Viral infection and pulmonary hypertension: is there an association?
Viral infection and pulmonary hypertension: is there an association?
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DOI：
10.1586/ers.11.17
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发表时间：
2011-04-01
影响因子：
3.9
通讯作者：
Bull, Todd
中科院分区：
文献类型：
--
作者：
Cool, Carlyne D.;Voelkel, Norbert F.;Bull, Todd
肺动脉高压（PAH）可能是特发性的、家族性的或与各种疾病过程相关。常见的血管病变是丛状病变。有文献证明丛状病变是血管增生性病变，但导致这种血管增生的原因尚不清楚。在这里，我们考虑的相关病毒，包括艾滋病毒，人类疱疹病毒-8，乙型肝炎B和丙型肝炎，与血管增生和PAH的发展。病毒感染的发病机制通常涉及促血管生成和促存活信号，类似于PAH表型异常内皮细胞中发现的信号。然而，单独的病毒感染不太可能导致PAH，因为-就像病毒诱导癌症一样-疾病的发展无疑需要其他辅助因子，包括遗传易感性。在这篇文章中，我们还讨论了免疫系统失调如何与病毒感染一起导致PAH。自身免疫性疾病和病毒都与免疫调节系统的缺陷有关，主要是T细胞系统。这些T细胞缺陷可能是丛状病变形成的共同途径。无论病毒可能导致PAH的途径如何，重要的是要认识到它们在这种罕见疾病中的作用。血管增殖中病毒途径的研究-体外和动物模型-可能导致PAH的新治疗靶点。
Pulmonary arterial hypertension (PAH) may be idiopathic, familial or associated with various disease processes. The vascular lesions common to all are the plexiform lesions. It is well documented that the plexiform lesions are angioproliferative, but what leads to this angioproliferation is not so clear. Here, we consider the association of viruses, including HIV, human herpesvirus-8, hepatitis B and hepatitis C, with angioproliferation and the development of PAH. The pathogenesis of viral infections often involves proangiogenic and prosurvival signals, similar to the signals found in the phenotypically abnormal endothelial cells of PAH. However, viral infections alone are unlikely to lead to PAH because - much like the viral induction of cancers - additional cofactors, including genetic predisposition, are undoubtedly required for the development of disease. In this article, we also discuss how a dysregulated immune system, in conjunction with a viral infection, could cause PAH. Both autoimmune diseases and viruses are associated with defects in the immune regulatory system, primarily in the T-cell system. These T-cell defects may be a common pathway for the formation of plexiform lesions. Regardless of the route by which viruses may lead to PAH, it is important to recognize their role in this rare disease. Studies of viral pathways in angioproliferation - both in vitro and in animal models - may lead to novel therapeutic targets in PAH.