Abstract

Vascular diseases including atherosclerosis, pulmonary hypertension (PH), or aortic aneurysm are characterized by vascular remodelling, inflammation, endothelial dysfunction and/or impaired vessel wall integrity. The goal is to discover pathogenic as well as protective signaling pathways and thus identify novel therapeutic strategies.We focus on class I PI 3-kinase isoforms, playing significant roles downstream of cell surface receptors in health and disease. Class I PI 3-kinase isoforms comprise a regulatory and one of four catalytic subunits (p110a, p110b, p110d, and p110g), respectively.
We showed that activation of p110a in smooth muscle cells (SMCs) is essential for pathogenic vascular remodelling in restenosis as well as in PH. Whereas p110a emerges as a disease promoting enzyme and thus a promising therapeutic target, recent projects unravel critical physiological functions of p110 isoforms in the vasculature.
Genetic inactivation of p110g worsens PH suggesting a rather protective role of this isoform. Exploring p110d in atherosclerotic mice, we unexpectedly found that lack of p110d in leukocytes led to enhanced plaque growth. This effect was completely rescued by injection of wild type Treg indicating important atheroprotective functions of p110d in Treg. A recent project focuses on the physiological role of p110a in the aortic wall.
Preliminary data suggest that p110a signalling maintains vascular integrity, while p110a deficiency in SMCs promotes aortic aneurysm formation. In conclusion, these data emphasize p110 isoforms as critical mediators of both protective and pathogenic processes in vascular diseases.

Figure 1

Clinical and Medical Relevance

Despite recent improvements, the morbidity and the mortality due to vascular diseases, remain unacceptably high. Particularly, atherosclerosis is the underlying cause of about 50% of all deaths in westernized societies. There are currently still no pharmacological strategies to causally treat vascular dysfunction. PI 3-kinase isoforms are expressed in all relevant cell types including SMCs, endothelial cells and leukocytes, where they induce significant protective as well as pathogenic signaling pathways. Elucidating these pathways in detail will provide promising new pharmacological targets.

