Genetic variants of the BMPR2 gene and their contribution to the development of pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a devastating disease characterized by a progressive increase in pressure in the pulmonary arteries. This leads to vascular remodeling and, eventually, right heart failure. Variants in the BMPR2 gene, which encodes the bone morphogenetic protein receptor type 2, are the most common genetic cause of hereditary and idiopathic PAH. These variants disrupt the transforming growth factor-beta (TGF-β) signaling pathway, triggering abnormal proliferation of pulmonary artery smooth muscle cells and apoptosis of endothelial cells. This results in complex vascular remodeling, characterized by thickening of the vascular walls, formation of plexiform lesions, and in situ thrombosis. Endothelial dysfunction also contributes to an imbalance between vasoconstrictors and vasodilators, exacerbating pulmonary hypertension. While current therapies aim to restore this balance, they have a limited impact on the underlying vascular remodeling. Emerging strategies seek to restore the functionality of BMPR2 variants or enhance their signaling through agonists and read-through molecules. Additionally, a higher penetrance of the disease has been observed in women carrying BMPR2 variants, suggesting an interaction with sex hormone metabolism. The research aims to understand the role of BMPR2 gene variants in the development of PAH and to explore emerging strategies to restore the functionality of these variants or enhance their signaling.