Little is known about interactions between endogenous anti-inflammatory paradigms and microvascular thrombosis in lung ischemia/reperfusion (I/R) injury. Interleukin (IL)-10 suppresses macrophage activation and down-regulates proinflammatory cytokine production, but there are no available data to suggest a link between IL-10, thrombosis, and fibrinolysis in the setting of I/R. We hypothesized that hypoxia/ischemia triggers IL-10 production, to dampen proinflammatory cytokine and adhesion receptor cascades and to restore vascular patency by fibrinolytic potentiation. Studies were performed in a mouse lung I/R model. IL-10 mRNA levels in lung were increased 43-fold over base line by 1 h of ischemia/2 h of reperfusion, with a corresponding increase in plasma IL-10. Expression was prominently localized in bronchial epithelial cells and mononuclear phagocytes. To study the link between IL-10 and fibrinolysis in vivo, the induction of plasminogen activator inhibitor-1 (PAI-1) was evaluated. Northern analysis demonstrated exaggerated pulmonary PAI-1 expression in IL-10 (؊/؊) mice after I/R, with a corresponding increase in plasma PAI/tissue-type plasminogen activator activity. In vivo, IL-10 (؊/؊) mice showed poor postischemic lung function and survival after I/R compared with IL-10 (؉/؉) mice. Despite a decrease in infiltration of mononuclear phagocytes in I/R lungs of IL-10 (؊/؊) mice, an increased intravascular pulmonary fibrin deposition was observed by immunohistochemistry and Western blotting, along with increased IL-1 expression. Recombinant IL-10 given to IL-10 (؊/؊) mice normalized the PAI/tissue-type plasminogen activator ratio, reduced pulmonary vascular fibrin deposition, and rescued mice from lung injury. Since recombinant hirudin (direct thrombin inhibitor) also sufficed to rescue IL-10 (؊/؊) mice, these data suggest a preeminent role for microvascular thrombosis in I/R lung injury. Ischemiadriven IL-10 expression confers postischemic pulmonary protection by augmenting endogenous fibrinolytic mechanisms.
Ischemia/reperfusion (I/R)1 lung injury plays a significant role in clinical situations such as lung transplantation (1-3). Lung failure associated with I/R is characterized by increased microvascular permeability, pulmonary vascular resistance with subsequent edema formation and impairment of gas exchange, and microembolism. The lungs are particularly susceptible to ischemia/reperfusion injury, presumably due to the rich vascularity of the lungs and the relatively large surface area over which blood-borne components can interact with endothelium. The proximate mechanisms of ischemic lung injury are diverse and include leukocyte activation and recruitment (1), complement activation (4), abnormalities in pulmonary vascular tone, and increased procoagulant activity, resulting in microcirculatory failure, cellular dysfunction, edema, and cell death. The local production of proinflammatory cytokines, such as IL-1␣ and tumor necrosis factor-␣, is considerably increased in I/R injury (5, 6), which can also feed...