MCT aggregates on and activates the
calcium-sensing receptor (CaSR) of pulmonary artery
endothelial cells to trigger endothelial damage and, ultimately, induces
pulmonary hypertension. MCT binds to the extracellular domain of the CaSR (calcium-sensing receptor). Thereby, the assembly of CaSR is enhanced and triggers the mobilisation of calcium signalling, and damages pulmonary artery endothelial cells. In addition, MCT strengthens this effect by binding to the
bone morphogenetic protein receptor type II (BMPR2), which is a
transmembrane receptor. BMPR2 inhibition occurs which in turn induces a blockade of BMPR1 receptor activation via
phosphorylation. Inhibiting this process disturbs cell differentiation processes and ossification. Interference with these receptors induce pulmonary arterial hypertension.
MAPK is a mitogen activated protein kinase that gets activated upon BMPR2 activation. The protein kinase in turn phosphorylates p38 via a reinforced cascade of intracellular signals. It also activates p21 which has a regulating role in the cell cycle. However, MCT administration inhibits this process via a blockade of BMPR2.
Cytokines such as
TNF-α are released which cause activation of
inflammation mechanisms, attracting
neutrophils among others. Furthermore, inducible
nitric oxide synthases (iNOS) are upregulated upon MCT induced cellular stress, whereas
endothelial NOS (eNOS) gets downregulated. The cytokine TGF-β (also released by macrophages via chemotaxis during inflammation reactions in a positive feedback loop with TNF-α) is a transforming growth factor that is upregulated as a result of iNOS increase, contributing to pulmonary artery proliferation. Increased levels of iNOS also stimulate
caspase-3 activity which increases
apoptosis levels. == See also ==