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Fig. 11 | BMC Pulmonary Medicine

Fig. 11

From: NOX4 expression and distal arteriolar remodeling correlate with pulmonary hypertension in COPD

Fig. 11

A possible mechanism of distal pulmonary arteriolar remodeling and its role in pathogenesis of PH in COPD. The scheme illustrates the possible mechanism of NOX4 in distal pulmonary arteriolar remodeling and pathogenesis of PH in COPD. In an early stage of COPD, distal arteriolar remodeling distal arteriolar remodeling and changes in proximal pulmonary artery blood rheology, structure and function of the right heart, including the decreased mPAD, and increased RVMES and RVMED could be determined by cMRI before a definite PH in COPD patients. Pathogenically, the hyperactivated TGFβ signaling triggered the expression of NOX genes, particularly the NOX4 gene in PASMCs and endothelial cells of distal vascules, and smooth muscle cells and epithelial cells of distal airways in COPD lungs. The augmented expression of NOX4 could induce the production of ROS, which in turn led the hyperplasia and hypertrophy of PASMCs, and ECM deposition. As a consequence, these resulted in the distal pulmonary vascular remodeling, and eventually led PAH in patients with a late stage of COPD. Solid lines indicate previously confirmed mechanisms, and dished lines represent proposed mechanisms that need further investigations. mPAD: main pulmonary artery diameter; PAH: pulmonary arterial hypertension; RVMED: right ventricular myocardial mass end-diastolic; RVMES: right ventricular myocardial mass end-systolic

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