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Moya F, Curstedt T, Johansson J, Sweet D. Synthetic surfactants. Semin Fetal Neonatal Med 2023; 28:101503. [PMID: 38036308 DOI: 10.1016/j.siny.2023.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Fernando Moya
- Division of Wilmington Pediatric Subspecialties, Department of Pediatrics, UNC School of Medicine, USA
| | - Tore Curstedt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Johansson
- Dept of Biosciences and Nutrition, Karolinska Institutet, Neo, 141 83, Huddinge Sweden
| | - David Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Grosvenor Road, Belfast, UK.
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Khudadah K, Ramadan A, Othman A, Refaey N, Elrosasy A, Rezkallah A, Heseba T, Moawad M, Mektebi A, Elejla S, Abouzid M, Abdelazeem B. Surfactant replacement therapy as promising treatment for COVID-19: an updated narrative review. Biosci Rep 2023; 43:BSR20230504. [PMID: 37497603 PMCID: PMC10412525 DOI: 10.1042/bsr20230504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023] Open
Abstract
Patients with COVID-19 exhibit similar symptoms to neonatal respiratory distress syndrome. SARS-CoV-2 spike protein has been shown to target alveolar type 2 lung cells which synthesize and secrete endogenous surfactants leading to acute respiratory distress syndrome in some patients. This was proven by post-mortem histopathological findings revealing desquamated alveolar type 2 cells. Surfactant use in patients with COVID-19 respiratory distress syndrome results in marked improvement in respiratory parameters but not mortality which needs further clinical trials comparing surfactant formulas and modes of administration to decrease the mortality. In addition, surfactants could be a promising vehicle for specific drug delivery as a liposomal carrier, which requires more and more challenging efforts. In this review, we highlight the current reviews and two clinical trials on exogenous surfactant therapy in COVID-19-associated respiratory distress in adults, and how surfactant could be a promising drug to help fight the COVID-19 infection.
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Affiliation(s)
| | - Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Othman
- Kuwait Oil Company Ahmadi Hospital, Al Ahmadi, Kuwait
| | - Neveen Refaey
- Women’s Health department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayoub Rezkallah
- Faculty of Medicine, University of Algeirs, Algeirs, Algeria
- Department of Hematology Laboratory and Blood Transfusion, Hospital Center University Lamine Debaghine, Algeirs, Algeria
| | - Toka Heseba
- Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Mostafa Hossam El Din Moawad
- Faculty of Pharmacy, Clinical Department, Alexandria University, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ammar Mektebi
- Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Sewar A Elejla
- Faculty of Medicine, Alquds University, Jerusalem, Palestine
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Basel Abdelazeem
- McLaren Health Care, Flint, Michigan, U.S.A
- Michigan State University, East Lansing, Michigan, U.S.A
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Severe COVID-19 ARDS Treated by Bronchoalveolar Lavage with Diluted Exogenous Pulmonary Surfactant as Salvage Therapy: In Pursuit of the Holy Grail? J Clin Med 2022; 11:jcm11133577. [PMID: 35806862 PMCID: PMC9267619 DOI: 10.3390/jcm11133577] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
Background: Severe pneumonia caused by coronavirus disease 2019 (COVID-19) is characterized by inflammatory lung injury, progressive parenchymal stiffening and consolidation, alveolar and airway collapse, altered vascular permeability, diffuse alveolar damage, and surfactant deficiency. COVID-19 causes both pneumonia and acute respiratory distress syndrome (COVID-19 ARDS). COVID-19 ARDS is characterized by severe refractory hypoxemia and high mortality. Despite extensive research, the treatment of COVID-19 ARDS is far from satisfactory. Some treatments are recommended for exhibiting some clinically positive impacts on COVID-19 patients although there are already several drugs in clinical trials, some of which are already demonstrating promising results in addressing COVID-19. Few studies have demonstrated beneficial effects in non-COVID-19 ARDS treatment of exogenous surfactant, and there is no evidence-based, proven method for the procedure of surfactant administration. Aim: The aim of this work is to underline the key role of ATII cells and reduced surfactant levels in COVID-19 ARDS and to emphasize the rational basis for exogenous surfactant therapy in COVID-19 ARDS, providing insights for future research. Methods: In this article, we describe and support via the literature the decision to administer large volumes of surfactant to two patients via bronchoalveolar lavage to maximize its distribution in the respiratory tract. Results: In this study, we report on two cases of COVID-19 ARDS in patients who have been successfully treated with diluted surfactants by bronchoalveolar lavage, followed by a low-dose bolus of surfactant. Conclusion: Combining the administration of diluted, exogenous pulmonary surfactant via bronchoalveolar lavage along with the standard therapy for SARS-CoV-2-induced ARDS may be a promising way of improving the management of ARDS.
