Ethanol‐induced lung and cardiac right ventricular inflammation and remodeling underlie progression to pulmonary arterial hypertension

Abstract Background Current research on ethanol‐induced cardiovascular anomalies has focused on left ventricular (LV) function and blood pressure. To extend this area of research, we sought to determine whether ethanol‐induced alterations in the structure and function of the right cardiac ventricle (RV) and pulmonary artery (PA) lead to pulmonary arterial hypertension (PAH). Methods Two groups of male Sprague–Dawley rats received a balanced liquid diet containing 5% ethanol (w/v) or a pair‐fed isocaloric liquid diet for 8 weeks. Weekly echocardiography was conducted to evaluate cardiopulmonary function, and lung and RV tissues were collected for ex vivo histological and molecular studies. Results The ethanol‐treated rats exhibited: (1) Elevated mean pulmonary arterial pressure and decreased pulmonary artery acceleration time/ejection time; (2) Pulmonary vascular remodeling comprising intrapulmonary artery medial layer thickening; and (3) RV hypertrophy along with increased RV/LV + septum, RV diameter, RV cardiomyocyte cross‐sectional area, and LV mass/body weight ratio. These responses were associated with increased lung and RV pro‐inflammatory markers, endothelin‐1 (ET‐1), TNF‐α, and IL‐6 levels and higher ET‐1, ET‐1 type A/B receptor ratio, and downregulation of the cytoprotective protein, bone morphogenetic protein receptor 2 (BMPR2), in the lungs. Conclusion These findings show that moderate ethanol‐induced cardiopulmonary changes underlie progression to PAH via an upregulated proinflammatory ET1‐TNFα‐IL6 pathway and suppression of the anti‐inflammatory BMPR2.