title: Metabolic dysfunction in pulmonary hypertension: the expanding relevance of the Warburg effect.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is an enigmatic vascular syndrome characterized by increased pulmonary arterial pressure and adverse remodelling of the pulmonary arterioles and often of the right ventricle. Drawing parallels with tumourigenesis, recent endeavours have explored the relationship between metabolic dysregulation and PH pathogenesis.
  
  
  METHODS
  We will discuss the general mechanisms by which cellular stressors such as hypoxia and inflammation alter cellular metabolism. Based on those principles, we will explore the development of a corresponding metabolic pathophenotype in PH, with a focus on WHO Groups I and III, and the implications that these alterations may have for future treatment of this disease.
  
  
  RESULTS
  Investigation of metabolic dysregulation in both the pulmonary vasculature and right ventricle during PH pathogenesis has provided a more unifying understanding of how disparate disease triggers coordinate end-stage disease manifestations. Namely, as defined originally in various cancers, the Warburg effect describes a chronic shift in energy production from mitochondrial oxidative phosphorylation to glycolysis. In many cases, this Warburg phenotype may serve as a central causative mechanism for PH progression, largely driving cellular hyperproliferation and resistance to apoptosis. Consequently, new therapeutic strategies have been increasingly pursued that target the Warburg phenotype. Finally, new technologies are increasingly becoming available to probe more completely the complexities of metabolic cellular reprogramming and may reveal distinct metabolic pathways beyond the Warburg effect that drive PH.
  
  
  CONCLUSIONS
  Studies of metabolic dysregulation in PH are just emerging but may offer powerful therapeutic means to prevent or even reverse disease progression at the molecular level.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Cottrill
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Chan
mesh_terms: D002952:Citric Acid Cycle / Q000502:physiology; D004721:Endoplasmic Reticulum / Q000502:physiology; D006019:Glycolysis / Q000502:physiology; D006352:Heart Ventricles / Q000378:metabolism; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000628:therapy; D000860:Hypoxia / Q000209:etiology; D051793:Hypoxia-Inducible Factor 1 / Q000502:physiology; D008659:Metabolic Diseases / Q000150:complications* / Q000628:therapy; D009185:Myelin Proteins / Q000502:physiology; D000070798:Nogo Proteins; D011014:Pneumonia / Q000209:etiology; D013312:Stress, Physiological / Q000502:physiology
chemical_list: D051793:Hypoxia-Inducible Factor 1; D009185:Myelin Proteins; D000070798:Nogo Proteins; C000603199:RTN4 protein, human
keywords: Glycolysis; Warburg effect; hypoxia; metabolism; mitochondria; pulmonary hypertension