Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [88]-114).

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (leaves [58]-87).

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Biochemistry. Title from title-page of electronic thesis. Bibliography: leaves 106-117

The mechanism by which insulin and other polypeptide growth factors alter cellular metabolism is not fully understood. In the case of insulin, it is thought that phosphorylation/dephosphorylation mechanisms may play a central role in the signalling pathway. This is based on evidence which includes demonstration that the receptor for insulin is a tyrosine-specific protein kinase which is activated in response to insulin binding. Ultimately, insulin binding to its receptor on the surface of intact fat cells leads to altered levels of serine phosphorylation of several soluble proteins, including the phosphorylation of ATP-citrate lyase and acetyi-CoA carboxylase. Recently, studies involving site-specific mutagenesis have shown that the tyrosine kinase function of the insulin receptor is essential for insulin signalling. The studies described in this thesis have addressed the problem of how activation of the insulin receptor/tyrosine kinase results in the altered serine phosphorylation observed in intact cells in response to insulin. To gain further understanding of the cellular components required for insulin signalling, reconstitution experiments have been carried out mixing isolated cellular fractions with preparations of insulin receptors. The effects of insulin on altering protein-serine and protein-tyrosine phosphorylation have been determined in this reconstituted system. Results show that in a high-speed (100,000 x g) supernatant fraction prepared from rat adipose tissue endogenous protein-serine kinases are sensitive to conditions which are commonly employed for assaying insulin receptor/kinase activity. This includes inhibition by micromolar concentrations of MnCI₂, by 40 mM NaF, and by low reaction temperature (0°C). When the insulin receptor, present in a WGA-Sepharose-purified preparation of detergent-solublized rat liver membranes, was assayed in the complete absence of both MnCI₂ and NaF, receptor/tyrosine kinase activity was only slightly reduced with little or no decrease in the responsiveness to insulin. Furthermore, when the WGA-Sepharose-purified membrane fraction was incubated at 37°C in the presence of [ɣ -³²P]ATP several endogenous proteins were observed to be phosphorylated in addition to the β-subunit of the insulin receptor. These membrane proteins appear to be phosphorylated on tyrosine as indicated by their resistance to alkali hydrolysis. Upon reconstitution of the adipose tissue high-speed supernatant fraction with the WGA-Sepharose-purified preparation of insulin receptors the most striking effects observed were the phosphorylation of a 40 kd protein subunit (pp40) and the dephosphorylation of a 25 kd protein subunit (pp25) present in adipose tissue. The phosphorylation of pp40 occurs on tyrosine and is insulin-responsive, whereas the dephosphorylation of pp25 occurs following reconstitution with either untreated control, or insulin-activated insulin receptors. To assess the effect that reconstituted insulin receptors may have on the phosphorylation of endogenous ATP-citrate lyase in adipose tissue high-speed supernatant, it was found that a more pure preparation of insulin receptors was required. Further purification of the insulin receptor to homogeneity was therefore attempted using insulin-agarose affinity chromatography. However, difficulties including low yield and instability of the receptor through purification have prevented progress with these studies at present. In a separate study, highly purified acetyl-CoA carboxylase was reconstituted with a crude fraction consisting of total Triton-solublized membrane proteins. In this reconstituted system phosphorylation of acetyl-CoA carboxylase was enhanced to an extent greater than 6-fold after incubation with [ɣ -³²P]ATP. Following chromatography of the crude Triton-solublized extract over WGA-Sepharose this acetyl-CoA carboxylase kinase activity was found to be present in the flow-through void fraction and not in the N-acetylglucosamine eluted fraction. The acetyl-CoA carboxylase kinase, at present, does not appear to be insulin-responsive, but further studies are needed to confirm this observation. / Medicine, Faculty of / Biochemistry and Molecular Biology, Department of / Graduate

