Culture of Pulmonary Arterial Endothelial Cells from Pulmonary Artery Catheter Balloon Tips: Considerations for Use in Pulmonary Vascular Disease

Endothelial dysfunction is a hallmark of pulmonary arterial hypertension (PAH) but there are no established methods to study pulmonary artery endothelial cells (PAECs) from living patients. We sought to culture PAECs from pulmonary artery catheter (PAC) balloons used during right heart catheterisation (RHC), to characterise successful culture attempts and to describe PAEC behavior. PAECs were grown in primary culture to confluence and endothelial cell phenotype confirmed. Standard assays for apoptosis, migration, and tube formation were performed between passage 3–8. We collected 49 PAC tips from 45 subjects with successful PAEC culture from 19 (39%) balloons. There were no differences in subject demographic or RHC procedural details in successful versus unsuccessful attempts. There was a higher but nonsignificant proportion of successful (10/19, 53%) versus unsuccessful (9/30, 30%) attempts from subjects who met hemodynamic criteria for PAH (p=0.10). Successful culture was more likely in subjects with lower cardiac index (p=0.03) and higher pulmonary vascular resistance (p=0.04). PAECs from a subject with idiopathic PAH were apoptosis resistant compared to commercial PAECs (p=0.04) and had reduced migration compared to PAECs from a subject with portopulmonary hypertension with high cardiac output (p=0.01). PAECs from a subject with HIV-associated PAH formed fewer (p=0.01) and shorter (p=0.02) vessel networks compared to commercial PAECs. Sustained culture and characterisation of PAECs from RHC balloons is feasible, especially in PAH with high hemodynamic burden. This technique may provide insight into endothelial dysfunction during PAH pathogenesis.