• Jiao Zhang, Jianjie Dong, Marcy Martin, Ming He, Brendan Gongol, Traci L Marin, Lili Chen, Xinxing Shi, Yanjun Yin, Fenqing Shang, Yan Wu, Hsi-Yuan Huang, Jin Zhang, Yu Zhang, Jian Kang, Esteban A Moya, Hsien-Da Huang, Frank L Powell, Zhen Chen, Patricia A Thistlethwaite, Zu-Yi Yuan, and John Y-J Shyy.
• 1 Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
• Am. J. Respir. Crit. Care Med. 2018 Aug 15; 198 (4): 509-520.

RationaleEndothelial dysfunction plays an integral role in pulmonary hypertension (PH). AMPK (AMP-activated protein kinase) and ACE2 (angiotensin-converting enzyme 2) are crucial in endothelial homeostasis. The mechanism by which AMPK regulates ACE2 in the pulmonary endothelium and its protective role in PH remain elusive.ObjectivesWe investigated the role of AMPK phosphorylation of ACE2 Ser680 in ACE2 stability and deciphered the functional consequences of this post-translational modification of ACE2 in endothelial homeostasis and PH.MethodsBioinformatics prediction, kinase assay, and antibody against phospho-ACE2 Ser680 (p-ACE2 S680) were used to investigate AMPK phosphorylation of ACE2 Ser680 in endothelial cells. Using CRISPR-Cas9 genomic editing, we created gain-of-function ACE2 S680D knock-in and loss-of-function ACE2 knockout (ACE2-/-) mouse lines to address the involvement of p-ACE2 S680 and ACE2 in PH. The AMPK-p-ACE2 S680 axis was also validated in lung tissue from humans with idiopathic pulmonary arterial hypertension.Measurements And Main ResultsPhosphorylation of ACE2 by AMPK enhanced the stability of ACE2, which increased Ang (angiotensin) 1-7 and endothelial nitric oxide synthase-derived NO bioavailability. ACE2 S680D knock-in mice were resistant to PH as compared with wild-type littermates. In contrast, ACE2-knockout mice exacerbated PH, a similar phenotype found in mice with endothelial cell-specific deletion of AMPKα2. Consistently, the concentrations of phosphorylated AMPK, p-ACE2 S680, and ACE2 were decreased in human lungs with idiopathic pulmonary arterial hypertension.ConclusionsImpaired phosphorylation of ACE2 Ser680 by AMPK in pulmonary endothelium leads to a labile ACE2 and hence is associated with the pathogenesis of PH. Thus, AMPK regulation of the vasoprotective ACE2 is a potential target for PH treatment.

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