Mon travail de thèse consistait à étudier la signalisation oncogénique de la tyrosine kinase (TyrK) cytoplasmique Src dans les cellules de cancer colorectal (CCR) à un stade avancé par une approche globale de phosphoprotéomique quantitative de type SILAC puis d'évaluer l'efficacité du Nilotinib, un inhibiteur de la Tyrk oncogénique BCR-Abl, sur les propriétés invasives des cellules de CCR. Dans un premier temps, nos résultats ont confirmé le rôle clé joué par Src dans l'acquisition des propriétés invasives de la tumeur. Puis, l'approche phosphoprotéomique de type SILAC a permis de mettre en évidence 136 protéines substrats de Src parmi lesquelles nous retrouvons des protéines de signalisation, des protéines associées au cytosquelette ou des protéines du trafic vésiculaire. De manière intéressante, j'ai révélé l'implication d'un réseau de TyrK dans les propriétés invasives Src-dépendantes. Nos résultats suggèrent qu'une thérapie multi-TyrK pourrait s'avérer intéressante pour traiter les CCR à un stade avancé. En complément de l'analyse SILAC, j'ai initié une approche pharmacologique pour caractériser les TyrK impliquées dans l'invasion des cellules de CCR. De manière surprenante, j'ai observé que le Nilotinib inhibe l'activité invasive des cellules de CCR avec une efficacité comparable à celle observée sur la croissance des cellules de LMC (IC50=20nM). Des approches d'invalidation génétique et de mutagénèse couplées à des tests d'invasion in vitro et in vivo ont permis de démontrer que le Nilotinib exerce son activité anti-invasive en ciblant le récepteur au collagène DDR1. Mes résultats laissent présager un intérêt thérapeutique potentiel du Nilotinib dans le traitement du cancer colorectal métastasant. / My thesis work was devoted to decipher the oncogenic signaling of the cytoplasmic tyrosine kinase (TyrK) Src in advanced colorectal cancer (CRC) cells using SILAC quantitative phosphoproteomics and to evaluate the efficiency of the oncogenic BCR-Abl inhibitor, Nilotinib, on the CRC cell invasive activity. Firstable, our results confirmed the key role of Src in the induction of cell invasion. Then, the SILAC phosphoproteomic approach revealed 136 Src substrates among which signaling proteins, cytoskeleton associated proteins or vesicular trafficking associated proteins. Interestingly, I have identified a TyrK network involved in Src-dependent invasive properties. Taken together, our results suggest that a multi-TyrK therapy may be interesting in clinic for the treatment of advanced CRC. In addition to the SILAC analysis, a pharmacological approach was set up to characterize TyrK involved in CRC cell invasion. Surprisingly, I found that Nilotinib inhibits CRC cell invasive activity with a similar efficiency to the one observed on the growth of CML (IC50 = 20nM). Knock down and mutagenesis experiments together with in vitro and in vivo invasion assay revealed the collagen receptor DDR1 as the main Nilotinib target in its anti-invasive activity. Our results suggest that Nilotinib could be of therapeutic value in metastatic CRC.

Durant la dernière décennie, les inhibiteurs de tyrosine kinases (ITK) ont radicalement changé l’évolution de certains cancers comme la leucémie myéloïde chronique (LMC) ou les tumeurs stromales gastro-intestinales (GIST). Ils sont aujourd’hui largement utilisés dans le traitement de diverses pathologies malignes, permettant un allongement de la survie globale. Cependant, certains patients ne montrent pas d’amélioration au cours du traitement par ITK. Les mécanismes évoqués sont multifactoriels et possèdent une origine pharmacocinétique, pharmacodynamique ou pharmacogénétique. En effet, l’une des causes majeures de variabilité commune à tous ces ITK réside dans un métabolisme impliquant le cytochrome 3A4, dont l’expression est soumise à de nombreux facteurs. L’objectif de cette thèse a été d’approfondir ces mécanismes et d’évaluer certaines stratégies afin d’augmenter l’efficacité de ces médicaments. Ce travail a consisté en premier lieu à développer une méthode chromatographique sensible et rapide permettant le dosage de