Comparison of direct and indirect models of early induced acute lung injury.

BACKGROUND: The animal experimental counterpart of human acute respiratory distress syndrome (ARDS) is acute lung injury (ALI). Most models of ALI involve reproducing the clinical risk factors associated with human ARDS, such as sepsis or acid aspiration; however, none of these models fully replicates human ARDS. AIM: To compare different experimental animal models of ALI, based on direct or indirect mechanisms of lung injury, to characterize a model which more closely could reproduce the acute phase of human ARDS. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were subjected to intratracheal instillations of (1) HCl to mimic aspiration of gastric contents; (2) lipopolysaccharide (LPS) to mimic bacterial infection; (3) HCl followed by LPS to mimic aspiration of gastric contents with bacterial superinfection; or (4) cecal ligation and puncture (CLP) to induce peritonitis and mimic sepsis. Rats were sacrificed 24 h after instillations or 24 h after CLP. RESULTS: At 24 h, rats instilled with LPS or HCl-LPS had increased lung permeability, alveolar neutrophilic recruitment and inflammatory markers (GRO/KC, TNF-α, MCP-1, IL-1ß, IL-6). Rats receiving only HCl or subjected to CLP had no evidence of lung injury. CONCLUSIONS: Rat models of ALI induced directly by LPS or HCl-LPS more closely reproduced the acute phase of human ARDS than the CLP model of indirectly induced ALI.

Alveolar Type II Cells or Mesenchymal Stem Cells: Comparison of Two Different Cell Therapies for the Treatment of Acute Lung Injury in Rats.

The use of cell therapies has recently increased for the treatment of pulmonary diseases. Mesenchymal stem/stromal cells (MSCs) and alveolar type II cells (ATII) are the main cell-based therapies used for the treatment of acute respiratory distress syndrome (ARDS). Many pre-clinical studies have shown that both therapies generate positive outcomes; however, the differences in the efficiency of MSCs or ATII for reducing lung damage remains to be studied. We compared the potential of both cell therapies, administering them using the same route and dose and equal time points in a sustained acute lung injury (ALI) model. We found that the MSCs and ATII cells have similar therapeutic effects when we tested them in a hydrochloric acid and lipopolysaccharide (HCl-LPS) two-hit ALI model. Both therapies were able to reduce proinflammatory cytokines, decrease neutrophil infiltration, reduce permeability, and moderate hemorrhage and interstitial edema. Although MSCs and ATII cells have been described as targeting different cellular and molecular mechanisms, our data indicates that both cell therapies are successful for the treatment of ALI, with similar beneficial results. Understanding direct cell crosstalk and the factors released from each cell will open the door to more accurate drugs being able to target specific pathways and offer new curative options for ARDS.

Effects of nebulized antithrombin and heparin on inflammatory and coagulation alterations in an acute lung injury model in rats.

BACKGROUND: During acute respiratory distress syndrome, proinflammatory mediators inhibit natural anticoagulant factors, which alter the normal balance between coagulation and fibrinolysis leading to a procoagulant state. We hypothesize that pulmonary administration of anticoagulants might be beneficial to treat acute respiratory distress syndrome for their anticoagulant and antiinflammatory effects and reduce the risk of systemic bleeding. OBJECTIVES: Our aim is to study the effects of nebulized antithrombin (AT) and combined AT and heparin in an animal model of acute lung injury. METHODS: Acute lung injury was induced in rats by the intratracheal administration of hydrochloric acid and lipopolysaccharide. AT alone (500 IU/kg body weight) or combined with heparin (1000 IU/kg body weight) were nebulized after the injury. Control groups received saline instead. Blood, lung tissue, bronchoalveolar lavage, and alveolar macrophages (AM) isolated from bronchoalveolar lavage were collected after 48 hours and analyzed. RESULTS: Nebulized anticoagulant treatments reduced protein concentration in the lungs and decreased injury-mediated coagulation factors (tissue factor, plasminogen activator inhibitor-1, plasminogen, and fibrinogen degradation product) and inflammation (tumor necrosis factor α and interleukin 1ß) in the alveolar space without affecting systemic coagulation and no bleeding. AT alone reduced fibrin deposition and edema in the lungs. Heparin did not potentiate AT coagulant effect but promoted the reduction of macrophages infiltration into the alveolar compartment. Anticoagulants reduced nuclear factor-kB downstream effectors in AM. CONCLUSIONS: Nebulized AT and heparin attenuate lung injury through decreasing coagulation and inflammation without altering systemic coagulation and no bleeding. However, combined AT and heparin did not produce a synergistic effect.

