The receptor for advanced glycation end-products (RAGE), a multiligand member of the Ig family, may play a crucial role in the regulation of lung fluid balance. We quantified soluble RAGE (sRAGE), a decoy isoform, and advanced glycation end-products (AGEs) from the bronchoalveolar lavage fluid of smokers and nonsmokers, and tested the hypothesis that AGEs regulate lung fluid balance through protein kinase C (PKC)-gp91 phox signaling to the epithelial sodium channel (ENaC). Human bronchoalveolar lavage samples from smokers showed increased AGEs (9.02 6 3.03 mg versus 2.48 6 0.53 mg), lower sRAGE (1,205 6 292 pg/ml versus 1,910 6 263 pg/ml), and lower volume(s) of epithelial lining fluid (97 6 14 ml versus 133 6 17 ml). sRAGE levels did not predict ELF volumes in nonsmokers; however, in smokers, higher volumes of ELF were predicted with higher levels of sRAGE. Single-channel patch clamp analysis of rat alveolar epithelial type 1 cells showed that AGEs increased ENaC activity measured as the product of the number of channels (N) and the open probability (Po) (NPo) from 0.19 6 0.08 to 0.83 6 0.22 (P = 0.017) and the subsequent addition of 4-hydroxy-2, 2, 6, 6-tetramethylpiperidine-N-oxyl decreased ENaC NPo to 0.15 6 0.07 (P = 0.01). In type 2 cells, human AGEs increased ENaC NPo from 0.12 6 0.05 to 0.53 6 0.16 (P = 0.025) and the addition of 4-hydroxy-2, 2, 6, 6-tetramethylpiperidine-N-oxyl decreased ENaC NPo to 0.10 6 0.03 (P = 0.013). Using molecular and biochemical techniques, we observed that inhibition of RAGE and PKC activity attenuated AGE-induced activation of ENaC. AGEs induced phosphorylation of p47 phox and increased gp91 phox -dependent reactive oxygen species production, a response that was abrogated with RAGE or PKC inhibition. Finally, tracheal instillation of AGEs promoted clearance of lung fluid, whereas concomitant inhibition of RAGE, PKC, and gp91 phox abrogated the response.Keywords: acute respiratory distress syndrome; chronic obstructive pulmonary disease; pulmonary edema; alveolar microenvironment; lung injury
Clinical RelevanceReceptor for advanced glycation end-products (RAGE) plays a critical role in regulating inflammation in the lung and may be a therapeutic target in the treatment of acute and chronic lung diseases. Herein we describe the signal transduction pathway through which RAGE regulates the epithelial sodium channel.