The prolonged exposure to hyperoxia can compromise macrophage functions and contribute to the development of ventilator-associated pneumonia. High levels of extracellular high-mobility group box-1 (HMGB1) in the airways of mice exposed to hyperoxia can directly cause macrophage dysfunction. Hence, inhibition of the release of nuclear HMGB1 into the extracellular milieu may help to maintain macrophage functions under hyperoxic conditions. The present study investigates whether ethacrynic acid (EA) affects hyperoxiainduced HMGB1 release from macrophages and improves their functions. Macrophage-like RAW 264.7 cells and bone marrowderived macrophages were exposed to different concentrations of EA for 24 hours in the presence of 95% O 2 . EA significantly decreased the accumulation of extracellular HMGB1 in cultured media. Importantly, the phagocytic activity and migration capability of macrophages were significantly enhanced in EA-treated cells. Interestingly, hyperoxia-induced NF-kB activation was also inhibited in these cells. To determine whether NF-kB plays a role in hyperoxia-induced HMGB1 release, BAY 11-7082, an inhibitor of NF-kB activation, was used. Similar to EA, BAY 11-7082 significantly inhibited the accumulation of extracellular HMGB1 and improved hyperoxia-compromised macrophage migration and phagocytic activity. Furthermore, 24-hour hyperoxic exposure of macrophages caused hyperacetylation of HMGB1 and its subsequent cytoplasmic translocation and release, which were inhibited by EA and BAY 11-7082. Together, these results suggest that EA enhances hyperoxia-compromised macrophage functions by inhibiting HMGB1 hyperacetylation and its release from macrophages, possibly through attenuation of the NF-kB activation. Therefore, the activation of NF-kB could be one of the underlying mechanisms that mediate hyperoxia-compromised macrophage functions.Keywords: hyperoxia; macrophage; high-mobility group box-1; phagocytosis; NF-kB
Clinical RelevanceWe demonstrate that modulating extracellular levels of highmobility group box-1 by inhibitors to NF-kB activation could be used as a potential approach to improve hyperoxiacompromised macrophage functions. If these results can be translated to humans, it is possible that ethacrynic acid could be used as part of the treatment for patients with ventilatorassociated pneumonia.