Abstract

Despite recent improvements in management of idiopathic pulmonary arterial hypertension, mortality remains high. Understanding the alterations in the transcriptome–phenotype of the key lung cells involved could provide insight into the drivers of pathogenesis. In this study, we examined differential gene expression of cell types implicated in idiopathic pulmonary arterial hypertension from lung explants of patients with idiopathic pulmonary arterial hypertension compared to control lungs. After tissue digestion, we analyzed all cells from three idiopathic pulmonary arterial hypertension and six control lungs using droplet-based single cell RNA-sequencing. After dimensional reduction by t-stochastic neighbor embedding, we compared the transcriptomes of endothelial cells, pericyte/smooth muscle cells, fibroblasts, and macrophage clusters, examining differential gene expression and pathways implicated by analysis of Gene Ontology Enrichment. We found that endothelial cells and pericyte/smooth muscle cells had the most differentially expressed gene profile compared to other cell types. Top differentially upregulated genes in endothelial cells included novel genes: ROBO4, APCDD1, NDST1, MMRN2, NOTCH4, and DOCK6, as well as previously reported genes: ENG, ORAI2, TFDP1, KDR, AMOTL2, PDGFB, FGFR1, EDN1, and NOTCH1. Several transcription factors were also found to be upregulated in idiopathic pulmonary arterial hypertension endothelial cells including SOX18, STRA13, LYL1, and ELK, which have known roles in regulating endothelial cell phenotype. In particular, SOX18 was implicated through bioinformatics analyses in regulating the idiopathic pulmonary arterial hypertension endothelial cell transcriptome. Furthermore, idiopathic pulmonary arterial hypertension endothelial cells upregulated expression of FAM60A and HDAC7, potentially affecting epigenetic changes in idiopathic pulmonary arterial hypertension endothelial cells. Pericyte/smooth muscle cells expressed genes implicated in regulation of cellular apoptosis and extracellular matrix organization, and several ligands for genes showing increased expression in endothelial cells. In conclusion, our study represents the first detailed look at the transcriptomic landscape across idiopathic pulmonary arterial hypertension lung cells and provides robust insight into alterations that occur in vivo in idiopathic pulmonary arterial hypertension lungs.

Highlights

  • Idiopathic pulmonary arterial hypertension (IPAH) is a disease characterized by excessive pulmonary vasoconstriction and pathologic remodeling of small pulmonary arterioles

  • All IPAH patients were on a phosphodiesterase-5 inhibitor and a prostacyclin analog, and two patients were on an endothelin antagonist

  • Comparing transcriptomic profiles of different cell types in healthy and IPAH lungs by scRNA-seq, we found that endothelial cells (ECs) and pericyte/SMCs displayed the most differentially expressed genes between IPAH and normal lungs compared to other cell types

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Summary

Introduction

Idiopathic pulmonary arterial hypertension (IPAH) is a disease characterized by excessive pulmonary vasoconstriction and pathologic remodeling of small pulmonary arterioles. These changes, in turn, lead to increased intravascular pressures in lung and right ventricular dysfunction. Advances in understanding of IPAH pathogenesis in the last 25 years has led to development of targeted therapies and associated improvement in survival rates in IPAH.[1] These current targeted treatments include prostacyclin analogs that increase. Despite recent improvements in management, IPAH remains a devastating disease.[2] understanding IPAH pathogenesis is critical to facilitate development of novel approaches to therapy in the near future

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