Auto-immunity and Pulmonary Arterial Hypertension
Auto-immunity and Pulmonary Arterial Hypertension
The investigators have recently evidenced the presence of antibodies to endothelial cells and
 fibroblasts in patients with idiopathic or SSc-associated PAH. The investigators also have
 identified several target antigens of anti-fibroblasts antibodies.

 The objective of this study is to further investigate for the presence of antibodies to
 endothelial cells and fibroblasts in patients and characterize the antigen specificity of
 autoantibodies in patients with different types of non idiopathic and non SSc-associated PAH,
 such as PAH associated with HIV infection, porto-pulmonary hypertension, congenital heart
 diseases, systemic lupus erythematosus, mixed connective tissue disease and Sjögren's
 syndrome
Two hundred and fifty patients with PAH will be included: 65 patients with idiopathic PAH
 (iPAH), 20 with PAH associated with HIV infection, 20 with porto-pulmonary hypertension, 20
 with PAH secondary to congenital heart disorders, 40 with SSc, 20 with SLE, 20 with MCTD and
 10 with a PAH associated with a Sjögren's syndrome.

 Two hundred patients without PAH will also be included: 80 patients with SSc and 20 in each
 of the following groups: HIV infection, porto-pulmonary hypertension, SLE, congenital heart
 disorders, MCTD and with Sjögren's syndrome.

 Twenty patients with proximal chronic thromboembolic pulmonary hypertension (CTPH) will also
 be included in a control arm of the study.

 Two hundred and fifty healthy blood donors age and sex-matched with patients with PAH, will
 be included as controls.

 By using 2D-immunoblotting techniques, we will evidence IgG antibodies to fibroblasts, EC,
 vascular smooth muscle cells (SMC) in multiple groups of patients and we will characterize
 target antigens of these autoantibodies. We will also assess the production of ROS: nitric
 oxide (NO), hydrogen peroxide (H2O2) and the effect of the whole serum (and the IgG
 particularly) on in VITRO proliferation of EC, fibroblasts and vascular SMC. For sera that
 will induce the production of ROS, we will study the effect of different vasodilatator
 (prostacycline, endothelin receptor antagonist, type 5 phosphodiesterase inhibitors) and
 anti-oxidant therapies.

 Expected results We will characterize target antigens of autoantibodies of patients with
 non-idiopathic and non SSc-associated PAH. We will compare these target to those previously
 identified in idiopathic or SSc-associated PAH. We will then, distinguish subpopulations of
 PAH patients whose serum or purified IgG (possibly specific for a given antigen) are able to
 induce ROS production or cell proliferation. For the population of ROS-producer patients, we
 will correlate the clinical response to vasodilatator therapy to results of in VITRO
 inhibition experiments with vasodilatators and anti-oxidant molecules.

 Perspectives The characterization of target antigens of EC, fibroblasts and vascular SMC
 specifically
Inclusion Criteria:

 age over 18

 -  for PAH patients: pre-capillary PAH evidenced by right-heart catheterization

 -  no associated systemic disease for idiopathic PAH patients

 -  for HIV patients, HIV1 infection confirmed by ELISA and western blot

 -  for patients with porto pulmonary hypertension: evidence by endoscopy of esophageal
 varices, confirmation of hepatic venous pressure gradient over 5 mmHg by
 catheterization of the hepatic veins

 -  for patients with congenital heart defect: evidence by imaging of atrial or
 ventricular septal defect, or patent ductus arterious and confirmed by heart
 catheterization

 -  patients with SSc will fulfill the American College of Rheumatology (ACR) and the
 LEROY and MEDSGER criteria

 -  patients with MCTD will fulfill the criteria for MCTD

 -  patients with SLE will fulfill the updated and revised ACR criteria

 -  patients with Sjögren's syndrome will fulfill the American-European consensus group
 criteria

 -  patients with chronic thromboembolic pulmonary hypertension: Lung scintiscan showing
 segmental mismatched perfusion defects and confirmation by angiography of the
 occlusion and the chance of success of endarterectomy according to the location of
 disease

 -  Signed written informed consent

 -  Patients with health insurance

 Exclusion Criteria:

 -  age under 18

 -  pregnant women

 -  absence of written informed consent

 -  associated malignant tumor