Juan Wang,* Yankun Zhang,* Huimin Liu, Lingling Liu, Chong Xu, Jing Zhang

Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jing Zhang, Department of Respiratory and Critical Care, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China, Tel/Fax +86022-60361612, Email tjzyyzhangjing@163.com

Abstract: Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease of the airways and lungs characterized by persistent respiratory symptoms and airflow limitation. Under hypoxic conditions, endothelial cells and immune cells secrete inflammatory mediators and growth factors, promoting the proliferation of pulmonary vascular smooth muscle cells and fibroblasts, leading to vascular remodeling. Considering the high morbidity and mortality of pulmonary hypertension (PH) in patients with COPD, we investigated the molecular mechanisms underlying vascular remodeling in COPD-related PH. Neurohumoral factor N-terminal brain natriuretic peptide (NT-proBNP), inflammatory mediators, growth factors, and forkhead box M1 (FOXM1) were evaluated as auxiliary diagnostic markers for COPD with PH and chronic cor pulmonale (CCP), aiming to facilitate early PH screening, prevention, and improvement of patient survival and quality of life. Circulating biomarkers (NT-proBNP, inflammatory mediators, growth factors) can be detected via clinical blood sampling, offering non-invasive, convenient diagnostic approaches with high specificity and sensitivity—ideal tools for disease screening. Intracellular molecular marker FOXM1, requiring tissue or enriched cell detection, serves as a histopathological marker and potential target for liquid biopsy, positioning it as a promising future screening tool.

Keywords: COPD, pulmonary hypertension, PH, chronic cor pulmonale, CCP, biomarkers, inflammatory cytokines, growth factors, FOXM1