Network toxicology and molecular docking to investigate the association of perfluorooctane sulfonate and pulmonary arterial hypertension via adverse outcome pathways

Pulmonary arterial hypertension (PAH) is a rare but serious disease that poses a significant threat to patients' quality of life and life expectancy. Perfluorooctane sulfonate (PFOS) is a widely used chemical that, due to its toxicity, persistence, and bioaccumulation properties, may increase the risk of developing PAH with prolonged exposure. This study investigated the molecular mechanisms linking PFOS exposure to PAH by integrating network toxicology and molecular docking methods. Data from multiple authoritative databases (CTD, GeneCards, OMIM, TCMIP, and DAVID) were collected, finally identified 18 target genes and 49 target phenotypes central to PFOS-induced PAH. A PFOS-gene-phenotype-PAH network was constructed, revealing significant upstream and downstream relationships. The analysis highlighted TNF-α and IL6 as pivotal molecular initiators, triggering inflammatory cascades that lead to PAH through established qualitative and quantitative adverse outcome pathways (AOPs). The molecular simulations confirmed that PFOS exposure significantly elevates TNF-α and IL6 levels, initiating a series of inflammatory events that culminate in PAH. These findings not only advance the understanding of PFOS as an environmental trigger for PAH but also offer a computational framework for future risk assessments. By integrating diverse datasets and constructing AOPs, this study provides valuable insights into the environmental factors influencing PAH, offering critical implications for policy-making and regulatory strategies to mitigate PFOS-related health risks.