Beyond the Genome: Challenges and Potential for Epigenetics-driven Therapeutic Approaches in Pulmonary Arterial Hypertension.

Pulmonary arterial hypertension (PAH) is a devastating disease of the cardiopulmonary system caused by the narrowing of the pulmonary arteries leading to increased vascular resistance and blood pressure. This leads to right ventricle remodeling, dysfunction and eventually death. While conventional therapies have largely focused on targeting vasodilation, other pathological features of PAH including aberrant inflammation, mitochondrial dynamics, cell proliferation, and migration have not been well explored. Thus despite some recent improvements in PAH treatment, the life expectancy and quality of life for patients with PAH remains poor. Showing many similarities to cancers, PAH is characterized by increased pulmonary arterial smooth muscle cell proliferation, decreased apoptotic signaling pathways, and changes in metabolism. The recent successes of therapies targeting epigenetic modifiers for the treatment of cancer has prompted epigenetic research in PAH, revealing many new potential therapeutic targets. In this review we discuss the emergence of epigenetic dysregulation in PAH and highlight epigenetic-targeting compounds which may be efficacious for the treatment of PAH.