The present investigation explored the acute and long-term impacts of postnatal hypoxia on pulmonary vascular function and remodeling and the role of m6A in the development of PH. Consistent with our original hypothesis, postnatal exposure to hypoxia resulted in significant remodeling of the pulmonary vasculature, increased mPAP, and reduced levels of m6A-related proteins. The reduced METTL3 expression was sustained into adulthood. These results suggest that m6A modification might be involved in the PH pathological process initiated by postnatal exposure to hypoxia.
Based on many epidemiological reports, the Developmental Origins of Health and Disease (DOHaD) theory suggests that exposure to adverse environmental factors (e.g., poor diet, stress, or infection) early in life can increase the likelihood of chronic diseases in adulthood. Recent reports found that transient hypoxemia during the perinatal period can increase pulmonary vasoconstriction during hypoxia exposure in adulthood 28. Previous work from our laboratory showed that both IUGR and EUGR led to an exacerbated response to hypoxia and the development of PH in adult rats1–3. The results from this investigation are in agreement with the findings from previous studies, and therefore support the premise that pulmonary vascular disease in adulthood is closely related to environmental factors in early life.
Postnatal exposure to hypoxia alters pulmonary vascular function
PH is a progressive disease consisting of multi-factorial pathogeny, which results in right heart failure with poor prognosis 29. It is well established that there is an interaction between hypoxia and PH, thus underscoring the importance of understanding the complex interactions between hypoxia and the development of pulmonary diseases. NO signaling pathways play a key role in hypoxic pulmonary hypertension 30. In animal models of chronic hypoxia in adulthood, the expression of eNOS protein increases after hypoxia. However, the expression of eNOS in neonatal rats after hypoxia is still unclear. Chicoine et al. found that chronic hypoxia in neonatal rats led to a decreased expression of eNOS protein 31. Whereas Sheak et al. showed that the expression of eNOS protein in neonatal rats did not change after hypoxia, but the expression of p-eNOS increased 32. In the present investigation, eNOS increased following postnatal exposure to hypoxia but decreased in the adult rat. This change could suggest that eNOS expression increased when PVECs were exposed to hypoxia. However, as PH progressed, PVECs became dysfunctional even under a normoxic state and they produced less eNOS. Regulated by a variety of molecules and pathways such as VEGF, the dysfunction of PVECs plays a key role in the development of PH 33. VEGF promotes angiogenesis and the proliferation, migration, and differentiation of endothelial cells by binding to the vascular endothelial growth factor receptor 2(VEGFR2)on the pulmonary vascular endothelium 32. Consistent with previous investigations34, these results demonstrated a consistent expression of VEGF and p-eNOS, which further suggests that VEGF is regulated by eNOS activity. VEGF can also affect eNOS phosphorylation, which likely alters local NO bioavailability and vasodilator signaling. These findings indicate that the mutual regulation between VEGF and p-eNOS is involved in the regulation of adult pulmonary vascular function following postnatal hypoxia.
Potential role of m6A in the development of hypoxia-induced PH
Compelling evidence suggests that epigenetic modification plays an essential role in the development of PH 35. In our previous study, we discovered that the binding of histone acetylation and hypoxia-inducible factor-1α (HIF-1α) to the endothelin-1(ET-1) gene promoter increased in PAH following IUGR 3. We also demonstrated the epigenetic regulation of Notch1 in the pulmonary microvascular rarefaction following EUGR 2. Another study found that nitric oxide synthase༈NOS༉ upregulation was associated with increased H3 and H4 histone acetylation in the eNOS promoter in a neonatal rodent persistent pulmonary hypertension of the newborn༈PPHN༉ model 25. However, the epigenetic regulation of these factors in mammals and whether m6A mediates PH remains unknown. Since m6A is a common chemical modification of RNAs in mammals, it functions in various vital biological pathways such as tumorigenesis 5, 36 and embryonic13, 37 and neuronal development 21, 38. Considerable attention has been given to the essential role of m6A in embryonic development and spermatogenesis 15. Still, there is little focus on the function of m6A in the lung or pulmonary vascular disease development.
We hypothesized that m6A also participates in PH following postnatal exposure to hypoxia. m6A methyltransferase and demethylase proteins exhibited lower levels in the postnatal hypoxia group than in the controls, while the total level of m6A in lung tissue was not affected by postnatal hypoxia. Among m6A-related proteins, WTAP levels did not change. This might be related to the fact that WTAP has no methyltransferase activity. Instead, it regulates m6A levels by combining with METTL3 / METTL14 complex 39. Future investigations should seek to identify other m6A-related proteins, which may help identify the specific role that m6A plays in the pathogenesis of hypoxia-induced PH.
METTL3 expression was consistently lower in the hypoxia group than in the controls. METTL3 participates in the development of tumors and the development of early embryos by regulating m6A modification 40–42. In a recent investigation43, METTL3 expression was significantly upregulated in patients with lung adenocarcinoma. Cytological experiments have demonstrated that METTL3 affects the growth, survival, and invasion of human lung cancer cells 43, which implies that METTL3 plays an important role in the long-term effects on pulmonary vasculature function following postnatal exposure to hypoxia.
The present investigation utilized MeRIP to analyze the specific m6A methylation changes following exposure to hypoxia. We found 21 hyper-methylated and 5 hypo-methylated peaks in 2-week-old rats exposed to hypoxia. In comparison, 7 peaks were hyper-methylated, and 13 peaks were hypo-methylated in adult rats who had suffered from postnatal hypoxia. While these might not seem like a significant finding, these differential peak-related genes are involved in many respiratory-related physiological processes such as respiratory tube development, Notch signal pathways, and the activation of endothelial cells. Thus, it is likely that m6A participates in the pathogenesis of PH. Interestingly, we found that the tricho-rhino-phalangeal syndrome 1 (Trps1) gene was hypomethylated in both the 2-week-old and 9-week-old rats who were exposed to postnatal hypoxia. TRPS1, a member of the GATA transcription factor family, is widely expressed in many tissues and organs and plays a critical role in mammalian development and differentiation 44, 45. TRPS1 is also highly expressed in lung cancer46 and is involved in regulating epithelial-to-mesenchymal transition (EMT) during embryonic development47. While EMT plays an important role in the occurrence and development of PH 48, it has not been reported whether Trps1 is also involved in the regulation of PH pathogenesis. Our results suggest that Trps1 mRNA methylation can regulate PH following postnatal hypoxia by affecting EMT in the newborn rat, and this effect can persist into adulthood. Future investigations will identify the specific role(s) of EMT in the development of hypoxia-induced PH.
Experimental considerations and future directions
While this investigation demonstrated that postnatal exposure to hypoxia impacts pulmonary vascular function and development, it is unclear if this results in impaired functional capacity (i.e., exercise tolerance) of these animals. Considering that pulmonary hypertension leads to reduced maximal oxygen uptake and exercise capacity in humans 49, it is likely that the impaired pulmonary vascular function in rats exposed to postnatal hypoxia studied herein would have reduced exercise capacity. Future investigations into the interplay between postnatal hypoxia-induced PH and reduced exercise tolerance may aid in the bench-to-bedside translation of our understanding of this disease and the associated molecular mechanisms.
This investigation sheds light on the long-term effect of postnatal exposure to hypoxia on pulmonary vascular functions and the role of m6A in regulating PH. These results suggest that m6A methylation is a biomarker of epigenetic modification of critical genes that regulate pulmonary arterial pressure and lung development and, therefore, may be potential therapeutic targets. However, additional investigations are required to delineate the specific regulatory mechanisms between m6A and PH and test the possibilities of regulating m6A methylation to treat PH.