAO M, TAKAKI A, MARUYAMA T, et al. Serum oxidative/anti-oxidative stress balance is dysregulated in potentially pulmonary hypertensive patients with liver cirrhosis: A case control study[J]. Intern Med, 2015, 54(22): 2815-2826. DOI: 10.2169/internalmedicine.54.4889. [15] MAIR KM, JOHANSEN AK, WRIGHT AF, et al. Pulmonary arterial hypertension: Basis of sex differences in incidence and treatment response[J]. Br J Pharmacol, 2014, 171(3): 567-579. DOI: 10.1111/bph.12281. [16] SEHGAL PB, YANG YM, MILLER EJ. Hypothesis: Neuroendocrine mechanisms (hypothalamus-growth hormone-STAT5 axis) contribute to sex bias in pulmonary hypertension[J]. Mol Med, 2015, 21(1): 688-701. DOI: 10.2119/molmed.2015.00122. [17] AL-NAAMANI N, KROWKA MJ, FORDE KA, et al. Estrogen signaling and portopulmonary hypertension: The pulmonary vascular complications of liver disease study (PVCLD2)[J]. Hepatology, 2021, 73(2): 726-737. DOI: 10.1002/hep.31314. [18] KAWUT SM, KROWKA MJ, TROTTER JF, et al. Clinical risk factors for portopulmonary hypertension[J]. Hepatology, 2008, 48(1): 196-203. DOI: 10.1002/hep.22275. [19] AUSTIN ED, LOYD JE. The genetics of pulmonary arterial hypertension[J]. Circ Res, 2014, 115(1): 189-202. DOI: 10.1161/CIRCRESAHA.115.303404. [20] International PPH Consortium, LANE KB, MACHADO RD, et al. Heterozygous germline mutations in BMPR2, encoding a TGF-beta receptor, cause familial primary pulmonary hypertension[J]. Nat Genet, 2000, 26(1): 81-84. DOI: 10.1038/79226. [21] DENG Z, MORSE JH, SLAGER SL, et al. Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor-Ⅱ gene[J]. Am J Hum Genet, 2000, 67(3): 737-744. DOI: 10.1086/303059. [22] NIKOLIC I, YUNG LM, YANG P, et al. Bone morphogenetic protein 9 is a mechanistic biomarker of portopulmonary hypertension[J]. Am J Respir Crit Care Med, 2019, 199(7): 891-902. DOI: 10.1164/rccm.201807-1236OC. [23] WANG RN, GREEN J, WANG Z, et al. Bone morphogenetic protein (BMP) signaling in development and human diseases[J]. Genes Dis, 2014, 1(1): 87-105. DOI: 10.1016/j.gendis.2014.07.005. [24] MILLER AF, HARVEY SA, THIES RS, et al. Bone morphogenetic protein-9. An autocrine/paracrine cytokine in the liver[J]. J Biol Chem, 2000, 275(24): 17937-17945. DOI: 10.1074/jbc.275.24.17937. [25] SCHARPFENECKER M, van DINTHER M, LIU Z, et al. BMP-9 signals via ALK1 and inhibits bFGF-induced endothelial cell proliferation and VEGF-stimulated angiogenesis[J]. J Cell Sci, 2007, 120(Pt 6): 964-972. DOI: 10.1242/jcs.002949. [26] DAVID L, MALLET C, MAZERBOURG S, et al. Identification of BMP9 and BMP10 as functional activators of the orphan activin receptor-like kinase 1(ALK1) in endothelial cells[J]. Blood, 2007, 109(5): 1953-1961. DOI: 10.1182/blood-2006-07-034124. [27] CONSTAM DB, ROBERTSON EJ. Regulation of bone morphogenetic protein activity by pro domains and proprotein convertases[J]. J Cell Biol, 1999, 144(1): 139-149. DOI: 10.1083/jcb.144.1.139. [28] BROWN MA, ZHAO Q, BAKER KA, et al. Crystal structure of BMP-9 and functional interactions with pro-region and receptors[J]. J Biol Chem, 2005, 280(26): 25111-25118. DOI: 10.1074/jbc.M503328200. [29] CHEN C, GRZEGORZEWSKI KJ, BARASH S, et al. An integrated functional genomics screening program reveals a role for BMP-9 in glucose homeostasis[J]. Nat Biotechnol, 2003, 21(3): 294-301. DOI: 10.1038/nbt795. [30] CHEN H, BRADY RIDGWAY J, SAI T, et al. Context-dependent signaling defines roles of BMP9 and BMP10 in embryonic and postnatal development[J]. Proc Natl Acad Sci U S A, 2013, 110(29): 11887-11892. DOI: 10.1073/pnas.1306074110. [31] LÓPEZ-COVIELLA I, BERSE B, KRAUSS R, et al. Induction and maintenance of the neuronal cholinergic phenotype in the central nervous system by BMP-9[J]. Science, 2000, 289(5477): 313-316. DOI: 10.1126/science.289.5477.313. [32] PARK JE, SHAO D, UPTON PD, et al. BMP-9 induced endothelial cell tubule formation and inhibition of migration involves Smad1 driven endothelin-1 production[J]. PLoS One, 2012, 7(1): e30075. DOI: 10.1371/journal.pone.0030075. [33] SHAO D, PARK JE, WORT SJ. The role of endothelin-1 in the pathogenesis of pulmonary arterial hypertension[J]. Pharmacol Res, 2011, 63(6): 504-511. DOI: 10.1016/j.phrs.2011.03.003. [34] UPTON PD, PARK J, de SOUZA PM, et al. Endothelial protective factors BMP9 and BMP10 inhibit CCL2 release by human