Non-canonical PKG1 regulation in cardiovascular health and disease

It is well established that the cyclic GMP-dependent protein kinase I (PKG1) is canonically activated by cyclic guanosine monophosphate (cGMP), enabling its regulation of vascular tone, cardiac function and smooth muscle homeostasis. However, diverse non-canonical stimuli of PKG1 have also been identified. This includes oxidants, the immune-derived cyclic nucleotide 2'3'-cyclic-GMP-AMP (cGAMP), cross-activation by cyclic adenosine 3',5'-monophosphate (cAMP) and small molecular activators. These alternative regulatory mechanisms allow fine tuning of PKG1 activity and enable the regulation of diverse cellular processes. Non-canonical activation of PKG1 plays a central role in maintaining normal cardiovascular function where oxidant-dependent mechanisms regulate blood pressure and cardiac diastolic relaxation. In addition, in situations where nitric oxide (NO) bioavailability is compromised because of endothelial dysfunction, oxidative activation can provide an alternative mechanism to maintain vascular homeostasis. Conversely in sepsis, excessive activation of PKG1 through direct oxidation or immune-derived cGAMP can contribute to hypotension and tissue injury. Thus, non-canonical modes of PKG1 activation play diverse roles which, depending on the context, can contribute to cardiovascular health or disease progression. Given its growing implications, targeting non-canonical PKG1 activation could offer promising new therapeutic strategies for cardiovascular diseases. However, achieving this requires a deeper understanding of how these alternate mechanisms influence cardiovascular health and pathology. By broadening our perspective on PKG1 regulation, this review aims to highlight new opportunities for the development of innovative cardiovascular therapies that extend beyond the canonical NO-cGMP pathway.