Introduction Elevated levels of inflammatory cytokines are associated with idiopathic and heritable pulmonary hypertension (PAH) and predict mortality, but their role in the pathobiology of PAH and the underlying mechanisms remain unclear. We investigated whether loss of bone morphogenetic protein receptor type II (BMPR-II), the underlying cause of heritable PAH, predisposes to increased inflammatory cytokine expression and pulmonary vascular remodelling.

Methods Regulation of cytokine expression by lipopolysaccharide (LPS) was studied in two in vitro models: (1) mouse pulmonary artery smooth muscle cells (PASMCs) heterozygous for a null allele in bmpr2 (BMPR2±), and (2) human PASMCs with a mutation in BMPR2 (BMPR2mut) and their wild-type counterparts. Cytokine production, regulation and effects on the pulmonary vascular system were examined in an in vivo model using the bmpr2± mouse.

Results Both mouse and human in vitro models showed that loss of BMPR2 function leads to increased mRNA expression and secretion of interleukin 6 and IL-8 both at baseline and after stimulation with LPS. This was associated with loss of expression of antioxidant enzymes such as superoxide dismutase 1 (SOD1) and SOD3, which is demonstrable in both mouse bmpr2± and human BMPR2mut cells. Treatment with the superoxide dismutase-mimetic, Tempol, partially reversed the exaggerated cytokine response to LPS but did not affect the underlying baseline increase. We demonstrated increased phospho-Stat3 signalling and pro-proliferative and pro-survival effects of IL-6 in BMPR2mut PASMCs which is not seen in the wild-type. This was confirmed in the in vivo model, as bmpr2± mice demonstrated increased IL-6 and IL-8 expression in sera, lung and liver tissue 3 and 24 h after exposure to 10 μg of LPS. A similar pattern of antioxidant enzyme reduction was also seen in lung tissue from these LPS-treated bmpr2± mice.

Conclusions Loss of BMPR-II predisposes to both an abnormal increase in IL-6 and IL-8 after stimulation with LPS and a dysfunctional response to these cytokines in PASMCs and mice. The mechanism for this involves loss of antioxidant function. This abnormal response may underlie the additional lung-specific trigger that promotes the development of PAH in patients with BMPR-II mutations, and may represent a target for future therapeutic interventions.