Abstract-Sepsis and endotoxemia impair hypoxic pulmonary vasoconstriction (HPV), thereby reducing systemic oxygenation. To assess the role of leukotrienes (LTs) in the attenuation of HPV during endotoxemia, the increase in left lung pulmonary vascular resistance (LPVR) before and during left mainstem bronchus occlusion (LMBO) was measured in mice with and without a deletion of the gene encoding 5-lipoxygenase (5-LO). LMBO increased the LPVR equally in saline-challenged wild-type and 5-LO-deficient mice (96Ϯ20% and 94Ϯ19%, respectively). Twenty-two hours after challenge with Escherichia coli endotoxin, the ability of LMBO to increase LPVR was markedly impaired in wild-type mice (27Ϯ7%; PϽ0.05) but not in 5-LO-deficient mice (72Ϯ9%) or in wild-type mice pretreated with MK886, an inhibitor of 5-LO activity (76Ϯ10%). Compared with wild-type mice, endotoxin-induced disruption of lung structures and inflammatory cell influx in the lung were markedly attenuated in 5-LO-deficient mice. Administration of MK571, a selective cysteinyl LT 1 receptor antagonist, 1 hour before endotoxin challenge preserved HPV and attenuated pulmonary injury in wild-type mice but did not prevent the endotoxin-induced increase in pulmonary myeloperoxidase activity. Taken together, these findings demonstrate that a 5-LO product, most likely a cysteinyl LT, contributes to the attenuation of HPV and to pulmonary injury after challenge with endotoxin. (Circ Res. 2001;88:832-838.)Key Words: cysteinyl leukotrienes Ⅲ pulmonary injury Ⅲ left mainstem bronchus occlusion H ypoxic pulmonary vasoconstriction (HPV) is characterized by vasoconstriction of pulmonary vessels in poorly ventilated hypoxic lung regions, thus optimizing pulmonary gas exchange. The sensor and effector mechanisms responsible for HPV reside in vascular smooth muscle cells of pulmonary arterioles 1,2 ; however, the precise mechanisms that mediate HPV remain incompletely understood. 3 HPV is markedly impaired in patients with clinical sepsis or the acute respiratory distress syndrome (ARDS). 4,5 Experimental endotoxemia has also been shown to impair HPV in several animal species. 6,7 Although the mechanisms responsible for the sepsis-induced attenuation of HPV remain incompletely elucidated, various inflammatory mediators including prostaglandins, 8 thromboxanes, 9 platelet-activating factor, 6 and cytokines 10 have all been implicated. Recently, we reported that increased pulmonary NO levels are necessary, but not sufficient, to impair HPV in a murine sepsis model. 11 These studies suggested that, in addition to increased pulmonary NO levels, the attenuation of HPV after endotoxin challenge requires unknown endotoxin-induced inflammatory products.Leukotrienes (LTs) are potent lipid mediators of inflammation derived from arachidonic acid (AA) metabolism. 12 Synthesis of LTs is initiated by the conversion of AA to HPETE by arachidonate 5-lipoxygenase (5-LO) in the presence of 5-LO-activating protein (FLAP). This intermediate can be dehydrated to the epoxide intermediate LTA 4 , which c...