Sense (supply of O 2 and demand for fuel) execute DIE LIVE. The metabolic basis of PAH vascular remodeling and cancer. The Republic, Plato 3/14/2009

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Inflammatory diseases Can match fuel generation (ATP) LIVE Sense (supply of O 2 and demand for fuel) execute Cannot match fuel generation (ATP) DIE Socrates and Polemarchus: Is not he who can best

1 3/14/29 The metabolic basis of PAH vascular remodeling and cancer RA PA Evangelos D. Michelakis, MD, FACC, FAHA Proliferativeantiapoptotic diseases Targets unique to the pulmonary circulation Degenerative diseases No Conflicts Pulmonary Hypertension Program University of Alberta Inflammatory diseases Can match fuel generation (ATP) LIVE Sense (supply of O 2 and demand for fuel) execute Cannot match fuel generation (ATP) DIE Socrates and Polemarchus: Is not he who can best strike a blow in a boxing match or any kind of fighting, best able to ward off a blow? Certainly And he who is most skilled in preventing or escaping from a disease is best able to create one? True And is he the best guard of a camp who is best able to steal a march upon the enemy? Certainly Then he who is a good keeper of everything is also a good thief? That I suppose is to be inferred Then if the just man is good at keeping money he is good at stealing it That is implied in the argument The Republic, Plato 1

2 3/14/29 A mitochondriak + channel axis: tone, apoptosis/proliferation Otto Warburg E. K. Weir S. Archer J. Yuan Apoptosis [K+]i Cyt c AIF survivin K + H 2 O 2 I II III IV O MnSOD 2 Mitochondria Ca ++ HIF1 Ca ++ V GSK3 Nucleus Born October , Freiburg MD in1911, Heidelberg Nobel Prize 1931 For his discovery of the nature and mode of action of the respiratory enzyme Stoffwechsel der Tumoren, 1926 The Warburg effect: Cancer is caused by abnormal metabolism of the cells: due to abnormal mitochondria the cancer cells use glycolysis, and not oxidative phosphorylation for energy production, even in the absence of hypoxia. 2

3 3/14/29 MRI PET mmhg. sec Control 3 2 PASMC MITOCHONDRIA PAH + PAH + PASMC K + CURRENT Circulation 22 Circ Res 24 Circulation 26 PAH DIC therapy induces apoptosis in the PA wall and reverses vascular remodeling PCNA L L L L DIC Propidium iodide (red) TUNEL (green) 12 Control PAH + %TUNEL Normal PAH + x 7 DIC PCNA x 7 DIC Propidium iodide (red) TUNEL (green) x Control PAH + + x 7 L L x 7 L L %PCNA x4 3

3/14/29 AcetylCoA without affecting normal cells and rats 1x Normal PASMC Ψm Vehicle Red Fluorescence (FU) NS 1

βoxidation 6 MonoacylCoA 3ketoacyl CoA thiolase 1x Normal PASMC TUNEL Vehicle TUNEL Propidium iodide TUNEL

Hexokinase GSK3β Hexokinase cyt c, AIF Apoptosis e NADH e Krebs Cycle FADH 2 I II III IV V H + ROS H+

The MCDKO mice have a normal phenotype at normoxia and are resistant to CHPHT Pressure (mmhg) 4 2 RA.

4 3/14/29 AcetylCoA without affecting normal cells and rats 1x Normal PASMC Ψm Vehicle Red Fluorescence (FU) NS 1 1 Vehicle Cytosol Glycolysis lactate pyruvate PDK PDH MCD MalonylCoA Free Fatty Acids AcetylCoA AcetylCoA CPT βoxidation 6 MonoacylCoA 3ketoacyl CoA thiolase 1x Normal PASMC TUNEL Vehicle TUNEL Propidium iodide TUNEL Normal Rat PVRi (mmhgming/ml) 1 NS Vehicle Propidium iodide All %TUNEL NS Vehicle ATP P Hexokinase GSK3β Hexokinase cyt c, AIF Apoptosis e NADH e Krebs Cycle FADH 2 I II III IV V H + ROS H+ Trimetazidine Mitochondrion Relaxation Proliferation Kv channels [Ca ++ ] i Apoptosis activation inhibition 6 The MCDKO mice have a normal phenotype at normoxia and are resistant to CHPHT Pressure (mmhg) 4 2 RA. sec RV PA Normoxia KO Hypoxia Normoxia Hypoxia WT Mean PAP (mmhg).6 RV / LVS Distance (m) No Hy No Hy WT KO 4

