Eirini Apostolou, Athanasios Stavropoulos, Alexandros Sountoulidis, Charoula Xirakia, Stavros Giaglis, Evdokia Protopapadakis, Konstantinos Ritis, Spyros Mentzelopoulos, Arja Pasternack, Martyn Foster, Olli Ritvos, George E. Tzelepis, Evangelos Andreakos and Paschalis Sideras  Am. J. Respir. Crit. Care Med. February 15, 2012 vol. 185 no. 4 382-391 
Abstract
Rationale: Activin-A is up-regulated in various respiratory disorders. However, its precise role in pulmonary pathophysiology has not been adequately substantiated in vivo.

Objectives: To investigate in vivo the consequences of dysregulated Activin-A expression in the lung and identify key Activin-A–induced processes that contribute to respiratory pathology.

Methods: Activin-A was ectopically expressed in murine lung, and functional, structural, and molecular alterations were extensively analyzed. The validity of Activin-A as a therapeutic target was demonstrated in animals overexpressing Activin-A or treated with intratracheal instillation of LPS. Relevancy to human pathology was substantiated by demonstrating high Activin-A levels in bronchoalveolar lavage (BAL) samples from patients with acute respiratory distress syndrome (ARDS).

Measurements and Main Results: Overexpression of Activin-A in mouse airways caused pulmonary pathology reminiscent of acute lung injury (ALI)/ARDS. Activin-A triggered a lasting inflammatory response characterized by acute alveolar cell death and hyaline membrane formation, sustained up-regulation of high-mobility group box 1, development of systemic hypercoagulant state, reduction of surfactant proteins SpC, SpB, and SpA, decline of lung compliance, transient fibrosis, and eventually emphysema. Therapeutic neutralization of Activin-A attenuated the ALI/ARDS–like pathology induced either by ectopic expression of Activin-A or by intratracheal instillation of LPS. In line with the similarity of the Activin-A–induced phenotype to human ARDS, selective up-regulation of Activin-A was found in BAL of patients with ARDS.

Conclusions: Our studies demonstrate for the first time in vivo the pathogenic consequences of deregulated Activin-A expression in the lung, document novel aspects of Activin-A biology that provide mechanistic explanation for the observed phenotype, link Activin-A to ALI/ARDS pathophysiology, and provide the rationale for therapeutic targeting of Activin-A in these disorders.

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