Article Text

Contribution of inflammation to the pathology of idiopathic pulmonary arterial hypertension in children
  1. S Hall1,
  2. P Brogan1,
  3. S G Haworth2,
  4. N Klein1
  1. 1
    Infectious Diseases and Microbiology, Institute of Child Health, London, UK
  2. 2
    Department of Cardiology, Great Ormond Street Hospital for Children, London, UK
  1. Correspondence to Dr S Hall, Infectious Diseases and Microbiology, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; s.hall{at}


Idiopathic pulmonary arterial hypertension (IPAH) is an incurable disease of multifactorial origin. Inflammation is frequently observed in IPAH, but its role in the pathobiology is unclear. In this study the distribution, nature and number of inflammatory cells in periarterial infiltrates in lungs of children with IPAH, pulmonary arterial hypertension associated with congenital heart disease (APAH) and in normal lung tissue were characterised and compared using immunohistochemistry The influence of treatment with combined prostacyclin and endothelin receptor blockers was also studied. In children with IPAH, both treated and untreated, but not in children with APAH or normal children, extensive periarterial infiltrates were present comprising macrophages and T lymphocytes with S100A4- and bone morphogenetic protein receptor type-2 (BMPR2)-positive cells. Although rarely co-expressing macrophage-specific antigens, BMPR2-positive cells were frequently closely associated with macrophages and lymphocytes. They were more abundant around peripheral arteries of children with IPAH than in APAH or normal lungs (15.1 (3.5), 2.3 (0.9) and 2.3 (0.9) cells/mm external elastic lamina, respectively; p<0.01 for IPAH vs APAH or normal lungs). Prostacyclin with endothelin receptor blockade resulted in a significant reduction in endothelial cell activation as indicated by human leucocyte antigen (HLA)-DR expression (treated 17% vs untreated 100%, p<0.002). This study shows that pulmonary inflammation is present in the lungs of children with IPAH. This may indicate a role for inflammation in the pathobiology of IPAH and provide the rationale for novel therapeutic intervention.

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  • ▸ Additional figures showing expression of CD3 and S100 and of co-localisation of BMPR2 with inflammatory markers are published online only at

  • Competing interests SGH has acted as a consultant and received unrestricted educational grants from Actelion, Encysive Pharmaceuticals, GlaxoSmithKline and Pfizer. SH,PB and NK have no conflicts of interest.

  • Ethics approval All tissue samples were used with the permission of the Local Research Ethics Committee of Great Ormond Street Hospital for Children (REC 05/Q0508/49) and, additionally, the explanted tissue was used with the explicit informed consent from the parents.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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