Earlier work showed that apoptosis of alveolar epithelial cells (AECs) in response to endogenous or xenobiotic factors is regulated by autocrine generation of angiotensin (ANG) II and its counterregulatory peptide ANG1-7. Mutations in surfactant protein C (SP-C) induce endoplasmic reticulum (ER) stress and apoptosis in AECs and cause lung fibrosis. This study tested the hypothesis that ER stress-induced apoptosis of AECs might also be regulated by the autocrine ANGII/ANG1-7 system of AECs. ER stress was induced in A549 cells or primary cultures of human AECs with the proteasome inhibitor MG132 or the SP-C BRICHOS domain mutant G100S. ER stress activated the ANGII-generating enzyme cathepsin D and simultaneously decreased the ANGII-degrading enzyme ACE-2, which normally generates the antiapoptotic peptide ANG1-7. TAPI-2, an inhibitor of ADAM17/TACE, significantly reduced both the activation of cathepsin D and the loss of ACE-2. Apoptosis of AECs induced by ER stress was measured by assays of mitochondrial function, JNK activation, caspase activation, and nuclear fragmentation. Apoptosis induced by either MG132 or the SP-C BRICHOS mutant G100S was significantly inhibited by the ANG receptor blocker saralasin and was completely abrogated by ANG1-7. Inhibition by ANG1-7 was blocked by the specific mas antagonist A779. These data show that ER stress-induced apoptosis is mediated by the autocrine ANGII/ANG1-7 system in human AECs and demonstrate effective blockade of SP-C mutation-induced apoptosis by ANG1-7. They also suggest that therapeutic strategies aimed at administering ANG1-7 or stimulating ACE-2 may hold potential for the management of ER stress-induced fibrotic lung disorders.idiopathic pulmonary fibrosis; BRICHOS domain mutations; ADAM17/ TACE; substituted peptide receptor antagonists APOPTOSIS OF ALVEOLAR EPITHELIAL cells (AECs) is increasingly being recognized as a critical event that initiates and propagates fibrosis in the lung parenchyma (20). The concept that AEC death was a critical determinant of fibrosis vs. normal repair was first proposed many years ago on the basis of two-hit toxicological experiments that demonstrated that fibrogenesis could be induced by experimental delay of epithelial repair after lung injury (1, 6), regardless of the presence or absence of inflammation. More recent evidence in support of this theory was found in the ability of caspase inhibitors (8, 25) or genetic deletion of apoptosis signaling molecules (2) to block fibrogenesis subsequent to lung injuries aimed at the epithelium (5).Understanding the regulation of AEC apoptosis is therefore critical to understanding the pathogenesis of lung fibrosis. Earlier work from this laboratory found that endogenous (24, 26) or xenobiotic inducers of AEC apoptosis (11) activate the autocrine synthesis of angiotensin (ANG)II from its precursor angiotensinogen (AGT) as well as its subsequent enzymatic processing to the mature peptide ANGII, all by the AEC itself. Further work demonstrated that the autocrine production of ANGII by AEC...