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Pioselli B, Salomone F, Mazzola G, Amidani D, Sgarbi E, Amadei F, Murgia X, Catinella S, Villetti G, De Luca D, Carnielli V, Civelli M. Pulmonary surfactant: a unique biomaterial with life-saving therapeutic applications. Curr Med Chem 2021; 29:526-590. [PMID: 34525915 DOI: 10.2174/0929867328666210825110421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
Pulmonary surfactant is a complex lipoprotein mixture secreted into the alveolar lumen by type 2 pneumocytes, which is composed by tens of different lipids (approximately 90% of its entire mass) and surfactant proteins (approximately 10% of the mass). It is crucially involved in maintaining lung homeostasis by reducing the values of alveolar liquid surface tension close to zero at end-expiration, thereby avoiding the alveolar collapse, and assembling a chemical and physical barrier against inhaled pathogens. A deficient amount of surfactant or its functional inactivation is directly linked to a wide range of lung pathologies, including the neonatal respiratory distress syndrome. This paper reviews the main biophysical concepts of surfactant activity and its inactivation mechanisms, and describes the past, present and future roles of surfactant replacement therapy, focusing on the exogenous surfactant preparations marketed worldwide and new formulations under development. The closing section describes the pulmonary surfactant in the context of drug delivery. Thanks to its peculiar composition, biocompatibility, and alveolar spreading capability, the surfactant may work not only as a shuttle to the branched anatomy of the lung for other drugs but also as a modulator for their release, opening to innovative therapeutic avenues for the treatment of several respiratory diseases.
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Affiliation(s)
| | | | | | | | - Elisa Sgarbi
- Preclinical R&D, Chiesi Farmaceutici, Parma. Italy
| | | | - Xabi Murgia
- Department of Biotechnology, GAIKER Technology Centre, Zamudio. Spain
| | | | | | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France; Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris. France
| | - Virgilio Carnielli
- Division of Neonatology, G Salesi Women and Children's Hospital, Polytechnical University of Marche, Ancona. Italy
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Silva LC, Angrimani DS, Regazzi FM, Lúcio CF, Veiga GA, Fernandes CB, Vannucchi CI. Exogenous surfactant replacement immediately at birth as preventive therapy for lung prematurity in neonatal lambs. Theriogenology 2021; 171:14-20. [PMID: 34000686 DOI: 10.1016/j.theriogenology.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
Surfactant treatment is a manner to reduce alveolar superficial tension and increase pulmonary compliance in premature neonates. Thus, we aimed to analyze the effect of exogenous surfactant treatment in combination with manual ventilation for preterm lambs. We used 15 ewes and their lambs (n = 16), prematurely born at 135 days. At birth, lambs were submitted to orotracheal intubation attached to a handheld resuscitation device and randomly allocated to: Control Group (n = 5; only manual ventilation), Single Surfactant Group (n = 5; manual ventilation coupled by intratracheal administration of 100 mg/kg surfactant) and Double Surfactant Group (n = 6; surfactant volume was divided into two doses (50 mg/kg + 50 mg/kg) administrated at birth and 30 min thereafter). A complete physical exam, arterial gas analysis, blood glucose, urea and creatinine concentration and chest radiographic assessment were performed at fixed times. All lambs had decreased body temperature until 20 min after birth. However, control and double surfactant groups reached a thermic plateau after 30 min. Regardless of the time-point, control lambs had higher heart rate in comparison to treated neonates, including bradycardia in Single Surfactant Group. Single instillation led to lower oxygenation degree, compared to the Double Surfactant Group, suggesting that surfactant treatment was not able to adequately spread within the alveoli. Lambs treated with surfactant had severe impairment of aerobic activity, leading to anaerobic metabolism. All groups had hypercapnia, which can be explained by inadequate respiratory pattern and pulmonary opacity (89% of the lambs had severe or moderate lung content). In conclusion, exogenous surfactant therapy in association with manual ventilation is ineffective in reverting pulmonary immaturity of the preterm lamb, leading to less vitality, hypoxemia, delayed pulmonary clearance and high mortality rate.
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Affiliation(s)
- Liege Cg Silva
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Daniel Sr Angrimani
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Fernanda M Regazzi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Cristina F Lúcio
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Gisele Al Veiga
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Claudia B Fernandes
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil
| | - Camila I Vannucchi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of São Paulo, Rua Prof. Dr. Orlando Marques de Paiva, 87, São Paulo, SP, 05508-270, Brazil.
