The 150-kd oxygen-regulated protein is a novel stress protein that is located in the endoplasmic reticulum and contributes to cell survival when this organelle is under stress. Expression of this protein was strongly increased in alveolar macrophages and alveolar epithelial cells from mice with acute lung injury induced by lipopolysaccharide. Transgenic mice overexpressing the 150-kd protein showed decreased histological severity of this lung injury, accompanied by lower total protein concentrations, and lactate dehydrogenase activity in bronchoalveolar lavage fluid. As indicated by nick end-labeling, lipopolysaccharide induced apoptosis in fewer alveolar wall cells in transgenic than in wild-type mice. Transgenic mice also showed increased survival after lipopolysaccharide injection (a log-rank test). Thus, the 150-kd protein, an endoplasmic reticulum-related molecular chaperone, is pivotal in resisting acute lung injury from lipopolysaccharide. Lipopolysaccharide (LPS), a toxic biological substance that initiates acute inflammation, can produce experimental acute lung injury (ALI) 1-3 resulting in hypoxemia. Ongoing exposure to hypoxemia/hypoxia induces death of lung cells, which are vulnerable to hypoxic conditions; hypoxia further increases lung inflammation after LPS exposure.4,5 Thus, hypoxia may play a central role in LPS-induced ALI.Extreme hypoxia induces changes in cellular metabolic homeostasis. The 150-kd oxygen-regulated protein (ORP150/HSP12A), first cloned from cultured astrocytes under hypoxic conditions, 6 is a molecular chaperone belonging to the heat shock protein (HSP) family. Located in the endoplasmic reticulum (ER), ORP150 resembles glucose-regulated proteins (GRPs) such as GRP78 and GRP94. 7 ORP150 expression is required for cells to survive hypoxic conditions, indicating that ORP150 is important in protection of cells from hypoxia/ischemia. 8 In the central nervous system, ORP150 overexpression was found to protect neurons from ischemia by suppression of apoptosis 9 and/or activation of Ca 2ϩ -dependent proteinases. 10,11 These findings establish an important role for this ER-located molecular chaperone in neuronal defense mechanisms against environmental stress.Although ORP150 normally is expressed in most tissues, its role in the development of respiratory diseases has not been evaluated. Severity of ALI is associated with degree of alveolar epithelial cell injury.12 As alveolar epithelial cells participate in essential functions including gas exchange, they must be protected from environmental stresses including hypoxia. Thus, understanding of cellular defense mechanisms against such events could lead to therapeutic strategies that enhance protection of alveolar epithelial cells from pathogenetic insults. Induction of ER-associated chaperones such as ORP150 has not been studied in the respiratory system as a possible mechanism for cytoprotection.We used a mouse model of LPS-induced ALI to examine changes in expression of ORP150 by alveolar epithelial cells, and to determine whether OR...