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Published on: August 8, 2022
Clinical effects of phosphodiesterase 3A mutations in inherited hypertension with brachydactyly
Okan Toka1, Jens Tank1, Carolin Schächterle1
1From the Children's' Hospital, Department of Pediatric Cardiology, Friedrich-Alexander University Erlangen, Erlangen, Germany (O.T.); Institute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany (J.T., J.J.); Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany (C.S., A.A., P.G.M., E.B.-K., I.H., A.M., Y.W.-N., J.S.-M., E.K., S.B., F.C.L.); Experimental and Clinical Research Center (ECRC), a joint co-operation between the Charité Medical Faculty and the Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany (A.A., P.G.M., E.B.-K., I.H., C.L., K.M., M.B., G.R., A.M., Y.W.-N., W.U., A.T., J.S.-M., S.B., F.C.L.); Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA (P.G.M.); Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, MA (P.G.M.); Department of Cardiology/Nephrology, Helios-Klinikum Berlin, Berlin, Germany (S.E., W.U., A.T., J.S.-M.); Department of Nephrology, Hannover University Medical School, Hannover, Germany (C.L.); Staatliche Technikerschule Berlin, Berlin, Germany (C.L.); Cardiology Section, VA Salt Lake City Health Care System, UT (M.A.M.); Departments of Internal Medicine and Pharmacology and Toxicology, University of Utah, Salt Lake City (M.A.M.); Blood Transfusion Center, Deutsches Rotes Kreuz, Oldenburg, Germany (T.M., A.D., S.G.); Division of Nephrology and Hypertension, Department of Medicine, Eastern Virginia Medical School, Norfolk, VA (H.R.T.); Hampton Veterans Affairs Medical Center, Hampton, VA (H.R.T); German Centre for Cardiovascular Research (DZHK), Berlin, Germany (E.K.); and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (F.C.L.).
Abstract:
Autosomal-dominant hypertension with brachydactyly is a salt-independent Mendelian syndrome caused by activating mutations in the gene encoding phosphodiesterase 3A. These mutations increase the protein kinase A-mediated phosphorylation of phosphodiesterase 3A resulting in enhanced cAMP-hydrolytic affinity and accelerated cell proliferation. The phosphorylated vasodilator-stimulated phosphoprotein is diminished, and parathyroid hormone-related peptide is dysregulated, potentially accounting for all phenotypic features. Untreated patients die prematurely of stroke; however, hypertension-induced target-organ damage is otherwise hardly apparent. We conducted clinical studies of vascular function, cardiac functional imaging, platelet function in affected and nonaffected persons, and cell-based assays. Large-vessel and cardiac functions indeed seem to be preserved. The platelet studies showed normal platelet function. Cell-based studies demonstrated that available phosphodiesterase 3A inhibitors suppress the mutant isoforms. However, increasing cGMP to indirectly inhibit the enzyme seemed to have particular use. Our results shed more light on phosphodiesterase 3A activation and could be relevant to the treatment of severe hypertension in the general population.
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