title: Circulating biomarkers in pulmonary arterial hypertension: update and future direction.
abstract: Pulmonary arterial hypertension (PAH) is a complex disease with a poor prognosis. In recent years, great advances have occurred in our understanding of the pathophysiologic mechanisms underlying the characteristic vascular proliferative lesions, thus allowing the development of several specific drugs. Nevertheless, PAH still presents a high mortality; therefore, early diagnosis and prognostic stratification seem to be of paramount importance in order to choose the best therapeutic strategies. Circulating biomarkers have been proposed as potentially noninvasive and objective parameters for diagnosis, prognosis, and response to therapy. The molecules evaluated to date, including markers of dysfunction and neurohormonal activation, myocardial injury, inflammation and oxidative stress, vascular damage and remodelling, end-organ failure, and gene expression, reflect the complex pathophysiology of PAH. However, not one of these shows all the characteristics of the ideal biomarker; thus, a multiparameter approach is probably desirable. Moreover, future direction could be research of structural proteins specifically expressed in the pathologic tissue that act as disease-specific markers. This report presents an extensive review of circulating biomarkers in PAH and some consideration about potential future direction in this area.
authors: Department of Cardiovascular and Respiratory Science, Policlinico Umberto I-Sapienza University of Rome, Rome, Italy.
authors: Beatrice
authors: B
authors: Pezzuto
authors: Department of Cardiovascular and Respiratory Science, Policlinico Umberto I-Sapienza University of Rome, Rome, Italy.
authors: Roberto
authors: R
authors: Badagliacca
authors: Department of Cardiovascular and Respiratory Science, Policlinico Umberto I-Sapienza University of Rome, Rome, Italy.
authors: Roberto
authors: R
authors: Poscia
authors: Department of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo-University of Pavia, Pavia, Italy.
authors: Stefano
authors: S
authors: Ghio
authors: Department of Cardiology, Monaldi Hospital-Second University of Naples, Naples, Italy.
authors: Michele
authors: M
authors: D'Alto
authors: Pulmonary Division, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors: Patrizio
authors: P
authors: Vitulo
authors: Ferrarotto Hospital, Catania, Italy.
authors: Massimilano
authors: M
authors: Mulè
authors: Pulmonary Division, Deparmtent of Clinical and Biological Sciences, University of Turin, Turin, Italy.
authors: Carlo
authors: C
authors: Albera
authors: IRCCS San Raffaele Pisana, Roma, Italy.
authors: Maurizio
authors: M
authors: Volterrani
authors: Department of Cardiovascular and Respiratory Science, Policlinico Umberto I-Sapienza University of Rome, Rome, Italy.
authors: Francesco
authors: F
authors: Fedele
authors: Department of Cardiovascular and Respiratory Science, Policlinico Umberto I-Sapienza University of Rome, Rome, Italy; IRCCS San Raffaele Pisana, Roma, Italy. Electronic address: dario.vizza@uniroma1.it.
authors: Carmine Dario
authors: CD
authors: Vizza
mesh_terms: D015415:Biomarkers / Q000097:blood*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000503:physiopathology; D018384:Oxidative Stress; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D015415:Biomarkers
keywords: Pulmonary arterial hypertension; biomarkers; prognosis