For nearly 100 y, pediatricians have regularly used oxygen to treat neonatal and childhood diseases. During this time, it has become clear that oxygen is toxic and that overzealous use can lead to significant morbidity. As we have learned more about the appropriate clinical indications for oxygen therapy, studies at the bench have begun to elucidate the molecular mechanisms by which cells respond to hyperoxia. In this review, we discuss transcription factors whose activity is regulated by oxygen, including nuclear factor, erythroid 2-related factor 2 (Nrf2), activator protein 1 (AP-1), p53, nuclear factor B (NF-B), signal transducers and activators of transcription protein (STAT), and ccat/enhancer binding protein (CEBP). Special attention is paid to the mechanisms by which hyperoxia affects these transcription factors in the lung. Finally, we identify downstream targets of these transcription factors, with a focus on heme oxygenase-1. A better understanding of how oxygen affects various signaling pathways could lead to interventions aimed at preventing hyperoxic injury. O xygen therapy has a long and tortuous history in Neonatology. The pendulum has swung from a liberal use of supplemental oxygen in the early 20th century, to limited application in the 1950s based on the association with retinopathy of prematurity. Today, clinical studies are focused on addressing which neonatal pathologic states require treatment with oxygen, and what level of oxygen administration is safe. In concert with these clinical studies, much work has been done at the bench to ascertain how oxygen affects gene expression. This is of particular relevance in neonates because changes in gene expression at critical times in development can have long-lasting effects and subsequent consequences on lung structure and function. This review will address lessons learned and new insights as to the effects of hyperoxia on pulmonary gene expression.
EVOLUTIONARY PERSPECTIVEResponses to atmospheric oxygen have evolved in eukaryotes during the last 1.5 billion years (1). The ability of organisms to reduce oxygen to water critically altered cellular metabolism and energy production, but also resulted in the formation of toxic reactive oxygen species (ROS) via the mitochondrial respiratory chain. These radicals are electron donors, which can damage DNA, RNA, protein, and lipids. They can also propagate deleterious reactions throughout cells and tissues resulting in death and apoptosis. In addition, these ROS can alter gene expression by modulating transcription factor activation, which then impact downstream targets. In oxygen breathing animals, only three tissues-the cornea, the skin, and the respiratory tract epithelium-are exposed to 21% Received January 8, 2009; accepted February 3, 2009 Abbreviations: AP-1, activator protein 1; ARE, antioxidant response elements; Bach1, basic leucine zipper transcription factor 1; BPD, bronchopulmonary dysplasia; C/EBP, ccat/enhancer binding protein; ENaC, epithelium sodium channel; HO-1, heme oxygenase...