Background
Pulmonary arterial hypertension (PH), whether idiopathic or related to
underlying diseases such as HIV infection, results from complex vessel remodeling
involving both pulmonary-artery smooth muscle cell (PA-SMC) proliferation and
inflammation. CCR5, a co-receptor for cellular HIV-1 entry expressed on macrophages and
vascular cells, may be involved in the pathogenesis of PH. Maraviroc is a new CCR5
antagonist designed to block HIV entry.
Methods and Results
Marked CCR5 expression was found in lungs from patients with idiopathic PH, in
mice with hypoxia-induced PH and in SIV-infected macaques, in which it was chiefly
localized in the PA-SMCs. To assess the role for CCR5 in experimental PH, we used both
gene disruption and pharmacological CCR5 inactivation in mice. Because maraviroc does
not bind to murine CCR5, we used human-CCR5ki mice for pharmacological and
immunohistochemical studies. Compared to wild-type mice,
CCR5−/− mice or human-CCR5ki mice treated with maraviroc
exhibited decreased PA-SMC proliferation and recruitment of perivascular and alveolar
macrophages during hypoxia exposure. CCR5−/− mice reconstituted
with wild-type bone-marrow cells and wild-type mice reconstituted with
CCR5−/− bone-marrow cells were protected against PH,
suggesting CCR5-mediated effects on PASMCs and macrophage involvement. The CCR5 ligands
CCL5 and the HIV-1 gp120 protein increased intracellular calcium and induced growth of
human and h-CCR5ki mouse PASMCs; maraviroc inhibited both effects. Maraviroc also
reduced the growth-promoting effects of conditioned media from CCL5-activated
macrophages derived from human-CCR5ki mice on PA-SMCs from wild-type mice.
Conclusions
The CCL5-CCR5 pathway represents a new therapeutic target in PH associated with
HIV or with other conditions.