Solymosi, E.A.* ; Kaestle-Gembardt, S.M.* ; Vadász, I.* ; Wang, L.* ; Neye, N.* ; Chupin, C.J.* ; Rozowsky, S.* ; Ruehl, R.* ; Tabuchi, A.* ; Schulz, H. ; Kapus, A.* ; Morty, R.E.* ; Kuebler, W.M.*
     
 
    
        
Chloride transport-driven alveolar fluid secretion is a major contributor to cardiogenic lung edema.
    
    
        
    
    
        
        Proc. Natl. Acad. Sci. U.S.A. 110, E2308-E2316 (2013)
    
    
    
		
		
			
				Alveolar fluid clearance driven by active epithelial Na(+) and secondary Cl(-) absorption counteracts edema formation in the intact lung. Recently, we showed that impairment of alveolar fluid clearance because of inhibition of epithelial Na(+) channels (ENaCs) promotes cardiogenic lung edema. Concomitantly, we observed a reversal of alveolar fluid clearance, suggesting that reversed transepithelial ion transport may promote lung edema by driving active alveolar fluid secretion. We, therefore, hypothesized that alveolar ion and fluid secretion may constitute a pathomechanism in lung edema and aimed to identify underlying molecular pathways. In isolated perfused lungs, alveolar fluid clearance and secretion were determined by a double-indicator dilution technique. Transepithelial Cl(-) secretion and alveolar Cl(-) influx were quantified by radionuclide tracing and alveolar Cl(-) imaging, respectively. Elevated hydrostatic pressure induced ouabain-sensitive alveolar fluid secretion that coincided with transepithelial Cl(-) secretion and alveolar Cl(-) influx. Inhibition of either cystic fibrosis transmembrane conductance regulator (CFTR) or Na(+)-K(+)-Cl(-) cotransporters (NKCC) blocked alveolar fluid secretion, and lungs of CFTR(-/-) mice were protected from hydrostatic edema. Inhibition of ENaC by amiloride reproduced alveolar fluid and Cl(-) secretion that were again CFTR-, NKCC-, and Na(+)-K(+)-ATPase-dependent. Our findings show a reversal of transepithelial Cl(-) and fluid flux from absorptive to secretory mode at hydrostatic stress. Alveolar Cl(-) and fluid secretion are triggered by ENaC inhibition and mediated by NKCC and CFTR. Our results characterize an innovative mechanism of cardiogenic edema formation and identify NKCC1 as a unique therapeutic target in cardiogenic lung edema.
			
			
				
			
		 
		
			
				
					
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        Publikationstyp
        Artikel: Journalartikel
    
 
    
        Dokumenttyp
        Wissenschaftlicher Artikel
    
 
    
        Typ der Hochschulschrift
        
    
 
    
        Herausgeber
        
    
    
        Schlagwörter
        Epithelial Cl- Transport ; Pulmonary Edema; Respiratory-distress-syndrome ; Acute Pulmonary-edema ; Ion-transport ; Na+ Absorption ; Epithelial Ion ; Ii Cells ; Cftr ; Furosemide ; Channels ; Volume
    
 
    
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        Sprache
        englisch
    
 
    
        Veröffentlichungsjahr
        2013
    
 
    
        Prepublished im Jahr 
        
    
 
    
        HGF-Berichtsjahr
        2013
    
 
    
    
        ISSN (print) / ISBN
        0027-8424
    
 
    
        e-ISSN
        1091-6490
    
 
    
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	    Band: 110,  
	    Heft: 25,  
	    Seiten: E2308-E2316 
	    Artikelnummer: ,  
	    Supplement: ,  
	
    
 
  
        
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            National Academy of Sciences
        
 
        
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        Begutachtungsstatus
        Peer reviewed
    
 
    
        Institut(e)
        Institute of Epidemiology (EPI)
    
 
    
        POF Topic(s)
        30503 - Chronic Diseases of the Lung and Allergies
    
 
    
        Forschungsfeld(er)
        Genetics and Epidemiology
    
 
    
        PSP-Element(e)
        G-503900-003
    
 
    
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        Erfassungsdatum
        2013-08-01