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Cattel F, Giordano S, Bertiond C, Lupia T, Corcione S, Scaldaferri M, Angelone L, De Rosa FG. Use of exogenous pulmonary surfactant in acute respiratory distress syndrome (ARDS): Role in SARS-CoV-2-related lung injury. Respir Physiol Neurobiol 2021; 288:103645. [PMID: 33657448 PMCID: PMC7916525 DOI: 10.1016/j.resp.2021.103645] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/11/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022]
Abstract
Several pre-clinical and clinical trials show that exogenous pulmonary surfactant has clinical efficacy in inflammatory lung diseases, especially ARDS. By infecting type II alveolar cells, COVID-19 interferes with the production and secretion of the pulmonary surfactant and therefore causes an increase in surface tension, which in turn can lead to alveolar collapse. The use of the pulmonary surfactant seems to be promising as an additional therapy for the treatment of ARDS. COVID-19 causes lung damage and ARDS, so beneficial effects of surfactant therapy in COVID-19-associated ARDS patients are conceivable, especially when applied early in the treatment strategy against pulmonary failure. Because of the robust anti-inflammatory and lung protective efficacy and the current urgent need for lung-supportive therapy, the exogenous pulmonary surfactant could be a valid supportive treatment of COVID-19 pneumonia patients in intensive care units in addition to the current standard of ARDS treatment
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Affiliation(s)
- Francesco Cattel
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Susanna Giordano
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cecilia Bertiond
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy; Tufts University School of Medicine, Boston, MA, USA
| | - Matilde Scaldaferri
- S.C. Farmacia Ospedaliera -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lorenzo Angelone
- Direzione Sanitaria d'Azienda -A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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van Rensburg L, van Zyl JM, Smith J. Deposition and transport of linezolid mediated by a synthetic surfactant Synsurf ® within a pressurized metered dose inhaler: a Calu-3 model. Drug Des Devel Ther 2018; 12:1107-1118. [PMID: 29765201 PMCID: PMC5942168 DOI: 10.2147/dddt.s147035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Previous studies in our laboratory demonstrated that a synthetic peptide containing lung surfactant enhances the permeability of chemical compounds through bronchial epithelium. The purpose of this study was to test two formulations of Synsurf® combined with linezolid as respirable compounds using a pressurized metered dose inhaler (pMDI). METHODS Aerosolization efficiency of the surfactant-drug microparticles onto Calu-3 monolayers as an air interface culture was analyzed using a Next Generation Impactor™. RESULTS The delivered particles and drug dose showed a high dependency from the preparation that was aerosolized. Scanning electron microscopy imaging allowed for visualization of the deposited particles, establishing them as liposomal-type structures (diameter 500 nm to 2 μm) with filamentous features. CONCLUSION The different surfactant drug combinations allow for an evaluation of the significance of the experimental model system, as well as assessment of the formulations providing a possible noninvasive, site-specific, delivery model via pMDI.
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Affiliation(s)
- Lyné van Rensburg
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Johann M van Zyl
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Johan Smith
- Department of Pediatrics, Tygerberg Children’s Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Glaser K, Fehrholz M, Curstedt T, Kunzmann S, Speer CP. Effects of the New Generation Synthetic Reconstituted Surfactant CHF5633 on Pro- and Anti-Inflammatory Cytokine Expression in Native and LPS-Stimulated Adult CD14+ Monocytes. PLoS One 2016; 11:e0146898. [PMID: 26790130 PMCID: PMC4720484 DOI: 10.1371/journal.pone.0146898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/24/2015] [Indexed: 02/01/2023] Open
Abstract
Background Surfactant replacement therapy is the standard of care for the prevention and treatment of neonatal respiratory distress syndrome. New generation synthetic surfactants represent a promising alternative to animal-derived surfactants. CHF5633, a new generation reconstituted synthetic surfactant containing SP-B and SP-C analogs and two synthetic phospholipids has demonstrated biophysical effectiveness in vitro and in vivo. While several surfactant preparations have previously been ascribed immunomodulatory capacities, in vitro data on immunomodulation by CHF5633 are limited, so far. Our study aimed to investigate pro- and anti-inflammatory effects of CHF5633 on native and LPS-stimulated human adult monocytes. Methods Highly purified adult CD14+ cells, either native or simultaneously stimulated with LPS, were exposed to CHF5633, its components, or poractant alfa (Curosurf®). Subsequent expression of TNF-α, IL-1β, IL-8 and IL-10 mRNA was quantified by real-time quantitative PCR, corresponding intracellular cytokine synthesis was analyzed by flow cytometry. Potential effects on TLR2 and TLR4 mRNA and protein expression were monitored by qPCR and flow