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ResearchIn-Press PreviewCardiologyPulmonologyVascular biology Open Access | 10.1172/jci.insight.200684

Apelin analog treatment reverses severe pulmonary arterial hypertension and right ventricular heart failure

Jennie Vu,1 Pavel Zhabyeyev,2 Kemar J. Brown,3 Joshua M. Gorham,3 Daniel M. DeLaughter,3 Huachen Chen,2 Thilina U. Jayawardena,2 Ander Vergara,2 Maria Alexiou,4 Anjalee Wijewardane,5 Conrad Fischer,5 Charlotte Avet,6 Abby Ewasiuk,2 Faqi Wang,2 Mark C. Chappell,7 Yuri Kim,8 Michel Bouvier,6 John C. Vederas,5 Christine E. Seidman,8 Jonathan G. Seidman,3 and Gavin Y. Oudit2

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Vu, J. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Zhabyeyev, P. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Brown, K. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Gorham, J. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by DeLaughter, D. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Chen, H. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Jayawardena, T. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Vergara, A. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Alexiou, M. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Wijewardane, A. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Fischer, C. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Avet, C. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Ewasiuk, A. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Wang, F. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Chappell, M. in: PubMed | Google Scholar

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Kim, Y. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Bouvier, M. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Vederas, J. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Seidman, C. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Seidman, J. in: PubMed | Google Scholar |

1Department of Physiology, University of Alberta, Edmonton, Canada

2Department of Medicine, University of Alberta, Edmonton, Canada

3Department of Genetics, Harvard Medical School, Boston, United States of America

4Department of Dentistry & Dental Hygiene, University of Alberta, Edmonton, Canada

5Department of Chemistry, University of Alberta, Edmonton, Canada

6Institute for Research in Immunology and Cancer, Université de Montréal, Montréal, Canada

7Department of Surgery/Hypertension and Vascular Research, Wake Forest University School of Medicine, Winston Salem, United States of America

8Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America

Find articles by Oudit, G. in: PubMed | Google Scholar |

Published June 18, 2026 - More info

JCI Insight. https://doi.org/10.1172/jci.insight.200684.
Copyright © 2026, Vu et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published June 18, 2026 - Version history
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Abstract

Pulmonary arterial hypertension (PAH) is a progressive vascular syndrome characterized by aberrant signaling, severe pulmonary artery remodeling, and right ventricular (RV) failure, a major driver of morbidity and mortality. Dysregulation of the apelinergic pathway has been implicated in pulmonary vascular remodeling in PAH. Using a sugen-hypoxia rat model of PAH, we assessed the ability of a novel apelin analog, resistant to native peptidase degradation, to reverse the pathological hallmarks of PAH and RV dysfunction. Apelin analog therapy corrected the vascular lesions in the lungs and nearly normalized pulmonary arterial pressures. Early cardiorenal syndrome, RV dilation and dysfunction as well as RV cardiomyocyte and fibroblast activation induced by pressure overload, were also reversed by apelin analog treatment. Single-nucleus RNA sequencing of the lungs and RV revealed apelin-analog treatment activated several protective pathways, including rebalancing protective BMPR2 (bone morphogenetic protein receptor type 2) signaling to counteract excessive pathogenic TGFBR2 (transforming growth factor β receptor 2) activity in PAH. These findings highlight the therapeutic potential of exogenous apelin in reversing pulmonary vascular and cardiac pathologies in PAH and support further investigation to evaluate the clinical benefits of apelin analog treatment in patients with PAH and RV failure.

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View Video S1: untreated pulmonary arterial hypertension heart

View Video S2: pulmonary arterial hypertension heart treated with apelin analog

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  • Version 1 (June 18, 2026): In-Press Preview

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