Abstract Body: Pulmonary hypertension (PH) is caused by lung vascular remodeling involving increased pulmonary arterial smooth muscle cell (PASMC) proliferation and apoptosis resistance. Na^+/H⁺ exchanger (NHE) isoform 1 (NHE1) is a membrane protein regulating intracellular pH (pH_i) via movement of H⁺. Our lab found increased NHE activity is associated with hyperproliferation in PASMCs from the Sugen Hypoxia (SuHx) animal model of PH. In this study, we tested the hypothesis that increased NHE1 activity also causes apoptosis resistance in SuHx PASMCs via dysregulation of pH_i.

PASMCs isolated from distal pulmonary arteries of control and SuHx rats were treated with NHE inhibitor, [5-(N-ethyl-N-isopropyl)-amiloride; EIPA;1 uM], NHE1 inhibitor [cariporide;10 uM] or vehicle for 24 h before analyzing cell apoptosis via Hoechst staining under baseline and stimulated (250 uM H₂O₂) conditions. Control PASMCs were infected with adenovirus containing green fluorescent protein (GFP), wild-type NHE1 (WT) or NHE1 lacking ion translocation activity (E262I). Protein expression and localization were assessed via immunoblotting. NHE activity was assessed from Na⁺-dependent recovery following an ammonium pulse.

At baseline, apoptosis in SuHx PASMCs was similar to control cells but following H₂O₂ stimulation, SuHx PASMCs were resistant to apoptosis (p<0.001). EIPA increased basal and stimulated apoptosis in SuHx cells. Surprisingly, treatment with cariporide did not alter SuHx apoptosis, suggesting that EIPA but not cariporide was able to sensitize SuHx cells to apoptosis, despite both drugs significantly inhibiting NHE activity, suggesting EIPA affects PASMC apoptosis through a mechanism other than pH_i regulation. To test this possibility, control PASMCs were infected with GFP, WT or E262I. NHE activity was increased in cells with WT, but not E262I, when compared to GFP (p<0.001). Overexpression of either WT or E262I inhibited apoptosis following treatment with H2O2 (p<0.001). We next explored CAAT/enhancer binding protein homologous transcription factor (CHOP), known to be involved in induction of apoptosis. CHOP expression was increased by H2O2 in control cells but was decreased in SuHx PASMCs. EIPA increased CHOP levels in SuHx cells, whereas, expression of both WT and E262I constructs inhibited the H₂O₂-induced CHOP increase in control PASMCs.

Our results indicate that NHE1 regulates apoptosis susceptibility in PASMCs during PH via modulation of CHOP rather than through pH_i regulation.