Abstract 13476: ROR2 Deficiency is Associated With Endothelial Dysfunction and Reduced Angiogenesis in Pulmonary Arterial Hypertension

Abstract

Introduction: Pulmonary arterial hypertension (PAH) is characterized by endothelial dysfunction and progressive loss of lung microvessels. Our group has shown that Wnt pathways are critical for pulmonary angiogenesis but the role of the Wnt/planar cell polarity specific receptor ROR2 in lung endothelial angiogenic responses is unknown. Hypothesis: We hypothesized that ROR2 is required for proper angiogenic responses in pulmonary microvascular endothelial cells (PMVECs) and its loss contributes to endothelial dysfunction in PAH. Methods and Results: Analysis of PAH lung tissues demonstrated reduced ROR2 expression within vascular lesions and in explanted PMVECs. ROR2 deficiency was associated with reduced proliferation and tube formation in response to VEGF-A, a major inducer of angiogenesis. We found that ROR2 promotes VEGF receptor 2 activation via direct phosphorylation of cytoplasmic residues (Y1175/Y951) and that restoring ROR2 expression in PAH PMVECs led to improved angiogenic responses. Besides angiogenic sprouting, we found that ROR2 is required for lung endothelial barrier formation by promoting the assembly of mature focal adhesions and adherens junctions through activation of Src and focal adhesion kinase (FAK). Compared to wild-type controls, endothelial-specific ROR2 knockout (ROR2 ECKO) mice demonstrated more severe hemodynamics, small vessel loss, and muscularization in chronic hypoxia. Moreover, ROR2 ECKO demonstrated severe RV dysfunction associated with reduced capillary density. We validated these findings in samples of decompensated RV tissue from PAH patients, monocrotaline, and Sugen-hypoxia rats which also demonstrated a significant reduction of ROR2 expression that correlated with RV capillary loss. Conclusion: ROR2 plays a protective role in the pulmonary and RV circulations and its loss prevents vessel repair in PAH. Targeting ROR2 could promote recovery of small vessel loss and RV adaptation in PAH.