Subacute exposure to moderate hypoxia can promote pulmonary edema formation. The tachykinins, a family of proinflammatory neuropeptides, have been implicated in the pathogenesis of pulmonary edema in some settings, including the pulmonary vascular leak associated with exposure to hypoxia. The effects of hypoxia on tachykinin receptor and peptide expression in the lung, however, remain poorly understood. We hypothesized that subacute exposure to moderate hypoxia increases lung neurokinin-1 (NK-1) receptor expression as well as lung substance P levels. We tested this hypothesis by exposing weanling Sprague-Dawley rats to hypobaric hypoxia (barometric pressure 0.5 atm) for 0, 24, 48, or 72 h. Hypoxia led to time-dependent increases in lung NK-1 receptor mRNA expression and lung NK-1 receptor protein levels at 48 and 72 h of exposure (P Ͻ 0.05). Immunohistochemistry and in situ NK-1 receptor labeling with substance Pconjugated fluorescent nanocrystals demonstrated that hypoxia increased NK-1 expression primarily in the pulmonary microvasculature and in alveolar macrophages. Hypoxia also led to increases in lung substance P levels by 48 and 72 h (P Ͻ 0.05) but led to a decrease in preprotachykinin mRNA levels (P Ͻ 0.05). We conclude that subacute exposure to moderate hypoxia upregulates lung NK-1 receptor expression and lung substance P peptide levels primarily in the lung microvasculature. We speculate that this effect may contribute to the formation of pulmonary edema in the setting of regional or environmental hypoxia. tachykinin; pulmonary edema; acute respiratory distress syndrome ACUTE LUNG INJURY and acute respiratory distress syndrome (ARDS) are clinical syndromes associated with significant morbidity and mortality in humans. The hallmarks of these syndromes are increased pulmonary capillary permeability, pulmonary edema formation, and profound hypoxemia (22). The precise mechanisms that lead to this pulmonary vascular leak remain uncertain (3, 21, 27), although many inflammatory and vasoactive substances have been implicated.Among the mediators implicated in the development of pulmonary edema are the tachykinins. These molecules, a part of the nonadrenergic, noncholinergic nervous system, are a family of peptides that are expressed in the lung in and around the pulmonary vasculature as well as in sensory nerves located primarily near the airways. Substance P, the tachykinin peptide most highly expressed in the lung, exerts its effects primarily through the neurokinin-1 (NK-1) receptor. This ligand-receptor pair mediates neurogenic inflammation in the airways via cytokines including IL-1, 20). In addition, substance P levels are markedly elevated in pulmonary edema fluid from ARDS patients (6), and the NK-1 receptor has been implicated in the pathophysiology of lung injury associated with pancreatitis (13), smoke inhalation (30), and viral infections (23) including respiratory syncytial virus (11).Previous work has also suggested that the tachykinin system may be altered in response to hypoxia. In particular,...