Hypercapnic acidosis attenuates ventilation-induced lung injury by a nuclear factor-κB-dependent mechanism.
OBJECTIVE
Hypercapnic acidosis protects against ventilation-induced lung injury. We wished to determine whether the beneficial effects of hypercapnic acidosis in reducing stretch-induced injury were mediated via inhibition of nuclear factor-κB, a key transcriptional regulator in inflammation, injury, and repair.


METHODS
Prospective randomized animal study.


METHODS
University research laboratory.


METHODS
Adult male Sprague-Dawley rats.


METHODS
In separate experimental series, the potential for hypercapnic acidosis to attenuate moderate and severe ventilation-induced lung injury was determined. In each series, following induction of anesthesia and tracheostomy, Sprague-Dawley rats were randomized to (normocapnia; FICO2 0.00) or (hypercapnic acidosis; FICO2 0.05), subjected to high stretch ventilation, and the severity of lung injury and indices of activation of the nuclear factor-κB pathway were assessed. Subsequent in vitro experiments examined the potential for hypercapnic acidosis to reduce pulmonary epithelial inflammation and injury induced by cyclic mechanical stretch. The role of the nuclear factor-κB pathway in hypercapnic acidosis-mediated protection from stretch injury was then determined.


RESULTS
Hypercapnic acidosis attenuated moderate and severe ventilation-induced lung injury, as evidenced by improved oxygenation, compliance, and reduced histologic injury compared to normocapnic conditions. Hypercapnic acidosis reduced indices of inflammation such as interleukin-6 and bronchoalveolar lavage neutrophil infiltration. Hypercapnic acidosis reduced the decrement of the nuclear factor-κB inhibitor IκBα and reduced the generation of cytokine-induced neutrophil chemoattractant-1. Hypercapnic acidosis reduced cyclic mechanical stretch-induced nuclear factor-κB activation, reduced interleukin-8 production, and decreased epithelial injury and cell death compared to normocapnia.


CONCLUSIONS
Hypercapnic acidosis attenuated ventilation-induced lung injury independent of injury severity and decreased mechanical stretch-induced epithelial injury and death, via a nuclear factor-κB-dependent mechanism.
School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
Maya
M
Contreras
Bilal
B
Ansari
Gerard
G
Curley
Brendan D
BD
Higgins
Patrick
P
Hassett
Daniel
D
O'Toole
John G
JG
Laffey
D000142:Acidosis, Respiratory / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology; D000818:Animals; D001707:Biopsy, Needle; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000502:physiology; D006935:Hypercapnia / Q000378:metabolism / Q000503:physiopathology; D007150:Immunohistochemistry; D015601:Injury Severity Score; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D008297:Male; D016328:NF-kappa B / Q000378:metabolism*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055397:Ventilator-Induced Lung Injury / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*
D015850:Interleukin-6; D016209:Interleukin-8; D016328:NF-kappa B