Figure 1.

Vascular cell types in the pulmonary arteries undergo dramatic remodeling during PH, especially noted in PAH and hypoxia-induced PH. Up-regulation of growth factors, electrical remodeling, and persistent inflammation produce abnormal PASMCs that proliferate excessively, occluding the arteries and restricting blood flow. Metabolic and mitochondrial dysregulation are crucial to several of these processes, as mitochondrial hyperpolarization and the glycolytic shift lead to the up-regulation of stress factors and impaired release of apoptotic factors. Adapted with permission from ⁸¹.