Figure 2
  • Rosenkranz, S., Howard, L.S., Gomberg-Maitland, M., Hoeper, M.M. (2020). Systemic consequences of pulmonary hypertension and right-sided heart failure. Circulation, epub ahead of print.
  • Canepa M., Franssen, F.M.E., Olschewski, H., Lainscak, M., Böhm, M., Tavazzi, L., Rosenkranz S. (2019). Diagnostic and Therapeutic Gaps in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease. JACC Heart Fail10, 823-833.
  • Klinke, A., Berghausen, E.M., Friedrichs, K., Molz, S., Lau, D., Remane, L., Berlin, M., Kaltwasser, C., Adam, M., Mehrkens, D., Mollenhauer, M., Manchanda, K., Ravekes, T., Heresi, G., Aytekin, M., Dweik, R., Hennigs, J., Kubala, L., Michaelsson, E., Rosenkranz, S., Rudolph, T.K., Hazen, S.L., Klose, H., Schermuly, R.T., Rudolph, V., Baldus, S. (2018). Myeloperoxidase aggravates pulmonary arterial hypertension by activation of vascular Rho-kinase. JCI Insight 3, e97530.
  • Gerhardt, M.J., Marsh, J., Morrison, M., Kazlauskas, A., Khadka, A., Rosenkranz, S., De Angelis MM, Saint-Geniez M, Jacobo SMP. (2017). ER stress-induced aggresome trafficking of HtrA1 protects against proteotoxicity. J Mol Cell Biol9, 516-532.
  • Opitz, C.F., Hoeper, M.M., Gibbs, J.S.R., Kaemmerer, H., Pepke-Zaba, J., Coghlan, J.G., Scelsi, L., D’Alto, M., Olsson, K.M., Ulrich, S., Scholtz, W., Schulz, U., Grünig, E., Vizza, C.D., Staehler, G., Bruch, L., Huscher, D., Pittrow, D., Rosenkranz, S. (2016). Pre-capillary, combined, and post-capillary pulmonary hypertension: A pathophysiological continuum. J Am Coll Cardiol68, 368-378.
  • Rosenkranz, S., Gibbs, J.S.R., Wachter, R., De Marco, T., Vonk-Noordegraaf, A., Vachiéry J.L. (2016). Left ventricular heart failure and pulmonary hypertension. Eur Heart J 37, 942-954.
  • Vantler, M., Jesus, J., Leppänen, O., Scherner, M., Berghausen, E.M., Mustafov, L., Chen, X., Kramer, T., Zierden, M., Gerhardt, F., ten Freyhaus, H., Blaschke, F., Sterner-Kock, A., Baldus, S., Zhao J.J., Rosenkranz, S. (2015). Class IA PI3K isoform p110a mediates vascular remodeling. Arterioscler Thromb Vasc Biol35, 1434-1444.
  • Ten Freyhas, H., Berghausen, E.M., Janssen, W., Leuchs, M., Zierden, M., Murmann, K., Klinke, A., Vantler, M., Caglayan, E., Kramer, T., Baldus, S., Schermuly, R.T., Tallquist, M.D., Rosenkranz, S. (2015). Genetic ablation of PDGF-dependent signaling pathways abolishes vascular remodeling and experimental pulmonary hypertension. Arterioscler Thromb Vasc Biol  35, 1236-1245.
  • Croon M, Szczepanowska K, Popovic M, Lienkamp C, Senft K, Brandscheid CP, Bock T, Gnatzy-Feik L, Ashurov A, Acton RJ, Kaul H, Pujol C, Rosenkranz S, Kruger M, and Trifunovic A (2022). FGF21 modulates mitochondrial stress response in cardiomyocytes only under mild mitochondrial dysfunction. Sci Adv8, eabn7105. doi:10.1126/sciadv.abn7105.
  • Joseph C, Berghausen EM, Behringer A, Rauch B, Ten Freyhaus H, Gnatzy-Feik LL, Krause M, Wong DWL, Boor P, Baldus S, Vantler M, and Rosenkranz S (2022). Coagulation-independent effects of thrombin and factor Xa: role of protease-activated receptors in pulmonary hypertension. Cardiovasc Res. doi:10.1093/cvr/cvac004.
  • Task Force for the management of C-otESoC, Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, Gonzalez-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodriguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, and Williams B (2022). European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc Res118, 1385-1412. doi:10.1093/cvr/cvab342.
