Most patients with acute lung injury (ALI) have reduced alveolar fluid clearance that has been associated with higher mortality. Several mechanisms may contribute to the decrease in alveolar fluid clearance. In this study, we tested the hypothesis that pulmonary edema fluid from patients with ALI might reduce the expression of ion transport genes responsible for vectorial fluid transport in primary cultures of human alveolar epithelial type II cells. Following exposure to ALI pulmonary edema fluid, the gene copy number for the major sodium and chloride transport genes decreased. By Western blot analyses, protein levels of ␣ENaC, ␣1Na,K-ATPase, and cystic fibrosis transmembrane conductance regulator decreased as well. In contrast, the gene copy number for several inflammatory cytokines increased markedly. Functional studies demonstrated that net vectorial fluid transport was reduced for human alveolar type II cells exposed to ALI pulmonary edema fluid compared with plasma (0.02 ؎ 0.05 versus 1.31 ؎ 0.56 l/cm 2 /h, p < 0.02). An inhibitor of p38 MAPK phosphorylation (SB202190) partially reversed the effects of the edema fluid on net fluid transport as well as gene and protein expression of the main ion transporters. In summary, alveolar edema fluid from patients with ALI induced a significant reduction in sodium and chloride transport genes and proteins in human alveolar epithelial type II cells, effects that were associated with a decrease in net vectorial fluid transport across human alveolar type II cell monolayers.
Impaired alveolar fluid clearance (AFC;2 i.e. the resolution of alveolar edema) is a common characteristic among patients with acute lung injury (ALI) and acute respiratory distress syndrome. The level of AFC impairment has significant prognostic value in determining morbidity and mortality (1, 2). Multiple clinically relevant experimental studies have tried to uncover the underlying mechanisms that reduce AFC in ALI, and several pathways have been implicated (3, 4).In the alveolar environment, basal AFC is determined predominately by amiloride-sensitive (epithelial sodium channel (ENaC)) and -insensitive sodium channels and the activity of the Na,K-ATPase (3, 5-8). Several stimuli can up-regulate AFC including -adrenergic agonists via cAMP-dependent mechanisms (3, 4). In the mouse and human lung, cAMP-dependent alveolar epithelial fluid transport is dependent on CFTR activity, especially in mediating -adrenergic receptor-driven alveolar epithelial fluid transport (9 -11).We and others have reported that, in the early phase of ALI, pulmonary edema fluid contains high levels of several proinflammatory cytokines, including IL-1, TNF␣,. Several of these proinflammatory cytokines have been studied in experimental fluid transport experiments. For example, during short in vitro exposures, TNF␣ increases AFC, which is mediated predominantly by both TNF␣ receptor-dependent and -independent effects (15, 16). In contrast, for exposures up to 24 h, TNF␣ decreases the expression of ENaC (␣, , and ␥ subunit...