Acute lung injury (ALI) is characterized by an early inflammatory response followed by a late fibroproliferative phase, and by an increase in the bronchoalveolar lavage fluid (BALF) concentrations of bioactive soluble FasL (sFasL). Activation of Fas (CD95) has been associated with the development of lung fibrosis in mice. The goal of this study was to determine the mechanisms that link Fas activation with the development of fibrosis in the lungs. We treated mice with three daily intratracheal instillations of a Fas-activating monoclonal antibody (Jo2) or a control IgG, and studied the animals at sequential times. Mice treated with Jo2 had increased caspase-3 activation in alveolar wall cells on Days 2, 4, and 7; an inflammatory response peaking on Day 7, and increased total lung collagen on Day 21. Gene expression profiling performed on Days 2, 4, and 7 showed sequential activation of co-regulated profibrotic genes, including marked up-regulation of matrix metalloproteinase 12 (MMP-12). Targeted deletion of MMP-12 protected mice from Fasinduced pulmonary fibrosis, even though the inflammatory responses in the lungs were similar to those of wild-type mice. Compared with wild-type mice, the mmp12 Ϫ/؊ mice showed decreased expression of the profibrotic genes egr1 and cyr61. We conclude that Fas activation in the lungs induces a complex response that includes apoptosis, inflammation, and eventually fibrosis, and that MMP-12 is essential for the fibrotic phenotype. We speculate that MMP-12 activity is required for activation of the profibrotic genes egr1 and cyr61.Keywords: apoptosis; inflammation; MMP-12; Fas; CYR61/CCN1 Acute lung injury (ALI) and its more severe form, the acute respiratory distress syndrome (ARDS), are characterized by an early inflammatory response, which is maximal during the first three days of clinically defined ALI/ARDS, and a subsequent fibroproliferative response (1, 2). The fibroproliferative response is thought to occur late in the course of ALI/ARDS, but autopsy studies have shown histopathologic evidence of fibroproliferation as early as Day 5, and human studies have identified evidence of collagen production in the lungs even on the first day of ALI/ARDS (3, 4). However, the mechanisms linking the early events in acute lung injury with subsequent fibrosis are incompletely understood. Correspondence and requests for reprints should be addressed to Gustavo MatuteBello, UW Medicine/South Lake Union Campus, 815 Mercer Street, Seattle, WA 98109. E-mail: matuteb@u.washington.edu
CLINICAL RELEVANCEThis study provides novel information suggesting that macrophage activation drives the lung fibrotic response to Fas activation, and that matrix metalloproteinase-12, a metalloelastase previously associated with emphysema, is essential for Fas-induced fibroproliferation.