Pulmonary hypertension: Pathophysiology beyond the lung.

Area of Science:

• Cardiopulmonary Medicine
• Systems Biology
• Neurogastroenterology

Background:

• Pulmonary hypertension (PH) is traditionally viewed as a pulmonary vasculature disease.
• Despite advances, PH prognosis remains poor, with a 5-year median survival.
• Recent research indicates neuroinflammation, autonomic dysfunction, and bone marrow cell trafficking in PH.

Purpose of the Study:

• To review evidence implicating the brain, bone marrow, and gut in PH pathophysiology.
• To synthesize evidence supporting a brain-gut-lung interaction hypothesis in PH.
• To identify future research directions for this novel concept.

Main Methods:

• Literature review and synthesis of existing studies.
• Analysis of evidence for organ system involvement in PH.
• Formulation of a brain-gut-lung interaction hypothesis.

Main Results:

• Evidence supports the involvement of the brain, bone marrow, and gut in PH.
• A complex interplay among these organs suggests a systemic disease model for PH.
• Neuroinflammation, altered autonomic function, and gut changes are implicated.

Conclusions:

• PH may be a systemic disease involving intricate brain-gut-lung interactions.
• This perspective offers novel therapeutic targets beyond the pulmonary vasculature.
• Further research is needed to validate and explore this hypothesis for PH treatment.