Article
Author: Rhodes, Christopher J ; Chan, Stephen Y. ; El Khoury, Wadih ; Trembath, Richard C. ; Humbert, Marc ; Pauciulo, Michael W ; Boueiz, Adel ; Vargas, Sara O. ; Negi, Vinny ; Wu, Haodi ; Barndt, Robert J. ; Karnes, Jason H. ; Kaufman, Brett ; Tang, Ying ; McNamara, Dennis ; Tai, Yi-Yin ; Bhat, Bal ; Chau, B Nelson ; Vargas, Sara O ; Satoh, Taijyu ; Barndt, Robert J ; Nichols, William C ; Belmonte, Frances ; Sitbon, Olivier ; Wilkins, Martin R ; Corey, Catherine G ; Morrell, Nicholas W ; Kim, Seungchan ; Torrino, Stephanie ; Parikh, Victoria N ; Schwartz, Brian ; Morrell, Nicholas W. ; Yu, Qiujun ; Graf, Stefan ; Desai, Ankit A. ; Speyer, Gil ; Chan, Stephen Y ; Mari, Bernard ; Zhao, Jingsi ; Rhodes, Christopher J. ; Li, Gang ; Parikh, Victoria N. ; Gomez, Delphine ; Southgate, Laura ; Chau, B. Nelson ; Kelly, Neil J ; Al Aaraj, Yassmin ; Pauciulo, Michael W. ; Liu, Mingjun ; Wilkins, Martin R. ; Zhang, Yingze ; Trembath, Richard C ; Cho, Michael H. ; Wang, Bing ; Wang, Jianrong ; Bertero, Thomas ; Corey, Catherine G. ; Schwantes-An, Tae-Hwi ; Shiva, Sruti ; Nouraie, Mehdi ; Sun, Wei ; Nichols, William C. ; Cho, Michael H ; Okawa, Satoshi ; Lacoux, Caroline ; Kelly, Neil J. ; Karnes, Jason H ; Desai, Ankit A
Hypoxic reprogramming of vasculature relies on genetic, epigenetic, and metabolic circuitry, but the control points are unknown. In pulmonary arterial hypertension (PAH), a disease driven by hypoxia inducible factor (HIF)–dependent vascular dysfunction, HIF-2α promoted expression of neighboring genes, long noncoding RNA (lncRNA) histone lysine
N
-methyltransferase 2E-antisense 1 (
KMT2E-AS1
) and histone lysine N-methyltransferase 2E (
KMT2E
).
KMT2E-AS1
stabilized KMT2E protein to increase epigenetic histone 3 lysine 4 trimethylation (H3K4me3), driving HIF-2α–dependent metabolic and pathogenic endothelial activity. This lncRNA axis also increased HIF-2α expression across epigenetic, transcriptional, and posttranscriptional contexts, thus promoting a positive feedback loop to further augment HIF-2α activity. We identified a genetic association between rs73184087, a single-nucleotide variant (SNV) within a
KMT2E
intron, and disease risk in PAH discovery and replication patient cohorts and in a global meta-analysis. This SNV displayed allele (G)–specific association with HIF-2α, engaged in long-range chromatin interactions, and induced the lncRNA-KMT2E tandem in hypoxic (G/G) cells. In vivo,
KMT2E-AS1
deficiency protected against PAH in mice, as did pharmacologic inhibition of histone methylation in rats. Conversely, forced lncRNA expression promoted more severe PH. Thus, the
KMT2E-AS1
/KMT2E pair orchestrates across convergent multi-ome landscapes to mediate HIF-2α pathobiology and represents a key clinical target in pulmonary hypertension.