Fas activation alters tight junction proteins in acute lung injury.

Background:The acute respiratory distress syndrome (ARDS) is characterized by protein-rich oedema in the alveolar spaces, a feature in which Fas-mediated apoptosis of the alveolar epithelium has been involved. Objective:To determine whether Fas activation increases protein permeability by mechanisms involving disruption of the paracellular tight junction (TJ) proteins in the pulmonary alveoli. Methods: Protein permeability and the expression of TJ proteins were assessed in vivo in wild-type and Fas-deficient lpr mice 16 hours after the intratracheal instillation of recombinant human soluble Fas ligand (rh-sFasL), and at different time points in vitro in human pulmonary alveolar epithelial cells (HPAEpiC) exposed to rh-sFasL Results:Activation of the Fas pathway increased protein permeability in mouse lungs and altered the expression of the TJ proteins occludin and zonula occludens-1 in the alveolar-capillary membrane in vivo and in human alveolar epithelial cell monolayers in vitro. Blockade of caspase-3, but not inhibition of tyrosine kinase dependent pathways, prevented the alterations in TJ protein expression and permeability induced by the Fas/FasL system in human alveolar cell monolayers in vitro. We also observed that both the Fas-induced increase of protein permeability and disruption of TJ proteins occurred before cell death could be detected in the cell monolayers in vitro. Conclusion:Targeting caspase pathways could prevent the disruption of TJs and reduce the formation of lung oedema in the early stages of ARDS.

Intratracheal instillation of alveolar type II cells enhances recovery from acute lung injury in rats.

BACKGROUND: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are characterized by excess production of inflammatory factors. Alveolar type II (ATII) cells help repair damaged lung tissue, rapidly proliferating and differentiating into alveolar type I cells after epithelial cell injury. In ALI, the lack of viable ATII favors progression to more severe lung injury. ATII cells regulate the immune response by synthesizing surfactant and other anti-inflammatory proteins and lipids. Cross-talk between ATII and other cells such as macrophages may also be part of the ATII function. The aim of this study was to test the anti-inflammatory and reparative effects of ATII cells in an experimental model of ALI. METHODS: In this study ATII cells (2.5 × 106 cells/animal) were intratracheally instilled in rats with HCl and lipopolysaccharide (LPS)-induced ALI and in healthy animals to check for side effects. The specific effect of ATII cells was compared with fibroblast transplantation. RESULTS: ATII cell transplantation promoted recovery of lung function, decrease mortality and lung inflammation of the animals with ALI. The primary mechanisms for benefit were paracrine effects of prostaglandin E2 (PGE2) and surfactant protein A (SPA) released from ATII cells that modulate alveolar macrophages to an anti-inflammatory phenotype. To our knowledge, these data are the first to provide evidence that ATII cells secrete PGE2 and SPA, reducing pro-inflammatory macrophage activation and ALI. CONCLUSION: ATII cells and their secreted molecules have shown an ability to resolve ALI, thereby highlighting a potential novel therapeutic target.

Barrier-protective effects of activated protein C in human alveolar epithelial cells.

Acute lung injury (ALI) is a clinical manifestation of respiratory failure, caused by lung inflammation and the disruption of the alveolar-capillary barrier. Preservation of the physical integrity of the alveolar epithelial monolayer is of critical importance to prevent alveolar edema. Barrier integrity depends largely on the balance between physical forces on cell-cell and cell-matrix contacts, and this balance might be affected by alterations in the coagulation cascade in patients with ALI. We aimed to study the effects of activated protein C (APC) on mechanical tension and barrier integrity in human alveolar epithelial cells (A549) exposed to thrombin. Cells were pretreated for 3 h with APC (50 µg/ml) or vehicle (control). Subsequently, thrombin (50 nM) or medium was added to the cell culture. APC significantly reduced thrombin-induced cell monolayer permeability, cell stiffening, and cell contraction, measured by electrical impedance, optical magnetic twisting cytometry, and traction microscopy, respectively, suggesting a barrier-protective response. The dynamics of the barrier integrity was also assessed by western blotting and immunofluorescence analysis of the tight junction ZO-1. Thrombin resulted in more elongated ZO-1 aggregates at cell-cell interface areas and induced an increase in ZO-1 membrane protein content. APC attenuated the length of these ZO-1 aggregates and reduced the ZO-1 membrane protein levels induced by thrombin. In conclusion, pretreatment with APC reduced the disruption of barrier integrity induced by thrombin, thus contributing to alveolar epithelial barrier protection.