neufs ITK commercialisés ou en phase avancée de développement. Cet outil, à la base du suivi thérapeutique pharmacologique, a été utilisé dans le cadre de la LMC pour mesurer les concentrations plasmatiques d’imatinib de plus de 3000 patients. Les informations cliniques de ces patients ont été saisies dans une base de données servant de support à l’évaluation de la réponse en fonction de la concentration. Nous avons ainsi confirmé que les patients présentant des concentrations supérieures au seuil d’efficacité de 1000 ng/mL avaient une plus grande probabilité de réponse. Dans la continuité de ce projet, nous avons évalué la relation concentration-efficacité de l’imatinib dans les GIST et trouvé un seuil d’efficacité voisin de 800 ng/mL. Tous les facteurs de variabilités ne sont cependant pas maitrisables avec un dosage plasmatique. La littérature rapporte en effet que certains ITK sont des substrats de transporteurs cellulaires potentiellement impliqués dans la résistance au traitement. Nous avons donc entrepris de doser ces ITK à l’intérieur même des cellules, d’abord in vitro afin d’évaluer ces mécanismes de transport, puis in vivo dans les cellules de patients traités par ces ITK. Un lien a ainsi été montré entre la capacité d’incorporation des molécules et la réponse au traitement. Enfin, le versant pharmacogénétique de l’un de ces transporteurs (MDR1) a été étudié, indiquant une relation entre certains haplotypes ou polymorphismes et la concentration plasmatique d’une part et la réponse à l’imatinib d’autre part. En conclusion, ces différentes stratégies basées sur le dosage plasmatique ou intracellulaire et sur la pharmacogénétique semblent apporter des éléments permettant l’amélioration de la réponse au ITK ou la détection précoce de mauvaise réponse. / During the last decade, tyrosine kinases inhibitors (TKI) have dramatically changed the prognosis of several cancers such as chronic myeloid leukaemia (CML) or gastro-intestinal stromal tumours (GIST). They are widely used in the treatment of various malignant pathologies, leading to a prolonged overall survival. However, some patients do not show improvement when treated with TKI. The supposed mechanisms are multifactorial and could have an origin in pharmacokinetics, pharmacodynamics or pharmacogenomics. Indeed, one of the major reasons of common variability of these TKI involves their metabolism by cytochrome 3A4, whose expression is subjected to many factors. The aim of this thesis was to deepen these mechanisms and to assess some strategies to increase the efficacy of these drugs. This work consisted first in developing a rapid and sensitive chromatographic method allowing determination of nine commercialised (or in advanced clinical development) TKI. Serving as a basis for therapeutic drug monitoring, this was used as part of CML management to measure imatinib plasmatic concentration of more than 3000 patients. The clinical information of these patients was recorded in a database and used as support for the evaluation of the response according to concentration. Thus, we confirmed that patients having concentration higher than the effectiveness threshold of 1000 ng/mL got higher probability of response. In the same way, we assessed relationship between imatinib concentration and efficacy in GIST and found an effectiveness threshold closed to 800 ng/mL. However, several factors of variability remain unmanageable with only plasmatic determination. Indeed, literature reported that some TKI were substrates of cellular transporters, potentially involved in the resistance to treatment. We therefore decided to determine concentration of these TKI into the cells, first in vitro to assess these mechanisms of transport, and then in vivo into the cells of patients treated by these TKI. A link was shown between the incorporation ability of molecules and the response to the treatment. Finally, a pharmacogenetic approach showed a relationship between some haplotypes or polymorphisms of a transporter (MDR1) and plasmatic concentration on one hand, and response to the imatinib on the other hand. In conclusion, these different strategies based on plasmatic or intracellular determination of TKI and on pharmacogenomics contribute to improvement of the response to TKI or early detection of non-response.

