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Despite its etiologic heterogeneity, the underlying unifying pathophysiology is characterized by increased vascular tone and adverse remodeling of the pulmonary circulation. Myeloperoxidase (MPO), an enzyme abundantly expressed in neutrophils, has potent vasoconstrictive and profibrotic properties, thus qualifying as a potential contributor to this disease. Here, we sought to investigate whether MPO is causally linked to the pathophysiology of PAH. Investigation of 2 independent clinical cohorts revealed that MPO plasma levels were elevated in subjects with PAH and predicted adverse outcome. Experimental analyses showed that, upon hypoxia, right ventricular pressure was less increased in\n                    <jats:italic>\n                      Mpo\n                      <jats:sup>\u2013\/\u2013<\/jats:sup>\n                    <\/jats:italic>\n                    than in WT mice. The hypoxia-induced activation of the Rho-kinase pathway, a critical subcellular signaling pathway yielding vasoconstriction and structural vascular remodeling, was blunted in\n                    <jats:italic>\n                      Mpo\n                      <jats:sup>\u2013\/\u2013<\/jats:sup>\n                    <\/jats:italic>\n                    mice. Mice subjected to i.v. infusion of MPO revealed activation of Rho-kinase and increased right ventricular pressure, which was prevented by coinfusion of the Rho-kinase inhibitor Y-27632. In the Sugen5416\/hypoxia rat model, PAH was attenuated by the MPO inhibitor AZM198. The current data demonstrate a tight mechanistic link between MPO, the activation of Rho-kinase, and adverse pulmonary vascular function, thus pointing toward a potentially novel avenue of treatment.\n                  <\/jats:p>","DOI":"10.1172\/jci.insight.97530","type":"journal-article","created":{"date-parts":[[2018,6,6]],"date-time":"2018-06-06T11:01:10Z","timestamp":1528282870000},"source":"Crossref","is-referenced-by-count":63,"title":["Myeloperoxidase aggravates pulmonary arterial hypertension by activation of vascular Rho-kinase"],"prefix":"10.1172","volume":"3","author":[{"given":"Anna","family":"Klinke","sequence":"first","affiliation":[{"name":"Heart Center, Department of Cardiology,"},{"name":"Center for Molecular Medicine Cologne CMMC, University of Cologne, Cologne, Germany."},{"name":"International Clinical Research Center, Centre of Biomolecular and Cellular Engineering (CBCE), St. Anne\u2019s University Hospital Brno, Brno, Czech Republic."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Berghausen","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology,"},{"name":"Center for Molecular Medicine Cologne CMMC, University of Cologne, Cologne, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Friedrichs","sequence":"additional","affiliation":[{"name":"Heart Center, Department of Cardiology,"},{"name":"Center for Molecular Medicine Cologne CMMC, University of Cologne, Cologne, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Molz","sequence":"additional","affiliation":[{"name":"University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Lau","sequence":"additional","affiliation":[{"name":"University Heart Center Hamburg, University Medical Center 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