5 3/14/29 Preserved Ψm in CHMCDKO PASMCs blocked the decrease in ROS, IK + and the rise in [Ca 2+ ] i TMRM WN WCH KON KOCH TMRM (F.U) TMZ and, inhibit CHPHT in Wtype mice Pressure (mmhg) CHPHT 6 CH+ CH+TMZ 4 CONTROL 2 Mitosox Mitosox (F.U) TUNEL DIC Merge+DAPI Fura2 IK + 1 pa ms IK + pa/pf at +7mV [Ca 2+ ] i (nm) CH+TMZ CH+ % TUNEL TMZ Decreased glycolysis in CHKO PASMC, prevents the inhibition of GSK3 and the dependent downregulation of Kv1. CHMCD +/+ +wor CHMCD +/+ MCD +/+ MCD / MCD / +GSK3i CHMCD / Kv1. GSK3β Merge+DAPI MCD / CHMCD +/+ +GSK3i MCD / +wor CHMCD +/+ MCD +/+ CHMCD / Kv1. Merge+DAPI KOCH WCH Hypoxia promotes Ψm hyperpolarization through a hexokinase II /VDAC dependent mechanism in W but not KO mice. HE Hexokinase II Mitotracker red Merge+DAPI Chronic Hypoxia, Akt, PDGF, etc [Ca ++ ] i activation GSK3β/ PGSK3β Kv1. expression GLY/GO + Hexokinase/VDAC interaction Ψm Apoptosis/Proliferation

6 3/14/29 Sense (supply of O 2 and demand for fuel) Sense (supply of O 2 and demand for fuel) execute ALTERNATE MEANS OF ENERGY GENERATION (cytoplasmic glycolysis) execute Can match fuel generation (ATP) Cannot match fuel generation (ATP) Can match fuel generation (ATP) Cannot match fuel generation (ATP) LIVE DIE LIVE DIE A49 Control TMRM intensity 12 (FU) Mitochondrial membrane potential CT scan (reconstructed tumor in blue) PET (glucose uptake) 4 M9K MCF7 SAEC Control % change by. mm Metabolism 3 2 Fatty acid oxidation Glycolysis 2 1 oxidation Cancer Cell, 27 treated Control (non small cell lung cancer) (non small cell lung cancer) TMRM: red DAPI: blue TMRM: red DAPI: blue 6

3/14/29 Cancer Cell, 27 NSC Lung Cancer + oxidation cmyc

& DAPI PDGF survivin Akt/PTEN p3 loss HIF activation

lactate pyruvate LDH PDH PDK AOS Depolarized mitochondria

c cyt c cyt c Ca++ K + Kv +VIVIT 2ATP uptake apoptosis

activated vs quiescenttcells TMRM Inactive CD8 +

Inactive CD8 + Activated CD8 + Activated CD8 + w/tnfα Ab

7 3/14/29 Cancer Cell, 27 NSC Lung Cancer + oxidation cmyc Untreated NSC Lung Cancer Kv1. +Kv1. & DAPI PDGF survivin Akt/PTEN p3 loss HIF activation lactate LDH + PDK AOS PDH pyruvate cyt c cyt c cyt c lactate pyruvate LDH PDH PDK AOS Depolarized mitochondria LDH sirna + AOS cell membrane K + Kv Ca ++ AOS cyt c cyt c cyt c cyt c Ca++ K + Kv +VIVIT 2ATP uptake apoptosis proliferation 36ATP uptake apoptosis proliferation activated vs quiescenttcells TMRM Inactive CD8 + Activated CD8 + Activated CD8 + w/ TNFα Ab rhtnfα Inactive CD8 + Activated CD8 + Activated CD8 + w/tnfα Ab rhtnfα A.F.U filter MitoSO A.F.U normal PASMC±drugs FLUO3 A.F.U PCNA % PCNA (+) 3 1 7

3/14/29 PAH: a state of insulin resistance? Mean PAP (mmhg) 4 3 2 1 CONTROL MCT ETAN REV. CONTROL MCT ETAN REV. TNFα/TNFR PDH Ψm ROS Kv [Ca ++ ] i GSK3 1.

An antiproliferative BMP2/PPARgamma/apoE axis in human and murine SMCs and its role in pulmonary hypertension Hansmann et al, JCI, 28 Mice with SMC targeted deletion of PPARγ develop PAH PPARγ

8 3/14/29 PAH: a state of insulin resistance? Mean PAP (mmhg) CONTROL MCT ETAN REV. CONTROL MCT ETAN REV. TNFα/TNFR PDH Ψm ROS Kv [Ca ++ ] i GSK3 1. Pulmonary arterial hypertension is linked to insulin resistance and reversed by peroxisome proliferatoractivated receptorgamma activation. Hansmann et al, Circulation, An antiproliferative BMP2/PPARgamma/apoE axis in human and murine SMCs and its role in pulmonary hypertension Hansmann et al, JCI, 28 Mice with SMC targeted deletion of PPARγ develop PAH PPARγ agonists (rosiglitazone, pioglitazone) can reverse PAH by activating proapoptotic and supressing proproliferative genes Thank you Stephen Archer E.K. Weir Sebastien Bonnet Sean McMurtry Gopi Sutendra Jayan Nagendran Ken Petruk John Mackey Linda Webster Ballarina II, Joan Miro, 192 8

A Mitochondria-K + Channel Axis Is Suppressed in Cancer and Its Normalization Promotes Apoptosis and Inhibits Cancer Growth

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