“…The PDE4 family is encoded by four different genes, PDE4A, PDE4B, PDE4C, and PDE4D, and the encoded isozymes have distinct tissue/cell expression patterns and functional roles. Their broad functions and distribution are likely to contribute to the side effects associated with pan-PDE4 inhibitor drugs; for example, the emetic side effects of pan-PDE4 inhibitors have been linked to PDE4D expression in the nervous system 16 , 17 . Therefore, identifying the PDE4 isozyme(s) that are most biologically relevant to the pathology of PH could guide the development of PDE4 isozyme-specific inhibitors.…”