vascular endothelial cells[J]. J Cell Sci, 2020, 133(14): jcs239715. DOI: 10.1242/jcs.239715. [35] CHEN X, ORRIOLS M, WALTHER FJ, et al. Bone morphogenetic protein 9 protects against neonatal hyperoxia-induced impairment of alveolarization and pulmonary inflammation[J]. Front Physiol, 2017, 8: 486. DOI: 10.3389/fphys.2017.00486. [36] HERRERA B, DOOLEY S, BREITKOPF-HEINLEIN K. Potential roles of bone morphogenetic protein (BMP)-9 in human liver diseases[J]. Int J Mol Sci, 2014, 15(4): 5199-5220. DOI: 10.3390/ijms15045199. [37] WIERCINSKA E, WICKERT L, DENECKE B, et al. Id1 is a critical mediator in TGF-beta-induced transdifferentiation of rat hepatic stellate cells[J]. Hepatology, 2006, 43(5): 1032-1041. DOI: 10.1002/hep.21135. [38] LONG L, ORMISTON ML, YANG X, et al. Selective enhancement of endothelial BMPR-Ⅱ with BMP9 reverses pulmonary arterial hypertension[J]. Nat Med, 2015, 21(7): 777-785. DOI: 10.1038/nm.3877. [39] ORMISTON ML, UPTON PD, LI W, et al. The promise of recombinant BMP ligands and other approaches targeting BMPR-Ⅱ in the treatment of pulmonary arterial hypertension[J]. Glob Cardiol Sci Pract, 2015, 2015(4): 47. DOI: 10.5339/gcsp.2015.47. [40] ATKINSON C, STEWART S, UPTON PD, et al. Primary pulmonary hypertension is associated with reduced pulmonary vascular expression of type Ⅱ bone morphogenetic protein receptor[J]. Circulation, 2002, 105(14): 1672-1678. DOI: 10.1161/01.cir.0000012754.72951.3d. [41] DAVID L, MALLET C, KERAMIDAS M, et al. Bone morphogenetic protein-9 is a circulating vascular quiescence factor[J]. Circ Res, 2008, 102(8): 914-922. DOI: 10.1161/CIRCRESAHA.107.165530. [42] MORRELL NW, BLOCH DB, TEN DIJKE P, et al. Targeting BMP signalling in cardiovascular disease and anaemia[J]. Nat Rev Cardiol, 2016, 13(2): 106-120. DOI: 10.1038/nrcardio.2015.156. [43] MA C, WANG H. Research progress of BMP9 and liver diseases[J]. Chin Pharmacol Bull, 2020, 36(8): 1045-1048. DOI: 10.3969/j.issn.1001-1978.2020.08.003.马翠, 王华. BMP9与肝脏疾病的研究进展[J]. 中国药理学通报, 2020, 36(8): 1045-1048. DOI: 10.3969/j.issn.1001-1978.2020.08.003. [44] WANG G, FAN R, JI R, et al. Novel homozygous BMP9 nonsense mutation causes pulmonary arterial hypertension: A case report[J]. BMC Pulm Med, 2016, 16: 17. DOI: 10.1186/s12890-016-0183-7. [45] HODGSON J, SWIETLIK EM, SALMON RM, et al. Characterization of GDF2 mutations and levels of BMP9 and BMP10 in pulmonary arterial hypertension[J]. Am J Respir Crit Care Med, 2020, 201(5): 575-585. DOI: 10.1164/rccm.201906-1141OC. [46] STAR GP, GIOVINAZZO M, LANGLEBEN D. Bone morphogenic protein-9 stimulates endothelin-1 release from human pulmonary microvascular endothelial cells: A potential mechanism for elevated ET-1 levels in pulmonary arterial hypertension[J]. Microvasc Res, 2010, 80(3): 349-354. DOI: 10.1016/j.mvr.2010.05.010. [47] CACOUB P, DORENT R, NATAF P, et al. Endothelin-1 in the lungs of patients with pulmonary hypertension[J]. Cardiovasc Res, 1997, 33(1): 196-200. DOI: 10.1016/s0008-6363(96)00189-7. [48] YOSHIBAYASHI M, NISHIOKA K, NAKAO K, et al. Plasma endothelin concentrations in patients with pulmonary hypertension associated with congenital heart defects. Evidence for increased production of endothelin in pulmonary circulation[J]. Circulation, 1991, 84(6): 2280-2285. DOI: 10.1161/01.cir.84.6.2280. [49] HONG C, CHEN HM, QI XL. Diagnosis and treatment strategies of portopulmonary hypertension[J]. Chin J Dig Surg, 2021, 20(10): 1042-1046. DOI: 10.3760/cma.j.cn115610-20210722-00359.洪城, 陈海明, 祁小龙. 门静脉高压相关性肺动脉高压的诊断与治疗策略[J]. 中华消化外科杂志, 2021, 20(10): 1042-1046. DOI: 10.3760/cma.j.cn115610-20210722-00359. [50] DUNMORE BJ, DRAKE KM, UPTON PD, et al. The lysosomal inhibitor, chloroquine, increases cell surface BMPR-Ⅱ levels and restores BMP9 signalling in endothelial cells harbouring BMPR-Ⅱ mutations[J]. Hum Mol Genet, 2013, 22(18): 3667-3679. DOI: 10.1093/hmg/ddt216. [51] TU L, DESROCHES-CASTAN A, MALLET C, et al. Selective BMP-9 inhibition partially protects against experimental pulmonary hypertension[J]. Circ Res, 2019, 124(6): 846-855. DOI: 10.1161/CIRCRESAHA.118.313356. [52] BOUVARD C, TU L, ROSSI M, et al. Different cardiovascular and pulmonary phenotypes for single-and double-knock-out mice deficient in BMP9 and BMP10[J]. Cardiovasc Res, 2021. DOI:10.1093/cvr/cvab187.[Online ahead of print]