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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, RESULTS. Meshes: Animals, Antihypertensive Agents, Binding Sites, Bone Morphogenetic Protein 4, Bone Morphogenetic Protein Receptors, Type II, Bone Morphogenetic Proteins, Cell Proliferation, Cells, Cultured, Cyclic GMP, Cyclic GMP-Dependent Protein Kinase Type I, Disease Models, Animal, Dose-Response Relationship, Drug, Familial Primary Pulmonary Hypertension, Humans, Hypertension, Pulmonary, Inhibitor of Differentiation Protein 1, Male, Monocrotaline, Muscle, Smooth, Vascular, Mutation, Myocytes, Smooth Muscle, Phosphodiesterase 5 Inhibitors, Phosphorylation, Piperazines, Promoter Regions, Genetic, Pulmonary Artery, Purines, RNA Interference, Rats, Rats, Sprague-Dawley, Signal Transduction, Sildenafil Citrate, Smad1 Protein, Smad5 Protein, Sulfones, Transfection, Vasodilator Agents.
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Does sildenafil potentiate bone morphogenetic protein signaling in pulmonary arterial smooth muscle cells and in experimental pulmonary hypertension? Context: Mutations in the bone morphogenetic protein type II receptor (BMPR-II) are responsible for the majority of cases of heritable pulmonary arterial hypertension (PAH), and BMPR-II deficiency contributes to idiopathic and experimental forms of PAH. Sildenafil, a potent type-5 nucleotide-dependent phosphodiesterase inhibitor, is an established treatment for PAH, but whether sildenafil affects bone morphogenetic protein (BMP) signaling in the pulmonary circulation remains unknown. Studies were undertaken in human pulmonary arterial smooth muscle cells (PASMCs) and in vivo in the monocrotaline rat model of PAH. In PASMCs, sildenafil enhanced BMP4-induced phosphorylation of Smad1/5, Smad nuclear localization, and Inhibitor of DNA binding protein 1 gene and protein expression. This effect was mimicked by 8-bromo-cyclic GMP. Pharmacological inhibition or small interfering RNA knockdown of cyclic GMP-dependent protein kinase I inhibited the effect of sildenafil on BMP signaling. In functional studies, we observed that sildenafil potentiated the antiproliferative effects of BMP4 on PASMC proliferation. Furthermore, sildenafil restored the antiproliferative response to BMP4 in PASMCs harboring mutations in BMPR-II. In the monocrotaline rat model of PAH, which is characterized by BMPR-II deficiency, sildenafil prevented the development of pulmonary hypertension and vascular remodeling, and partly restored Smad1/5 phosphorylation and Inhibitor of DNA binding protein 1 gene expression in vivo in monocrotaline exposed rat lungs.
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Sildenafil enhances canonical BMP signaling via cyclic GMP and cyclic GMP-dependent protein kinase I in vitro and in vivo, and partly restores deficient BMP signaling in BMPR-II mutant PASMCs. Our findings demonstrate a novel mechanism of action of sildenafil in the treatment of PAH and suggest that targeting BMP signaling may be beneficial in this disease. Final Decision: yes