Fig. 1. PDK is important in the metabolic remodeling of PAH and is up-regulated in human PAH lungs. PDK is important in the metabolic remodeling of PAH.

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Fig. 1. PDK is important in the metabolic remodeling of PAH and is up-regulated in human PAH lungs. PDK is important in the metabolic remodeling of PAH and is up-regulated in human PAH lungs. (A) Schematic demonstrating how PDK and SIRT3 and UCP2 suppress mitochondrial function by independent mechanisms (inhibition of PDH and glucose oxidation, global increase in mitochondrial acetylation, and global decrease in mitochondrial calcium, respectively). This mitochondrial suppression inhibits apoptosis and promotes proliferation, leading to the proliferative vascular remodeling characteristic of PAH. DCA is a selective PDK inhibitor and does not affect other mechanisms of PDH inhibition. DCA may inhibit the feedback loop that links PDK-driven mitochondrial suppression and secondary normoxic activation of HIF1α to HIF-induced PDK induction. ETC, electron transport chain; Ca++mito, intramitochondrial calcium; acetyl-CoA, acetyl–coenzyme A. (B) Confocal immunohistochemistry of a PAH and a non-PAH control lung with parallel staining for PDK1, PDK2, smooth muscle actin (SMA), and 4ʹ,6-diamidino-2-phenylindole (DAPI, a nuclear marker). Yellow boxes on differential interference contrast (DIC) images focus on small resistance PAs, shown at higher magnification (right). An example of the stain only with secondary antibody is shown at the bottom. See Table 1 for patient information. (C) Immunoblots of peripheral lung tissues from PAH and control (non-PAH) lungs (for patient information, see Table 1) probed for p-PDH-E1α, PDH-E1α, PDK1, and PDK2. Quantification of the PDK1 or PDK2 over actin and p-PDH-E1α/PDH-E1α (normalized to actin) in each gel is shown. *P < 0.05, Mann-Whitney U test. ATP, adenosine triphosphate. Evangelos D. Michelakis et al., Sci Transl Med 2017;9:eaao4583 Published by AAAS