In mammals, freshly ejaculated spermatozoa do not possess the ability to fertilize a mature oocyte. They acquire fertilization competence upon residing for a period of time in the female reproductive tract. The physiological changes that bring about these time-dependent changes in motility pattern and acquisition of fertilizing ability of spermatozoa are collectively referred to as capacitation, culminating in sperm hyperactivation. Capacitation-associated increase in sperm protein tyrosine phosphorylation (PYP), exhibited by mammalian sperm, is one of the major downstream events, regulating hyperactivated motility. However, it is still unclear which are the tyrosine kinases and phosphatases involved in modulating the capacitation-associated increase in global PYP. In order to determine this, our laboratory earlier showed the role of PYP in hamster sperm capacitation using a specific EGFR protein tyrosine kinase (PTK) inhibitor, tyrphostin A47 (TP-47). Interestingly, inhibition of capacitation by 0.5 mM TP-47 was associated with induction of a slow circular motility pattern, accompanied by inhibition of PYP of certain proteins (Mr. 45,000-52,000), localized to the principle piece of the sperm flagellum. Two such proteins, hypo-tyrosine phosphorylated, were found to be tektin-2 and ODF-2, using 2D-PAGE followed by MS/MS analysis. Interestingly, a global phosphoproteome analysis of human spermatozoa showed that PYP changes are associated with capacitation and asthenospermic condition in infertile men is attributed to the failure of capacitation-associated increase in PYP. Such individuals exhibited impaired sperm motility. There is a need to understand the exact mechanism of phosphorylation of sperm flagellar proteins, which is necessary to assess sperm’s ability to fertilize the mature oocyte. Therefore, the focus of the present work was to elucidate the role of receptor tyrosine kinases (RTKs) and the non-receptor tyrosine kinases (NRTKs) in mammalian (hamster) sperm capacitation. Recent studies have shown that apart from EGFR other RTKs like IGF1R, FGFR, VEGFR, MuSK, TrkA are expressed in mammalian spermatozoa and actively involved in sperm capacitation. However, there is very little information available in the context of sperm capacitation and associated PYP. Therefore, attempts were made to understand the role of various RTKs (IGF1R, FGFR and VEGFR) in hamster sperm capacitation and associated PYP. Initially, the role of IGF1R tyrosine kinase during sperm capacitation was studied. Immunolocalization of IGF1R in spermatozoa showed a strong signal in the sperm acrosome and the principal piece of the sperm flagellum. Inhibition of IGF1R kinase with an IGF1R-specific inhibitor TP-1-O-Me-AG538 (TP-538) showed inhibitory effect on sperm capacitation and the associated hyperactivation. But, inhibitors of FGFR and VEGFR tyrosine kinases did not show such an effect. Interestingly, inhibition of IGF1R by TP538 was associated with inhibition of PYP of certain proteins (Mr. 45,000-120,000), localized to head, mid piece and principle piece regions of the sperm flagellum. Phosphoproteomic analysis using 2D-PAGE-western blot with anti-phosphotyrosine antibodies identified 17 differentially phosphorylated protein spots. Out of the 17 spots, 12 were identified by MALDI-MS/MS analysis. The proteins identified to be differentially phosphorylated, upon inhibition of IGF1R, were PDHE1, ODF-2, Tubulin β 2C chain, PDHE2 and ATP synthase β subunit. The RTKs being present in the membrane level may not be directly involved in the phopshorylation of downstream target proteins associated with the mitochondrial membrane, sperm axonemal structures and outer dense fibers. Therefore, the RTKs may interact directly or indirectly with the downstream NRTKs, which may be involved in the phosphorylation of target sperm proteins. Till date, six different families of NRTKs are shown to be expressed in mammalian spermatozoa. The major family of NRTKs involved in sperm function is the Src family of kinases. However, there is very little information available in the context of sperm capacitation and the associated PYP. Therefore, studies were carried out to understand the role of Src family of NRTKs in sperm capacitation and associated PYP. Presence of active Src signaling was observed by the immunolocalization of activated Src (pY416) in the acrosome, mid piece and the principal piece regions of the sperm flagellum. Inhibition of Src family of kinase with a specific Src family kinase inhibitor PP2, showed inhibition of sperm capacitation and the associated hyperactivation. Inhibition of Src family of kinases with PP2 was associated with decrease in PYP of several proteins (Mr. 45,000-120,000), localized mainly to the mid piece region, followed by the principle piece region of the sperm flagellum. Phosphoproteomic analysis using 2D-PAGE-western blot with anti-phosphotyrosine antibodies identified 38 differentially phosphorylated protein spots. Out of the 38 spots, 16 were identified by MALDIMS/MS analysis and these corresponded to seven proteins which included PDHE1, ODF-2, Tubulin β 2C chain, Tektin-2, GAPDS, PDHE2 and ATP synthase β subunit. Additionally, the biochemical and molecular characteristics of the identified proteins were also studied. Bioinformatic analysis predicted the presence of phosphorylation motifs for several kinases and interestingly, all the proteins identified had a Src kinase motif. Comparing the current observations and the previous work in the laboratory, two proteins ODF-2 and Tektin-2 were found to be regulated by EGFR, IGF1R and Src family of kinases. Therefore, characterization of the capacitation-associated tyrosine phoposphorylated proteins ODF-2 and Tektin-2 was performed. By employing PCR and Northern blotting techniques, the presence of the transcripts of both the proteins was shown. Additionally, the ontogeny of expression of ODF2 and Tektin-2 in hamster testis development was studied and the results indicated that the expression of both the proteins started from week 3 onwards till week 8. To confirm the meiotic stage-associated expression of ODF-2 and Tektin-2, germ cells were sorted based on their DNA content. ODF-2 and Tektin-2 transcripts were first expressed in the meiotic germ cells (pachytene spermatocytes) and their expression was upregulated in the post-meiotic germ cells (round spermatids). Sequential extraction of sperm proteins showed that, Tektin-2 was majorly extracted out in the Triton X-100 and DTT fraction, whereas, ODF-2 was maximally extracted in the presence of urea and DTT. In conclusion, these observations indicate that IGF1R and Src family of tyrosine kinases are critical for mammalian sperm capacitation and associated global PYP. Inhibition of sperm capacitation was associated with hypo-tyrosine-phospohorylation of certain proteins associated with mitochondrial membrane, axonemal structures and outer dense fibers of the sperm flagellum. Future work can be directed towards understanding the role of other RTKs and NRTKs involved in sperm capacitation and the molecular characterization of hypophosphorylated proteins critical for sperm function and its fertilization competence.

