Recent studies indicate that cyclic AMP (cAMP) induces cytotoxic T lymphocyte antigen (CTLA) 4. CTLA4 is expressed in T cells, and is a negative regulator of T cell activation. CTLA4 expression is regulated by T cell receptor plus CD28 (adaptive immune signaling) at both the transcriptional and post-transcriptional level. Here, we examine the pathways by which cAMP regulates CTLA4 expression, focusing on transcriptional activation. Elevating intracellular cAMP levels by cellpermeable cAMP analogs, the adenylyl cyclase activator, forskolin, or phosphodiesterase inhibitors increases CTLA4 mRNA expression in EL4 murine T cells and primary CD41 T cells. Activation of protein kinase A (using the protein kinase A-selective agonist, N6-phenyladenosine-cAMP), but not exchange proteins activated by cAMP (using the exchange proteins activated by cAMP-selective 8-pCPT-2Me-cAMP), increases CTLA4 promoter activity. Mutation constructs of the CTLA4 promoter uncover an enhancer binding site located within the 2150 to 2130 bp region relative to the transcription start site. Promoter analysis and chromatin immunoprecipitation assays suggest that cAMP response element-binding is a putative transcription factor induced by cAMP. We have previously shown that CTLA4 mediates decreased pulmonary inflammation in an LPSinduced murine model of acute lung injury (ALI). We observed that LPS can induce CTLA4 transcription via the same cAMP-inducible promoter region. The immunosuppressant, rapamycin, decreases cAMP and LPS-induced CTLA4 transcription in vitro. In vivo, LPS induces cAMP accumulation in bronchoalveolar lavage fluid, bronchoalveolar lavage cells, and lung tissues in ALI. We demonstrate that rapamycin decreases cAMP accumulation and CTLA4 expression in ALI. Together, these data suggest that cAMP may negatively regulate pulmonary inflammatory responses in vivo and in vitro by altering CTLA4 expression.Keywords: cytotoxic T lymphocyte antigen 4; cAMP; acute lung injury; protein kinase A; rapamycin Activated T cells express negative regulators, including cytotoxic T lymphocyte antigen (CTLA) 4, a negative regulator of T cell activation (1-3). CTLA4 binds to CD80 or CD86 with greater affinity than CD28 to block costimulatory signals, leading to inhibition of cell cycle progression and IL-2 production (4). The blockade of CTLA4 by antibody prevents the accumulation of inducible cyclic AMP (cAMP) early repressor and cAMP response element modulator, and leads to the rescue of IL-2 expression (5, 6). cAMP has a similar inhibitory effect on proliferation and IL-2 production in T cells (7,8).cAMP is an important second messenger in many biological processes. cAMP is synthesized from ATP by adenylyl cyclase and degraded by phosphodiesterase (PDE). In physiological conditions, a wide range of signaling molecules, such as epinephrine, glucagon, and prostaglandin E2, increase cAMP accumulation via G protein-coupled receptor. cAMP can also be activated in response to microbial challenges or LPS (9). The main targets of cAMP are protein kinase ...