The discovery of mechanisms that regulate salt and water transport by the alveolar and distal airway epithelium of the lung has generated new insights into the regulation of lung fluid balance under both normal and pathological conditions. There is convincing evidence that active sodium and chloride transporters are expressed in the distal lung epithelium and are responsible for the ability of the lung to remove alveolar fluid at the time of birth as well as in the mature lung when pathological conditions lead to the development of pulmonary edema. Currently, the best described molecular transporters are the epithelial sodium channel, the cystic fibrosis transmembrane conductance regulator, Na+-K+-ATPase, and several aquaporin water channels. Both catecholamine-dependent and -independent mechanisms can upregulate isosmolar fluid transport across the distal lung epithelium. Experimental and clinical studies have made it possible to examine the role of these transporters in the resolution of pulmonary edema.

Transcriptional adaptations to hypoxia are mediated by hypoxia-inducible factor (HIF)-1, a heterodimer of HIF-␣ and aryl hydrocarbon receptor nuclear translocator subunits. The HIF-1␣ and HIF-2␣ subunits both undergo rapid hypoxia-induced protein stabilization and bind identical target DNA sequences. When coexpressed in similar cell types, discriminating control mechanisms may exist for their regulation, explaining why HIF-1␣ and HIF-2␣ do not substitute during embryogenesis. We report that, in a human lung epithelial cell line (A549), HIF-1␣ and HIF-2␣ proteins were similarly induced by acute hypoxia (4 h, 0.5% O 2 ) at the translational or posttranslational level. However, HIF-1␣ and HIF-2␣ were differentially regulated by prolonged hypoxia (12 h, 0.5% O 2 ) since HIF-1␣ protein stimulation disappeared because of a reduction in its mRNA stability, whereas HIF-2␣ protein stimulation remained high and stable. Prolonged hypoxia also induced an increase in the quantity of natural antisense HIF-1␣ (aHIF), whose gene promoter contains several putative hypoxia response elements to which (as we confirm here) the HIF-1␣ or HIF-2␣ protein can bind. Finally, transient transfection of A549 cells by dominant-negative HIF-2␣, also acting as a dominant-negative for HIF-1␣, prevented both the decrease in the HIF-1␣ protein and the increase in the aHIF transcript. Taken together, these data indicate that, during prolonged hypoxia, HIF-␣ proteins negatively regulate HIF-1␣ expression through an increase in aHIF and destabilization of HIF-1␣ mRNA. This transregulation between HIF-1␣ and HIF-2␣ during hypoxia likely conveys target gene specificity.

In cultured alveolar epithelial cells, hypoxia induces a downregulation of the two main Na proteins, the epithelial Na channel (ENaC) and the Na,K-ATPase. However, the in vivo effects of hypoxia on alveolar epithelial transport have not been well studied. Therefore, the objectives of this study were to investigate in an in vivo rat model if hypoxia induces a reduction in vectorial Na and fluid transport across the alveolar epithelium in vivo, and if a change in net fluid transport is associated with modification in the expression and/or activity of Na transport proteins. Rats were exposed to 8% O(2) from 3 to 24 h. Hypoxia induced a progressive decrease in alveolar liquid clearance (ALC) reaching 50% at 24 h, an effect that was related primarily to a decrease in amiloride-sensitive transepithelial Na transport. On RNase protection assay of alveolar type II (ATII) cells isolated immediately after hypoxic exposure, steady state levels of mRNA were increased for alpha-rENaC and beta(1)-Na, K-ATPase, whereas the levels of gamma-rENaC and alpha(1)-Na,K-ATPase were unchanged. On Western blots of ATII cell membranes, alpha-ENaC subunit protein slightly increased, whereas the amount of alpha(1)- and beta(1)-Na,K-ATPase protein were unchanged with hypoxia. Thus, the decrease in transepithelial Na transport was not explained by a parallel change in gene expression or the quantity of transport proteins. Interestingly, hypoxia-induced decrease in ALC was completely reversed by intra-alveolar administration of the beta(2) agonist, terbutaline (10(-4) M). These results suggest that hypoxia-induced decrease in Na transport is not simply related to a downregulation of Na transport proteins but rather to a decrease in Na protein activity by either internalization of the proteins and/or direct alteration of the protein in the membrane. The dramatic increase of ALC with beta(2)-agonist therapy indicates that the decrease of transepithelial Na and fluid transport during hypoxia is rapidly reversible, a finding of major clinical significance.