  • Hoeper MM, Dwivedi K, Pausch C, Lewis RA, Olsson KM, Huscher D, Pittrow D, Grunig E, Staehler G, Vizza CD, Gall H, Distler O, Opitz C, Gibbs JSR, Delcroix M, Park DH, Ghofrani HA, Ewert R, Kaemmerer H, Kabitz HJ, Skowasch D, Behr J, Milger K, Lange TJ, Wilkens H, Seyfarth HJ, Held M, Dumitrescu D, Tsangaris I, Vonk-Noordegraaf A, Ulrich S, Klose H, Claussen M, Eisenmann S, Schmidt KH, Swift AJ, Thompson AAR, Elliot CA, Rosenkranz S, Condliffe R, Kiely DG, and Halank M (2022). Phenotyping of idiopathic pulmonary arterial hypertension: a registry analysis. Lancet Respir Med. doi:10.1016/S2213-2600(22)00097-2.
  • Hoeper MM, Pausch C, Grunig E, Staehler G, Huscher D, Pittrow D, Olsson KM, Vizza CD, Gall H, Distler O, Opitz C, Gibbs JSR, Delcroix M, Ghofrani HA, Rosenkranz S, Park DH, Ewert R, Kaemmerer H, Lange TJ, Kabitz HJ, Skowasch D, Skride A, Claussen M, Behr J, Milger K, Halank M, Wilkens H, Seyfarth HJ, Held M, Dumitrescu D, Tsangaris I, Vonk-Noordegraaf A, Ulrich S, and Klose H (2022). Temporal trends in pulmonary arterial hypertension: results from the COMPERA registry. Eur Respir J59. doi:10.1183/13993003.02024-2021.
  • Hoeper MM, Pausch C, Olsson KM, Huscher D, Pittrow D, Grunig E, Staehler G, Vizza CD, Gall H, Distler O, Opitz C, Gibbs JSR, Delcroix M, Ghofrani HA, Ewert R, Kaemmerer H, Kabitz HJ, Skowasch D, Behr J, Milger K, Halank M, Wilkens H, Seyfarth HJ, Held M, Dumitrescu D, Tsangaris I, Vonk-Noordegraaf A, Ulrich S, Klose H, Claussen M, Eisenmann S, Schmidt KH, Rosenkranz S, and Lange TJ (2022). Prognostic value of improvement endpoints in pulmonary arterial hypertension trials: A COMPERA analysis. J Heart Lung Transplant41, 971-981. doi:10.1016/j.healun.2022.03.011.
  • Wissmuller M, Xanthouli P, Benjamin N, Grunig E, Richter MJ, Gall H, Ghofrani HA, Herkenrath S, Skowasch D, Pizarro C, Halank M, Hohmann C, Hellmich M, Gerhardt F, and Rosenkranz S (2022). Profiles and treatment patterns of patients with pulmonary arterial hypertension on monotherapy at experienced centres. ESC Heart Fail. doi:10.1002/ehf2.13804.
  • Berghausen EM, Janssen W, Vantler M, Gnatzy-Feik LL, Krause M, Behringer A, Joseph C, Zierden M, Freyhaus HT, Klinke A, Baldus S, Alcazar MA, Savai R, Pullamsetti SS, Wong DW, Boor P, Zhao JJ, Schermuly RT, and Rosenkranz S (2021). Disrupted PI3K subunit p110alpha signaling protects against pulmonary hypertension and reverses established disease in rodents. J Clin Invest131. doi:10.1172/JCI136939.
  • Birtel J, Spital G, Book M, Habbig S, Baumner S, Riehmer V, Beck BB, Rosenkranz D, Bolz HJ, Dahmer-Heath M, Herrmann P, Konig J, and Charbel Issa P (2021). NPHP1 gene-associated nephronophthisis is associated with an occult retinopathy. Kidney Int100, 1092-1100. doi:10.1016/j.kint.2021.06.012.
  • Klinger JR, Chakinala MM, Langleben D, Rosenkranz S, and Sitbon O (2021). Riociguat: Clinical research and evolving role in therapy. Br J Clin Pharmacol87, 2645-2662. doi:10.1111/bcp.14676.
  • Batool M, Berghausen EM, Zierden M, Vantler M, Schermuly RT, Baldus S, Rosenkranz S, and Ten Freyhaus H (2020). The six-transmembrane protein Stamp2 ameliorates pulmonary vascular remodeling and pulmonary hypertension in mice. Basic research in cardiology 115, 68.
     
  • Benza RL, Corris PA, Klinger JR, Langleben D, Naeije R, Simonneau G, Ghofrani HA, Jansa P, Rosenkranz S, Scelsi L, Thenappan T, Raina A, Meier C, Busse D, and Hoeper MM (2020). Identifying potential parameters associated with response to switching from a PDE5i to riociguat in RESPITE. Int J Cardiol 10.1016/j.ijcard.2020.05.044.
     
  • Rosenkranz S, Howard LS, Gomberg-Maitland M, and Hoeper MM (2020). Systemic Consequences of Pulmonary Hypertension and Right-Sided Heart Failure. Circulation 141, 678-93.
Prof. Dr. Stephan Rosenkranz
Prof. Dr. Stephan Rosenkranz

Clinic III of Internal Medicine - CMMC Research Building

CMMC - PI - C 13

Clinic III of Internal Medicine - CMMC Research Building

Robert-Koch-Str. 21

50931 Cologne

Publications - Stephan Rosenkranz

Link to PubMed