Abstract 18578: BMP9 Regulates Endothelial Expression of Mediators of Pulmonary Vascular Remodeling

Abstract

Background: Loss-of-function mutations in GDF2 /BMP9 are found in heritable pulmonary arterial hypertension (PAH), suggesting a protective role, while protective or pathogenic effects are found in experimental PAH studies depending on context. The net contribution of BMP9 in PAH thus remains controversial. Hypothesis: BMP9 regulates the secretome of pulmonary microvascular endothelium (PMVEC) to contribute to pulmonary artery smooth muscle cell (PASMC) phenotype modulation. Methods: We tested recombinant BMP9, BMP9/BMP10 trap ALK1-Fc, and BMP9 neutralizing antibody before and after development of pulmonary hypertension (PH) in distinct experimental models. We analyzed the impact of BMP9 on the PMVEC transcriptome, intersection with human and experimental PAH lung transcriptomes, and tested the impact of EC-derived genes on PASMC phenotype and growth. Results: ALK1-Fc and anti-BMP9 prevented or reversed experimental PH administered before or after onset of experimental PH. Recombinant disulfide-linked BMP9 was not protective in SUGEN/Hypoxia (SU-Hx)- or monocrotaline (MCT)-induced experimental PH, in contrast to previous studies using incompletely disulfide-linked BMP9, suggesting dissociated monomers might function as competitive BMP9 antagonists. Consistent with this interpretation, BMP9 upregulated PMVEC genes associated with pulmonary vascular remodeling in experimental and human PAH including CXCL12, IGFBP4, ET-1, VEGF-A, and PDGF-BB. Stimulation of PMVEC with BMP9 induced a contractile phenotype ( CNN1;TAGLN ) in co-cultured PASMC. Administration of ALK1-Fc or anti-BMP9 attenuated expression of several of these growth factors in SU-Hx PH. In experimental PH ALK1-Fc and ACTRIIA-Fc elicited peripheral edema, a phenotype associated with use of ALK1-Fc in human trials. Conclusions: BMP9 contributes to experimental PH by regulating expression of EC-derived molecules modulating PASMC growth and phenotype. In contrast to broad strategies that inhibit BMP9 and BMP10 associated with HHT mimicry in clinical trials and rodent PH models, treatment with anti-BMP9 was well-tolerated. Selective antagonism of BMP9 represents a potential therapeutic strategy for human PAH.