Regulation of the L-arginine – ADMA – Nitric Oxide (NO) Pathway in the Pulmonary Vascular Response to Hypoxia and its Role for Survival of High-Risk COPD Patients

NO PRESSURE will address the hypothesis that intermittent hypoxaemia is a major driver of the pulmonary pathophysiology and the systemic co-morbidity that is present at a sub-clinical level already in early disease stages of a significant sub-group of COPD patients with a high risk of rapidly declining lung function and poor prognosis. The project has been conceptualized to achieve ground-breaking scientific insight into the role of intermittent hypoxaemia as a driver of COPD progression and outcome via dysfunction of the L-arginine-ADMA-NO pathway. Its five work packages will span from molecular regulation of the pulmonary L-arginine-ADMA-NO pathway in hypoxia to cellular oxygen sensing and signal transduction mechanisms, via translational studies in genetically modified mouse models and genotyped healthy humans, to clinical proof-of-concept studies of exercise-induced, intermittent hypoxaemia as a diagnostic indicator to identify a subgroup of high-risk COPD patients and the ability to therapeutically intervene by pharmacological modification of the L arginine-ADMA-NO pathway.Combining state-of-the-art molecular biology techniques, specifically designed genetically engineered animal models, and translation of the obtained results into genomically characterized humans who will be exposed to hypoxia, NO PRESSURE will achieve a unique level of depth in our understanding of the molecular pathophysiology of the lung’s response to hypoxia with proven relevance to human biology. Beyond this, NO PRESSURE will take the step towards validation of pathophysiologically proven biomarkers and, thus, molecular mechanisms in the world’s unique long-term prospective cohort for lung disease. In addition, it will deliver unequivocal evidence for clinical utility in two small, but well defined COPD patient cohorts, with one having a focus on prognostic relevance and the other one opening the avenue towards future pharmacotherapeutic intervention to improve prognosis.