Sotatercept: A novel therapeutic approach for pulmonary arterial hypertension through transforming growth factor-β signaling modulation

Figure 1 Schematic representation of the proposed mechanism of action of sotatercept. By binding and sequestering activin-class ligands - such as activin A, growth differentiation factor 8, and growth differentiation factor 11 - it reduces overactive drosophila mothers against decapentaplegic protein 2/3 signaling while restoring deficient drosophila mothers against decapentaplegic protein 1/5/8 signaling. This rebalancing exerts antiproliferative and anti-inflammatory effects on the pulmonary vasculature, reversing pathological remodeling of small pulmonary arteries. BMPS: Bone morphogenetic proteins; ALK: Anaplastic lymphoma kinase; Smad: Drosophila mothers against decapentaplegic protein; GDF: Growth differentiation factor; ActRIIA/B: Activin receptor type 2A/B.