Early physiological and biological features in three animal models of induced acute lung injury.

INTRODUCTION: Critically ill patients often develop acute lung injury (ALI) in the context of different clinical conditions. We aimed to explore differences in early local and systemic features in three experimental animal models of ALI. METHODS: Mechanically ventilated male Sprague-Dawley rats were randomized to high tidal volume (VT) ventilation (HVT) (n = 8, VT 24 ml/kg), massive brain injury (MBI) (n = 8, VT 8 ml/kg) or endotoxemia (LPS) (n = 8, VT 8 ml/kg). Each experimental group had its own control group of eight rats (VT 8 ml/kg). We measured arterial blood gases, mean arterial pressure, lung compliance, inflammatory mediators in plasma and their expression and gelatinase activity in the lungs after 3 h of injury. RESULTS: Despite maintaining relatively normal lung function without evidence of important structural changes, we observed altered lung and systemic inflammatory responses in all three experimental models. LPS triggered the most robust inflammatory response and HVT the lowest systemic proinflammatory response. The HVT group had higher Il6, Tnf and Cxcl2 mRNA in lungs than MBI animals. Metalloproteinase activity/expression and neutrophilic recruitment in the lungs were higher in HVT than in LPS or MBI. CONCLUSIONS: The early responses to direct or remote lung insult in our three models of ALI captured different physiological and biological features that could lead to respiratory and/or multiorgan failure.

Upper-airway inflammation triggered by vibration in a rat model of snoring.

STUDY OBJECTIVES: To determine whether the vibratory mechanical stimulus due to snoring induces upper-airway inflammation in an in-vivo rat model. DESIGN: Prospective controlled animal study. SETTING: University laboratory. PATIENTS OR PARTICIPANTS: Sixteen male Sprague-Dawley rats (250-300 g). INTERVENTIONS: The upper trachea of 8 rats was cannulated, and the upper airway was subjected to vibration (60 Hz; +/- 10 cm H2O) with a periodic pattern consisting of 1 second of vibration followed by 3 seconds of no vibration. This snoring-like vibration was applied for 3 hours. The animals breathed spontaneously through a cannula in the lower trachea. In a control group (8 rats), the animals were similarly instrumented, but no upper-airway vibration was applied. MEASUREMENTS AND RESULTS: The effect of vibration was assessed by measuring the vibration-induced increase in gene expression of the pro-inflammatory cytokine tumor necrosis factor-alpha and of the neutrophil attractant chemokine macrophage inflammatory protein-2 in the soft-palate tissue. Real-time reverse-transcription polymerase chain reaction measurement of mRNA showed that vibration induced a significant overexpression of both tumor necrosis factor-alpha and macrophage inflammatory protein-2: 6.01-fold +/- 2.47-fold (p = .005) and 2.38-fold +/- 0.54 -fold (p = .021) increase when compared with control (mean +/- SEM). CONCLUSIONS: The mechanical stimulus of vibration per se triggers an early proinflammatory process in the upper airway.

Effect of stretch on structural integrity and micromechanics of human alveolar epithelial cell monolayers exposed to thrombin.

