Therapeutic potential of KLF2-induced exosomal microRNAs in pulmonary hypertension

Pulmonary arterial hypertension (PAH) is a severe disorder of lung vasculature that causes right heart failure. Homoeostatic effects of flow-activated transcription factor Kruppel-like factor 2 (KLF2) are compromised in PAH. Here, we show that KLF2-induced exosomal microRNAs, miR-181a-5p and miR-324-5p act together to attenuate pulmonary vascular remodelling and that their actions are mediated by Notch4 and ETS1 and other key regulators of vascular homoeostasis. Expressions of KLF2, miR-181a-5p and miR-324-5p are reduced, while levels of their target genes are elevated in pre-clinical PAH, idiopathic PAH and heritable PAH with missense p.H288Y KLF2 mutation. Therapeutic supplementation of miR-181a-5p and miR-324-5p reduces proliferative and angiogenic responses in patient-derived cells and attenuates disease progression in PAH mice. This study shows that reduced KLF2 signalling is a common feature of human PAH and highlights the potential therapeutic role of KLF2-regulated exosomal miRNAs in PAH and other diseases associated with vascular remodelling.

• Sindi, H. A.
• Russomanno, G.
• Satta, S.
• Abdul-Salam, V. B.
• Jo, K. B.
• Qazi-Chaudhry, B.
• Ainscough, A. J.
• Szulcek, R.
• Jan Bogaard, H.
• Morgan, C. C.
• Pullamsetti, S. S.
• Alzaydi, M. M.
• Rhodes, C. J.
• Piva, R.
• Eichstaedt, C. A.
• Grunig, E.
• Wilkins, M. R.
• Wojciak-Stothard, B.