Au cours des dernières décennies, de nombreux composés à activité anti-tumorale agissant sur des cibles thérapeuthiques variées ont été préparés. Parmi ceux-ci, les inhibiteurs de kinases ont démontré leurs activités et ont abouti à la mise sur le marché de nouveaux médicaments utilisés en oncologie. Ainsi, nous nous sommes intéressés à la préparation de nouveaux inhibiteurs de kinases compétitifs de l'ATP à motif indolin-2-one. Dans la première partie bibliographique, les trois grandes familles de kinases ainsi que leur régulation et leur implication dans divers processus cellulaires sont décrites. Ensuite, les principales familles d'inhibiteurs à motif indolin-2-one décrites dans la littérature sont détaillées. Enfin, une description des différentes familles d'inhibiteurs à motif indolin-2-one précédemment préparées au laboratoire ainsi que leur activité biologique est présentée. En tenant compte de ces résultats, la deuxième partie détaille l'étude de relation structure-activité qui a été poursuivie et a permis la préparation de quatre familles de composés : des isoindigos glycosylés acétylés, des 7'-azaisoindigos glycosylés acétylés, des indolin-2-ones substituées en position 3 par des chaînes latérales fonctionnalisées par un groupement alpha-amino-acides et un nouvel hétérocycle de type pyrrolo-alpha-carboline. Dans la dernière partie les activités antiprolifératives sur différentes lignées cellulaires cancéreuses des composés préparés dans le cadre de ce travail, ainsi que leur activité inhibitrice sur diverses kinases sont présentées.

Les inhibiteurs de tyrosine kinases (ITKs) sont une nouvelle classe thérapeutique ayant connu un grand essor ces dix dernières années. Inhibiteurs compétitifs de l’adénosine triphosphate (ATP), ils sont utilisés dans le traitement de nombreux cancers dans lesquels une dérégulation de tyrosine kinases a été mise en évidence. Malgré une efficacité prouvée, des cas de résistance sont rapportés, en particulier avec l’exemple de la leucémie myéloïde chronique (LMC) et le traitement par ITK. Cette variabilité inter-individuelle peut être due à des mécanismes de résistance propre de la cellule tumorale ou à des variations dans les paramètres pharmacocinétiques de la molécule. De nombreuses études ont analysé l’impact de polymorphismes (SNPs) dans des gènes codants pour les déterminants pharmacocinétiques et pharmacodynamiques des ITKs. Nous avons analysé l’impact de SNPs sur l’obtention de la réponse moléculaire majeure à 1 an dans 2 cohortes de patients atteints de LMC et traités par imatinib. C1236T, G2677T/A et C3435T, 3 SNPs du gène MDR-1 codant pour la glycoprotéine P et les SNPs de la région codante du gène SLC22A1 à l’origine du transporteur d’influx hOCT1. L’impact bénéfique de l’allèle 1236T ou haplotype *4 et l’impact péjoratif de l’allèle 2677G ou haplotype *1, retrouvés dans la 1ère cohorte n’ont pas été retrouvés dans la 2ième cohorte suggérant un impact mineur voire nul de ces derniers sur la réponse à l’imatinib. L’impact des SNPs de SLC22A1 observés dans la 2ième cohorte nécessite d’être confirmé. Des travaux supplémentaires à plus grande échelle, selon des critères nécessitant d’être harmonisés, sont nécessaires avant d’espérer pouvoir aboutir à une «médecine personnalisée» pour l’imatinib mais également de façon générale pour l’ensemble des ITKs. / Tyrosine kinases inhibitors (TKIs) are a new class of drugs having bloomed over the past decade. As competitive inhibitors of the adenosine triphosphate, they are used in the treatment of many cancers in which deregulation of tyrosine kinases has been demonstrated. In spite of dramatic efficacy, cases of resistance have been reported particularly with chronic