PAK4 as a cardiometabolic node: tissue-specific metabolic control, cardiovascular remodeling, and therapeutic trade-offs
- 1Department of Biomedical Sciences, Department of Physiology, College of Medicine, Smart Marine Therapeutic Center, Cardiovascular and Metabolic Disease Center, Inje University Busan 47392 Korea
- 2VNU University of Science, Vietnam National University Hanoi 100000 Vietnam
- 3Department of Cardiovascular Aging, National Cerebral and Cardiovascular Center Research Institute, Osaka 564-8565 Japan
Abstract
Cardiometabolic disease reflects interdependent dysfunction across adipose tissue, liver, skeletal muscle, vasculature, and heart. p21-activated kinase 4 (PAK4), a group II serine/threonine kinase controlling cytoskeletal organization and development, has emerged as a nutrient-responsive regulator in metabolic tissues. We position PAK4 as a candidate cardiometabolic node rather than a proven master regulator or direct energy sensor. Established mechanisms include suppression of adipocyte lipolysis and browning, hepatocyte NCoR1-PPARα-dependent fatty-acid oxidation and ketogenesis, skeletal-muscle AMPKα2-GLUT4 signaling, together with promotion of hepatic stellate-cell activation via YAP phosphorylation at Thr428. These programs could alter the substrate, inflammatory, redox, and endocrine environment encountered by the cardiovascular system. We refine the hepatic ketone deficiency concept into a PAK4-ketone supply-demand mismatch hypothesis: reduced hepatic ketogenesis may limit adaptive ketone availability when myocardial demand rises, though inter-organ causality remains unproven. PAK4 is essential for embryonic cardiac morphogenesis, and limited adult endothelial studies suggest stress-protective roles in ischemic and inflammatory settings, whereas functions in adult cardiomyocytes, fibroblasts, and vascular smooth muscle cells remain largely undefined. An exploratory scan of Gene Expression Omnibus datasets identified recurrent nominal increases in PAK4 mRNA in selected failing or remodeled human myocardium and steatotic liver, but no universal cardiometabolic signature. These findings define a tissue-dependent therapeutic dilemma in which peripheral metabolic benefits of PAK4 inhibition or degradation may coexist with uncharacterized cardiac, isoform, and exposure-related risks. Resolving this paradox will require adult inducible cell-specific models, inter-organ flux studies, cardiac proteomics and phosphoproteomics, and comparison of catalytic inhibitors, degraders, and tissue-directed delivery systems.
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BibTeX
@article{nguyen2026pak4,
title = {{PAK4 as a cardiometabolic node: tissue-specific metabolic control, cardiovascular remodeling, and therapeutic trade-offs}},
author = {To Hoai Thi Nguyen and Khanh Duc Tran and Trong Kha Pham and Ju Eun Seol and Ippei Shimizu and Hyoung Kyu Kim and Jin Han},
journal = {The Korean Journal of Physiology \& Pharmacology : Official Journal of the Korean Physiological Society and the Korean Society of Pharmacology},
year = {2026},
month = nov,
doi = {10.4196/kjpp.26.314},
url = {https://doi.org/10.4196/kjpp.26.314},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - PAK4 as a cardiometabolic node: tissue-specific metabolic control, cardiovascular remodeling, and therapeutic trade-offs
AU - To Hoai Thi Nguyen
AU - Khanh Duc Tran
AU - Trong Kha Pham
AU - Ju Eun Seol
AU - Ippei Shimizu
AU - Hyoung Kyu Kim
AU - Jin Han
PY - 2026
DA - 2026/11/01
JO - The Korean Journal of Physiology & Pharmacology : Official Journal of the Korean Physiological Society and the Korean Society of Pharmacology
DO - 10.4196/kjpp.26.314
UR - https://doi.org/10.4196/kjpp.26.314
AB - Cardiometabolic disease reflects interdependent dysfunction across adipose tissue, liver, skeletal muscle, vasculature, and heart. p21-activated kinase 4 (PAK4), a group II serine/threonine kinase controlling cytoskeletal organization and development, has emerged as a nutrient-responsive regulator in metabolic tissues. We position PAK4 as a candidate cardiometabolic node rather than a proven master regulator or direct energy sensor. Established mechanisms include suppression of adipocyte lipolysis and browning, hepatocyte NCoR1-PPARα-dependent fatty-acid oxidation and ketogenesis, skeletal-muscle AMPKα2-GLUT4 signaling, together with promotion of hepatic stellate-cell activation via YAP phosphorylation at Thr428. These programs could alter the substrate, inflammatory, redox, and endocrine environment encountered by the cardiovascular system. We refine the hepatic ketone deficiency concept into a PAK4-ketone supply-demand mismatch hypothesis: reduced hepatic ketogenesis may limit adaptive ketone availability when myocardial demand rises, though inter-organ causality remains unproven. PAK4 is essential for embryonic cardiac morphogenesis, and limited adult endothelial studies suggest stress-protective roles in ischemic and inflammatory settings, whereas functions in adult cardiomyocytes, fibroblasts, and vascular smooth muscle cells remain largely undefined. An exploratory scan of Gene Expression Omnibus datasets identified recurrent nominal increases in PAK4 mRNA in selected failing or remodeled human myocardium and steatotic liver, but no universal cardiometabolic signature. These findings define a tissue-dependent therapeutic dilemma in which peripheral metabolic benefits of PAK4 inhibition or degradation may coexist with uncharacterized cardiac, isoform, and exposure-related risks. Resolving this paradox will require adult inducible cell-specific models, inter-organ flux studies, cardiac proteomics and phosphoproteomics, and comparison of catalytic inhibitors, degraders, and tissue-directed delivery systems.
SN - 1226-4512
SN - 2093-3827
ER -