Fig. 7

Comprehensive outline and new strategies on PAH. The interaction between PASMCs and HPAECs in hypoxia is also rarely reported and should be payed attention. Meanwhile, the specific pathological features of PAH should be marked to distinguish other PH subtypes to accurately define the clinical diagnosis of PAH. In pathogenesis, the “oestrogen paradox” should be further clarified regarding the role of endogenous and exogenous oestrogen in PAH. The “conflict” of oestrogen observed by clinical studies and animal experiments should also be investigated. Subsequent studies should emphasize the gaps in enhancing validation of efficacy in multiple PAH animal models, and pharmacokinetic studies and safety evaluations of natural medicines in animals are conducted in next study. Clinical study about natural medicines for the treatment of PAH should design scientific end-points, suitable targets and biomarkers