INS and Insulin resistance: On the other hand, the proproliferative estrogen metabolite 16OHE1 inducespulmonary vascular remodelling and may promote insulin resistance inPAH.7,9 For example, Fessel et al.9 found that treating BMPR2-mutant vascular smooth muscle cells with 16OHE1significantly decreased mobilization of the glucose transporter Glut4 inresponse to insulin and expression of PPAR-γ and lipid transporter CD36.