Figure 1.

Metabolic signaling pathways promoting pulmonary hypertension. During the development of pulmonary hypertension, vascular cells release growth factors, which activate the hypoxia-inducible factors (HIF). HIF triggers signaling pathways that have a direct proliferative effect in both endothelial and smooth muscle cells. HIF can also modulate metabolic pathways such as glycolysis, pentose phosphate pathway, randle cycle, glutaminolysis and tricarboxylic acid cycle, which activate several downstream pathways. (EGFR, epidermal growth factor receptor; FGF2, fibroblast growth factor 2; PDGF, platelet-derived growth factor; GLUT, glucose transporter; HIF, hypoxia-inducible factors; ROS, reactive oxygen species).