G6pd N126D Variant Increases the Risk of Developing VEGFR (Vascular Endothelial Growth Factor Receptor) Blocker‐Induced Pulmonary Vascular Disease

Background G6PD (glucose‐6‐phosphate‐dehydrogenase) is a key enzyme in the glycolytic pathway and has been implicated in the pathogenesis of cancer and pulmonary hypertension‐associated vascular remodeling. Here, we investigated the role of an X‐linked G6pd mutation (N126D polymorphism), which is known to increase the risk of cardiovascular disease in individuals from sub‐Saharan Africa and many others with African ancestry, in the pathogenesis of pulmonary hypertension induced by a vascular endothelial cell growth factor receptor blocker used for treating cancer. Methods and Results CRISPR‐Cas9 genome editing was used to generate the G6pd variant (N126D; G6pd N126D ) in rats. A single dose of the vascular endothelial cell growth factor receptor blocker sugen‐5416 (SU; 20 mg/kg in DMSO), which is currently in a Phase 2/3 clinical trial for cancer treatment, was subcutaneously injected into G6pd N126D rats and their wild‐type littermates. After 8 weeks of normoxic conditions, right ventricular pressure and hypertrophy, pulmonary artery remodeling, the metabolic profile, and cytokine expression were assessed. Right ventricular pressure and pulmonary arterial wall thickness were increased in G6PD N126D +SU/normoxic rats. Simultaneously, levels of oxidized glutathione, inositol triphosphate, and intracellular Ca 2+ were increased in the lungs of G6PD N126D +SU/normoxic rats, whereas nitric oxide was decreased. Also increased in G6PD N126D +SU/normoxic rats were pulmonary levels of plasminogen activator inhibitor‐1, thrombin‐antithrombin complex, and expression of proinflammatory cytokines CCL3 (chemokine [C‐C motif] ligand), CCL5, and CCL7. Conclusions Our results suggest G6PD N126D increases inositol triphosphate‐Ca 2+ signaling, inflammation, thrombosis, and hypertrophic pulmonary artery remodeling in SU‐treated rats. This suggests an increased risk of vascular endothelial cell growth factor receptor blocker‐induced pulmonary hypertension in those carrying this G6PD variant.