myeloid leukemia (CML) and TKI treatment. This inter-individual variability may be due to mechanisms of intrinsic resistance of tumor cells or changes in the pharmacokinetic parameters of the molecule. Numerous studies have analyzed the impact of polymorphisms (SNPs) in genes coding for pharmacokinetic and pharmacodynamic determinants. We analyzed the impact of SNPs on major molecular response at 1 year in 2 cohorts of patients with CML treated with imatinib. C1236T, G2677T/A, C3435T, three SNPs in the MDR-1 gene encoding P-glycoprotein and SNPs in the coding region of the SLC22A1 gene encoding hOCT1. The protective impact of the 1236T allele or haplotype*4 and the pejorative impact of the 2677G allele or haplotype*1, found in the 1st cohort, were not replicated in the 2nd cohort, suggesting minor or no impact on the response to imatinib. The impact of SLC22A1 SNPs observed in the 2nd cohort needs to be confirmed. Further works on a larger cohort, according to criteria that need to be harmonized, are necessary before we reach a “personalized medicine” for imatinib but also for all TKIs

L’hypertension artérielle pulmonaire (HTAP) correspond à un groupe de maladies qui se caractérise par une obstruction vasculaire suite à une vasoconstriction excessive, une prolifération cellulaire et la création de thromboses in situ, conduisant à une augmentation progressive des résistances vasculaires pulmonaires puis au décès. De nombreuses avancées dans la prise en charge de l’HTAP ont été réalisées ces dernières années avec la mise à disposition de médicaments principalement vasodilatateurs. Cependant, aucun de ces médicaments n’est curatif de la maladie témoignant de la nécessité à obtenir de nouvelles thérapeutiques. Des molécules axant leur effet sur la lutte contre la prolifération cellulaire liée à l’activation des récepteurs à tyrosine-kinases (RTK) ou le stress oxydant (SO) paraissent aujourd’hui comme de potentielles innovations thérapeutiques dans l’HTAP. Cependant, à l’heure actuelle, les données sur le SO dans l’HTAP sont trop peu détaillées pour cibler correctement cette voie physiopathologique. De même, les inhibiteurs de tyrosine-kinases ont montré un bénéfice dans la prise en charge de l’HTAP mais associé à des effets indésirables graves tels qu’une toxicité cardiaque. Dans ce travail, nous avons approfondi le mécanisme d’action du SO dans la physiopathologie de l’HTAP et complété l’identification des RTK dans le remodelage vasculaire pulmonaire afin de permettre la mise au point de thérapeutiques efficaces avec un rapport bénéfice risque favorable pour le patient. / Pulmonary arterial hypertension (PAH) corresponds to a group of diseases characterized by a vascular obstruction due to vasoconstriction, cellular proliferation and in situ thrombosis, leading to a progressive increase in pulmonary vascular resistances. New knowledge in the PAH management were performed in the last few years, specifically for vasodilators. However, none of those treatments cure the disease and new drugs are still needed. Molecules targeting cellular proliferation induced by tyrosine kinases receptors (TKR) activation or oxidative stress (OS) seem to be potential therapeutic innovations. However, knowledge on OS in PAH is not enough accomplished in PAH to target accurately this pathophysiologic pathway. Similarly, tyrosine kinase inhibitors have shown efficacy in PAH management but associated with severe adverse events as cardiac toxicity. In this study, mechanism of action of OS in pathophysiology of PAH was detailed and identification of TKR involved in vascular remodeling was completed in order to find efficient therapeutics with a favorable risk benefit ratio for PAH patient.