FHIT, a novel modifier gene in pulmonary arterial hypertension

Svenja Dannewitz Prosseda, Xuefei Tian, Kazuya Kuramoto, Mario Boehm, Deepti Sudheendra, Kazuya Miyagawa, Fan Zhang, David Solow-Cordero, Joshua C. Saldivar, Eric D. Austin, James E. Loyd, Lisa Wheeler, Adam Andruska, Michele Donato, Lingli Wang, Kay Huebner, Ross J. Metzger, Purvesh Khatri, Edda Spiekerkoetter

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Rationale: Pulmonary arterial hypertension (PAH) is characterized by progressive narrowing of pulmonary arteries, resulting in right heart failure and death. BMPR2 (bone morphogenetic protein receptor type 2) mutations account for most familial PAH forms whereas reduced BMPR2 is present in many idiopathic PAH forms, suggesting dysfunctional BMPR2 signaling to be a key feature of PAH. Modulating BMPR2 signaling is therapeutically promising, yet how BMPR2 is downregulated in PAH is unclear. Objectives: We intended to identify and pharmaceutically target BMPR2 modifier genes to improve PAH. Methods: We combined siRNA high-throughput screening of .20,000 genes with a multicohort analysis of publicly available PAH RNA expression data to identify clinically relevant BMPR2 modifiers. After confirming gene dysregulation in tissue from patients with PAH, we determined the functional roles of BMPR2 modifiers in vitro and tested the repurposed drug enzastaurin for its propensity to improve experimental pulmonary hypertension (PH). Measurements and Main Results: We discovered FHIT (fragile histidine triad) as a novel BMPR2 modifier. BMPR2 and FHIT expression were reduced in patients with PAH. FHIT reductions were associated with endothelial and smooth muscle cell dysfunction, rescued by enzastaurin through a dual mechanism: upregulation of FHIT as well as miR17-5 repression. Fhit 2 / 2 mice had exaggerated hypoxic PH and failed to recover in normoxia. Enzastaurin reversed PH in the Sugen5416/hypoxia/normoxia rat model, by improving right ventricular systolic pressure, right ventricular hypertrophy, cardiac fibrosis, and vascular remodeling. Conclusions: This study highlights the importance of the novel BMPR2 modifier FHIT in PH and the clinical value of the repurposed drug enzastaurin as a potential novel therapeutic strategy to improve PAH.

Original languageEnglish (US)
Pages (from-to)83-98
Number of pages16
JournalAmerican journal of respiratory and critical care medicine
Issue number1
StatePublished - Jan 1 2019
Externally publishedYes


  • BMPR2
  • Cardiovascular diseases
  • Enzastaurin
  • Pulmonary hypertension
  • Repurposed drugs

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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