Introduction: Right ventricular (RV) dysfunction is the leading cause of death in pulmonary arterial hypertension (PAH), but the molecular determinants of RV dysfunction are not well defined. In addition, most molecular evaluations of RV dysfunction use small animal models, and data from large animal models is sparse. Methods: Control and pulmonary artery banded (PAB) male piglets were subjected to cardiac MRI to quantify RV ejection fraction (EF), mass, and end systolic volume (ESV). Total RNA was isolated from RV free wall specimens and subjected to Next Gene RNAsequencing. RV mitochondrial enrichments were analyzed with quantitative mass spectrometry to define RV proteome changes. Bioinformatics analyses integrated transcriptomics, proteomics, and MRI data to identified pathways associated with RV dysfunction, hypertrophy, and volume. Results: Both transcriptomic and proteomic profiling revealed significantly different molecular signatures when comparing control to PAB piglets. Both analyses identified metabolism of lipids, lysosome, and mitochondrial fatty acid beta-oxidation pathways were associated with RVEF, while dilated cardiomyopathy, and arrhythmogenic RV cardiomyopathy pathways correlated with RV mass, and metabolism, metabolic pathways, citric acid cycle, and respiratory electron transport pathways were associated with RVESV. Fatty acid metabolism was identified on our analyses, and ferroptosis, a nonapoptotic form of cell death initiated by lipid peroxidation, was associated with RVESV and RV mass. Finally, in addition to coding genes we identified 72 lncRNAs that were strongly (r>|0.85|) associated with RVEF. Conclusions: A combined proteomics and transcriptomics analysis identified multiple lncRNAs and lipid metabolism pathways associated with pathological RV remodeling and RV function. Future studies are needed to define how modulation of these pathways could impact modulate RV size and function in large animal models.
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