Neuroblastoma Suppressor of Tumorigenicity 1 Mediates Endothelial-to-Mesenchymal Transition in Pulmonary Arterial Hypertension Related to Congenital Heart Disease

Endothelial-to-mesenchymal transition (EndMT) plays a critical role in the flow-induced vascular remodeling process, such as pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). NBL1 (neuroblastoma suppressor of tumorigenicity 1) is a secreted glycoprotein that has been implicated in CHD–PAH by aggravating the phenotypic transformation of smooth muscle cells. However, the underlying mechanisms regarding the interplay between NBL1 and endothelial cells in CHD–PAH remain to be fully elucidated. Thus, we aimed to identify the potential effect of NBL1 on EndMT using a novel flow-associated PAH model with Nbl1 knockout rats. The phenotype of EndMT was detected using RNA sequencing and further examined using western blotting and immunostaining of pulmonary arteries. Our observations demonstrated that the novel strategy of Nbl1 knockout effectively attenuated flow-associated PAH through downregulation of EndMT to some extent. Mechanistic experiments were established on human pulmonary artery endothelial cells to confirm that EndMT was induced by NBL1 in vitro. After 7 days’ stimulation with NBL1, concentrations of EndMT-related biomarkers and downstream transcription factors were quantified using RNA sequencing, western blotting, and immunocytochemistry. Both in vitro and in vivo experiments supported the imbalance of increased TGF-β (transforming growth factor-β) and dysregulation of BMP (bone morphogenetic protein) signaling by NBL1. Blocking the canonical TGF-β pathway efficiently preserved endothelial function upon NBL1 stimulation. These data suggested that NBL1 aggravated flow-associated PAH by inducing EndMT via the TGF-β and BMP signaling pathway. Thus, antagonizing NBL1 and rebalancing TGF-β and BMP signaling may be a suitable therapeutic target for CHD–PAH.

Correspondence and requests for reprints should be addressed to Xiangbin Pan, M.D., Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. E-mail:
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Supported by National Natural Science Foundation of China grants 81670289 and 81970444, The Fundamental Research Funds for the Central Universities grant 2019PT350005, Beijing Municipal Science and Technology Project grant Z201100005420030, and National high level talents special support plan grant 2020-RSW02.

Author Contributions: B.W., R.P., Y.X., X.H., Q.W., and X.P. designed the study. B.W., R.P., P.K., Z.L., Y.L., and W.O. performed experiments. B.W., P.K., and Z.L. performed data collection and analysis. B.W., R.P., and W.O. drafted the manuscript. Y.X., X.H., Q.W., and X.P. edited and revised the manuscript. All authors have read and approved final version of the manuscript.

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Originally Published in Press as DOI: 10.1165/rcmb.2022-0157OC on September 28, 2022.

Author disclosures are available with the text of this article at www.atsjournals.org.

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