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FIGURE 1 Endothelial dysfunction is a key early event in PAH, leading to an imbalance between vasodilators (e.g., NO, prostacyclin) and vasoconstrictors (e.g., endothelin-1, thromboxane) ( Inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) are elevated in PAH, contributing to endothelial damage and vascular remodeling ( Oxidative stress plays a critical role in the pathogenesis of PAH, primarily through its effects on endothelial dysfunction, vascular remodeling, and cellular metabolic reprogramming
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