Alveolar epithelial cells in patients with acute lung injury subjected to mechanical ventilation are exposed to increased procoagulant activity and mechanical strain. Thrombin induces epithelial cell stiffening, contraction, and cytoskeletal remodeling, potentially compromising the balance of forces at the alveolar epithelium during cell stretching. This balance can be further compromised by the loss of integrity of cell-cell junctions in the injured epithelium. The aim of this work was to study the effect of stretch on the structural integrity and micromechanics of human alveolar epithelial cell monolayers exposed to thrombin. Confluent and subconfluent cells (A549) were cultured on collagen-coated elastic substrates. After exposure to thrombin (0.5 U/ml), a stepwise cell stretch (20%) was applied with a vacuum-driven system mounted on an inverted microscope. The structural integrity of the cell monolayers was assessed by comparing intercellular and intracellular strains within the monolayer. Strain was measured by tracking beads tightly bound to the cell surface. Simultaneously, cell viscoelasticity was measured using optical magnetic twisting cytometry. In confluent cells, thrombin did not induce significant changes in transmission of strain from the substrate to overlying cells. By contrast, thrombin dramatically impaired the ability of subconfluent cells to follow imposed substrate deformation. Upon substrate unstretching, thrombin-treated subconfluent cells exhibited compressive strain (9%). Stretch increased stiffness (56-62%) and decreased cell hysteresivity (13-22%) of vehicle cells. By contrast, stretch did not increase stiffness of thrombin-treated cells, suggesting disruption of cytoskeletal structures. Our findings suggest that thrombin could exacerbate epithelial barrier dysfunction in injured lungs subjected to mechanical ventilation.

Vibration enhances interleukin-8 release in a cell model of snoring-induced airway inflammation.

STUDY OBJECTIVES: To test a cell model of snoring-induced airway inflammation and to assess whether a vibration stimulus simulating the one experienced by airway tissues in snoring patients induces inflammation in airway epithelial cells. DESIGN: Prospective controlled study in cell culture. SETTING: University laboratory. PATIENTS OR PARTICIPANTS: Human bronchial epithelial cells (BEAS-2B cell line). INTERVENTIONS: Cell cultures were subjected to vibration (60 Hz, +/- 0.3 mm) for time periods of 6 hours, 12 hours, and 24 hours. The vibratory stimulus was applied with and without treatment with inhibitors of the 3 main pathways of mitogen-activated protein kinases (MAPK): p38, MEK1/2, and JNK. MEASUREMENTS AND RESULTS: The effect of vibration was assessed by comparing cell proliferation and release of interleukin-8 (IL-8; measured by enzyme-linked immunosorbent assay) in cells subjected to the vibratory stimulus (both when treated and untreated with MAPK inhibitors) and in controls. Application of vibration up to 24 hours did not significantly modify cell proliferation. By contrast, the concentration of IL-8 in the supernatant was significantly increased after 12 hours and 24 hours of vibration. The inhibition of the p38, MEK1/2, and JNK MAPK pathways significantly reduced the overexpression of IL-8 resulting from the vibration stimulus. CONCLUSIONS: A mechanical vibration simulating snoring triggered an inflammatory cascade, as reflected by the increase in IL-8 release mediated by MAPK pathways. The novel model developed is potentially applicable to studying the effects of the vibration due to snoring in the different cell types (epithelial, endothelial, muscular, neuronal) involved in airway pathophysiology during respiratory sleep disturbances.

Viscoelasticity of human alveolar epithelial cells subjected to stretch.

Alveolar epithelial cells undergo stretching during breathing and mechanical ventilation. Stretch can modify cell viscoelastic properties, which may compromise the balance of forces in the alveolar epithelium. We studied the viscoelasticity of alveolar epithelial cells (A549) subjected to equibiaxial distention with a novel experimental approach. Cells were cultured on flexible substrates and subjected to stepwise deformations of up to 17% with a device built on an inverted microscope. Simultaneously, cell storage (G') and loss (G'') moduli were measured (0.1-100 Hz) with optical magnetic twisting cytometry. G' and G'' increased with strain up to 64 and 30%, respectively, resulting in a decrease in G''/G' (15%). This stretch-induced response was inhibited by disruption of the actin cytoskeleton with latrunculin A. G' increased with frequency following a power law with exponent alpha = 0.197. G'' increased proportionally to G' but exhibited a more marked frequency dependence at high frequencies. Stretching (14%) caused a fall in alpha (13%). At high stretching amplitudes, actual cell strain (14.4%) was lower than the applied substrate strain (17.3%), which could indicate a partial cell detachment. These data suggest that cytoskeletal prestress modulates the elastic and frictional properties of alveolar epithelial cells in a coupled manner, according to soft glassy rheology. Stretch-induced cell stiffening could compromise the balance of forces at the cell-cell and cell-matrix adhesions.