Mechanical ventilation is necessary for patients with acute respiratory failure, but can cause or propagate lung injury. We previously identified cyclooxygenase-2 as a candidate gene in mechanical ventilationinduced lung injury. Our objective was to determine the role of cyclooxygenase-2 in mechanical ventilation-induced lung injury and the effects of cyclooxygenase-2 inhibition on lung inflammation and barrier disruption. Mice were mechanically ventilated at low and high tidal volumes, in the presence or absence of pharmacologic cyclooxygenase-2-specific inhibition with 3-(4-methylsulphonylphenyl)-4-phenyl-5-trifluoromethylisoxazole (CAY10404). Lung injury was assessed using markers of alveolar-capillary leakage and lung inflammation. Cyclooxygenase-2 expression and activity were measured by Western blotting, real-time PCR, and lung/plasma prostanoid analysis, and tissue sections were analyzed for cyclooxygenase-2 staining by immunohistochemistry. High tidal volume ventilation induced lung injury, significantly increasing both lung leakage and lung inflammation relative to control and low tidal volume ventilation. High tidal volume mechanical ventilation significantly induced cyclooxygenase-2 expression and activity, both in the lungs and systemically, compared with control mice and low tidal volume mice. The immunohistochemical analysis of lung sections localized cyclooxygenase-2 expression to monocytes and macrophages in the alveoli. The pharmacologic inhibition of cyclooxygenase-2 with CAY10404 significantly decreased cyclooxygenase activity and attenuated lung injury in mice ventilated at high tidal volume, attenuating barrier disruption, tissue inflammation, and inflammatory cell signaling. This study demonstrates the induction of cyclooxygenase-2 by mechanical ventilation, and suggests that the therapeutic inhibition of cyclooxygenase-2 may attenuate ventilator-induced acute lung injury.
Keywords: cyclooxygenase-2; mechanical ventilation; lung injuryMechanical ventilation is a life-saving therapy for patients with acute respiratory failure. However, it can cause or worsen lung injury, particularly at larger tidal volumes (1, 2). Positive-pressure mechanical ventilation may expose the lungs, and particularly the alveoli, to overdistention, resulting in volutrauma with the subsequent release of inflammatory and vasoactive cytokines and prostanoids that propagate lung injury (1, 3). Therapeutic trials aimed at decreasing lung injury have focused on minimizing the damage from mechanical ventilation with the use of "protective" low tidal volume ventilator strategies. However, because of the heterogeneity of lung injury, even at lower tidal volumes, different regions of the lung may be subjected to higher stretch (4). Although using lower tidal volumes decreases markers of injury and inflammation and significantly improves survival in patients with acute lung injury, mortality remains high (1). A better understanding of the mechanisms by which mechanical ventilation injures the lungs will be key in identifying ...