Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Quentin Felty

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Changwon Yoo

Second Advisor's Committee Title

Committee chair-Co major professor

Third Advisor's Name

Deodutta Roy

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Juan Luizzi

Fourth Advisor's Committee Title

Committee member

Fifth Advisor's Name

Alok Deoraj

Fifth Advisor's Committee Title

Committee member


Pulmonary Arterial Hypertension, PAH, PCB, sex bias, estrogen.

Date of Defense



The overall objective of the research presented in this dissertation was to investigate molecular risk factors of susceptibility to estrogenic chemicals, polychlorinated biphenyls (PCBs), hormone replacement therapy, and oral contraceptives and how that leads to the development of pulmonary arterial hypertension (PAH). Environmental and molecular risk factors for PAH are not clearly understood. This is a major hurdle for the development of new therapy against PAH as well as understanding individual susceptibility to this disease. Gender has been shown to impact the prevalence of PAH. Although controversial, estrogens have been implicated to be a risk factor for PAH. Thus, we hypothesize that women exposed to estrogenic chemicals are at increased risk of developing PAH when endocrine disrupting chemicals interact with unopposed estrogen to worsen pulmonary arterial disease. In support of this hypothesis, we have accomplished the following: Microarray data on PAH were collected and subsequent meta-analysis was conducted using genome-wide association and environment-wide association approaches on published studies as well as GEO and NHANES data. All PCB geometric mean concentrations found higher levels in people at risk of PAH than people not at risk of PAH. The sum of non-dioxin-like PCBs and the sum of dioxin-like PCBs were significantly higher in people at risk of PAH than people not at risk of PAH. Also, different levels of LOD (including PCBs concentration >LOD, > 50th percentile, 50th-75th percentile, and ≥75th percentile) were significantly higher in people at risk of PAH than people not at risk of PAH. We reported that females used estrogen pills and oral contraceptive were associated with risk of PAH. However, females used progestin and estrogen/progestin pills were not at risk of PAH. Molecular risk factor analysis using machine learning approaches revealed that VAMP2, LAMA5, POLR2C, VEGFB, and PRKCH genes are causal genes of PAH pathogenesis. Gene ontology and pathway analysis of PAH showed that genes involved in the apoptosis pathway, p53 pathway, Ras Pathway, T-cell activation, TGF-beta pathway, VEGF pathway, and Wnt pathway appear to be significantly associated with PAH. Documenting the exposure to estrogenic chemicals among the general U.S. population, and identifying agents and molecular risk factors associated with PAH have the potential to fill research gaps and facilitate our understanding of the complex role environmental chemicals play in producing toxicity in the lungs.





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