cytometry. Results Neither CHF5633 nor any of its components induced inflammation or apoptosis in native adult CD14+ monocytes. Moreover, LPS-induced pro-inflammatory responses were not aggravated by simultaneous exposure of monocytes to CHF5633 or its components. In LPS-stimulated monocytes, exposure to CHF5633 led to a significant decrease in TNF-α mRNA (0.57 ± 0.23-fold, p = 0.043 at 4h; 0.56 ± 0.27-fold, p = 0.042 at 14h). Reduction of LPS-induced IL-1β mRNA expression was not significant (0.73 ± 0.16, p = 0.17 at 4h). LPS-induced IL-8 and IL-10 mRNA and protein expression were unaffected by CHF5633. For all cytokines, the observed CHF5633 effects paralleled a Curosurf®-induced modulation of cytokine response. TLR2 and TLR4 mRNA and protein expression were not affected by CHF5633 and Curosurf®, neither in native nor in LPS-stimulated adult monocytes. Conclusion The new generation reconstituted synthetic surfactant CHF5633 was tested for potential immunomodulation on native and LPS-activated adult human monocytes. Our data confirm that CHF5633 does not exert unintended pro-inflammatory effects in both settings. On the contrary, CHF5633 significantly suppressed TNF-α mRNA expression in LPS-stimulated adult monocytes, indicating potential anti-inflammatory effects.
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Affiliation(s)
- Kirsten Glaser
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
- * E-mail:
| | - Markus Fehrholz
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
| | - Tore Curstedt
- Department of Molecular Medicine and Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Steffen Kunzmann
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
| | - Christian P. Speer
- University Children´s Hospital, University of Würzburg, Würzburg, Germany
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Wang N, Zhang D, Sun G, Zhang H, You Q, Shao M, Yue Y. Lipopolysaccharide-induced caveolin-1 phosphorylation-dependent increase in transcellular permeability precedes the increase in paracellular permeability. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:4965-77. [PMID: 26357463 PMCID: PMC4560510 DOI: 10.2147/dddt.s77646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Lipopolysaccharide (LPS) was shown to induce an increase in caveolin-1 (Cav-1) expression in endothelial cells; however, the mechanisms regarding this response and the consequences on caveolae-mediated transcellular transport have not been completely investigated. This study aims to investigate the role of LPS-induced Cav-1 phosphorylation in pulmonary microvascular permeability in pulmonary microvascular endothelial cells (PMVECs). Methods Rat PMVECs were isolated, cultured, and identified. Endocytosis experiments were employed to stain the nuclei by DAPI, and images were obtained with a fluorescence microscope. Permeability of endothelial cultures was measured to analyze the barrier function of endothelial monolayer. Western blot assay was used to examine the expression of Cav-1, pCav-1, triton-insoluble Cav-1, and triton-soluble Cav-1 protein. Results The LPS treatment induced phosphorylation of Cav-1, but did not alter the total Cav-1 level till 60 min in both rat and human PMVECs. LPS treatment also increased the triton-insoluble Cav-1 level, which peaked 15 min after LPS treatment in both rat and human PMVECs. LPS treatment increases the intercellular cell adhesion molecule-1 expression. Src inhibitors, including PP2, PP1, Saracatinib, and Quercetin, partially inhibited LPS-induced phosphorylation of Cav-1. In addition, both PP2 and caveolae disruptor MβCD inhibited LPS-induced increase of triton-insoluble Cav-1. LPS induces permeability by activating interleukin-8 and vascular endothelial growth factor and targeting other adhesion markers, such as ZO-1 and occludin. LPS treatment also significantly increased the endocytosis of albumin, which could be blocked by PP2 or MβCD. Furthermore, LPS treatment for 15 min significantly elevated Evans Blue-labeled BSA transport in advance of a decrease in transendothelial electrical resistance of PMVEC monolayer at this time point. After LPS treatment for 30 min, transendothelial electrical resistance decreased significantly. Moreover, PP2 and MβCD blocked LPS-induced increase in Evans Blue-labeled BSA level. Conclusion Our study demonstrates that LPS-induced Cav-1 phosphorylation may lead to the increase of transcellular permeability prior to the increase of paracellular permeability in a Src-dependent manner. Thus, LPS-induced Cav-1 phosphorylation may be a therapeutic target for the treatment of inflammatory lung disease associated with elevated microvascular permeability.
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Affiliation(s)
- Nan Wang
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China ; Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Dan Zhang
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China ; Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Gengyun Sun
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Hong Zhang
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China ; Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Qinghai You
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Min Shao
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yang Yue
- Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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