Exploratory Study of Prognostic Plasma Biomarkers in Patients with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is characterized by progressive pulmonary vascular lumen occlusion, ultimately leading to right ventricular failure and death. Risk stratification is essential for the management of patients with PAH. So far, B-type natriuretic peptide and its N-terminal pro–form are the only circulating biomarkers used as part of composite PAH risk assessment tools. Identification of other biomarkers of vascular or systemic origin may also be valuable to provide additional information on disease severity and prognosis. Using proximity extension assay, over 700 proteins related to oncology and neurology were measured in the plasma of 60 PAH patients and 28 age- and -sex matched controls. Among the 114 proteins found to be significantly upregulated in PAH patients, 14 were independently associated with death/lung transplantation after adjustment for the 2015 ESC/ERS, the REVEAL 2.0 risk scores, and the refined 4-stratum risk assessment model. Among them, EDA2R, WFDC2 and TNFRSF10B displayed incremental prognostic value on top of these predictive models. Combining our previously published proteomic datasets generated from different panels with the same cohort, a set of 23 proteins was identified, many of which are strongly associated with chronological age, that predict outcome of patients with PAH after adjusting for risk assessment tools. In conclusion, we identified proteins likely involved in the pathophysiology of the disease and potential candidates to prognostic enrichment.