Introduction
Ischemia-reperfusion-induced acute lung injury (IR-ALI) represents a complex condition characterized by the interruption and subsequent restoration of blood supply to the lungs, leading to aberrant physiological processes that disrupt vascular permeability and incite dysregulated inflammatory responses [
1‐
3]. The pathogenesis of IR-ALI involves the excessive generation of reactive oxygen species (ROS), upregulation of pro-inflammatory cytokines, activation of the nuclear factor-κB (NF-κB) pathway, infiltration of neutrophils into the alveoli, and dysfunction of both the epithelium and endothelium. Additionally, lung cell apoptosis plays a significant role in the development of pulmonary dysfunction associated with IR injury. These pathophysiological events contribute to heightened pulmonary vascular resistance, augmented microvascular permeability, and the onset of lung edema. IR-ALI can arise in various clinical scenarios, encompassing lung transplantation, major surgical procedures, cardiopulmonary bypass surgery, pulmonary embolism, resuscitation for cardiac arrest, and hemorrhagic shock [
1‐
3]. Despite advancements in therapeutic strategies, the mortality rate of ALI and its severe form, acute respiratory distress syndrome (ARDS), remains alarmingly high, ranging from 30 to 40% [
1‐
3]. Presently, there is a notable dearth of clinically effective medications specifically tailored for the treatment of IR-ALI, with available interventions primarily focused on supportive care. Therefore, the identification and development of novel therapeutic approaches to address IR-ALI constitute an imperative research endeavor.
Rev-Erbα, a nuclear receptor also known as Nr1d1, stands as a pivotal component of the circadian clock machinery, exerting transcriptional repression as its primary function. Recent studies underscore the profound influence of the circadian clock system on vital physiological processes, including energy metabolism, oxidative stress, inflammation, cellular proliferation, and senescence [
4,
5]. Consequently, Rev-Erbα emerges as an enticing therapeutic target amenable to modulation via available small-molecule agonists and antagonists [
4]. A growing body of evidence substantiates the detrimental effects of clock disturbances on pulmonary function and the development of lung disorders [
5,
6]. Various factors, ranging from air pollutants, particulate matter, xenobiotic detoxification, cigarette smoke, shift work, jet lag, hypoxia/hyperoxia, ventilator-induced ALI, to bacterial and viral pathogens, can disrupt the molecular clock within the lungs, thereby exacerbating the progression of lung diseases [
6]. These findings emphasize the role of clock disruption in orchestrating diverse cellular and molecular changes during lung disease development. Moreover, recent investigations shed light on the regulatory role of Rev-Erbα in the context of lung injury, pulmonary fibrosis, and chronic obstructive pulmonary disease (COPD), where circadian clock synchronization appears to be of paramount importance.
Animal models with disrupted or inhibited expression of Rev-Erbα display adverse effects on pulmonary function, increased vulnerability to infection, and an aggravated inflammatory response, resulting in unfavorable recovery outcomes. Conversely, animals exhibiting Rev-Erbα overexpression or administered a Rev-Erbα agonist exhibit diminished production of inflammatory cytokines and improved lung damage [
7‐
9]. Despite these observations implying the significance of Rev-Erbα in lung inflammation, the precise contribution of Rev-Erbα to IR-ALI remains inadequately comprehended. In this study, we postulate that the diminution of Rev-Erbα abundance induced by IR potentiates both pulmonary and cellular inflammatory responses. Additionally, we hypothesize that the activation of Rev-Erbα using small molecule agonists, such as SR9009, would mitigate IR-ALI.
Discussion
The involvement of circadian clock dysfunction in the development and advancement of various inflammatory diseases is widely acknowledged. Nevertheless, the precise contribution of tissue-specific local circadian clocks to distinct pathophysiological processes has not been extensively investigated. In this study, we show that the pharmacologically targeting using SR9009, a Rev-Erbα agonist, successfully protected against IR-ALI in a rat model via decreasing lung edema, neutrophil infiltration, PAP, production of inflammatory cytokines, NF-κB and MAPK activation, leukocyte recruitment, and cell apoptosis. Ultimately, this reduces lung tissue damage. But the beneficial effects of SR9009 was abrogated by SR8278, a Rev-Erbα antagonist. In vitro experiments, SR9009 decreased levels of phosphorylated NF-κB p65 and KC, and increased levels of IκB-α in MLE-12 cells exposed to HR. Conversely, loss of SR9009’s target Rev-Erbα (Rev-Erbα siRNA ) abolished the protective benefits of SR9009 treatment, indicating that the effects of SR9009 are Rev-Erbα-dependent. These experiments indicate that SR9009 may have potential benefits as an adjuvant therapy for IR-ALI and that its protective mechanism may be via the Rev-Erbα signaling pathway.
Oxidative stress, caused by an imbalance between pro- and antioxidation, plays a role in the pathogenesis of ALI/ARDS [
16]. Neutrophil-generated oxygen radicals can impair the integrity of the alveolar epithelial barrier, leading to increased plasma leakage and lung tissue edema. The Rev-Erbα pathway has been implicated in the modulation of oxidative stress, and it is now understood that oxidative stress can also impact Rev-Erbα pathways bidirectionally [
19]. The susceptibility of Rev-Erbα transcription and circadian oscillation to oxidative stress and inflammation has been observed [
19]. In contrast, Rev-Erbα enhances cellular antioxidant defense mechanisms and regulates mitochondrial energy production, thereby protecting cells against oxidative stress [
20]. Our study showed that SR9009, an agonist of Rev-Erbα, reduced oxidative stress in IR-induced lung injury. These findings were supported by a reduction in H
2O
2 levels and lipid membrane peroxidation, as well as an increase in glutathione levels in lung tissue. SR9009 also reduced neutrophil infiltration, as indicated by a decrease in neutrophil and MPO-positive cell counts. By suppressing neutrophil-endothelium interactions, SR9009 decreased the production of proinflammatory cytokines and free radicals. These effects contributed to the attenuation of lung edema, as evidenced by lower W/D and LW/BW ratios, reduced K
f, and decreased protein concentration in the BALF. These results are consistent with previous research showing that SR9009 can alleviate oxidative stress and reduce neutrophil infiltration in myocardial IR injury [
21].
Previous investigations have implicated a complex network of inflammatory cytokines and chemokines in mediating, amplifying, and perpetuating the lung injury process [
12]. It has long been thought that reducing the early inflammatory responses is a key promising strategy for intervention of ALI [
22]. Our experiment showed that SR9009 significantly attenuated the increased levels of inflammatory mediators such as proinflammatory TNF-α, CINC-1 and IL-6 in the BALF after IR-ALI. Our findings were also comparable with those in previous investigations showing that SR9009 alleviated inflammatory mediator production, thereby reducing inflammation, and preventing ventilation and cigarette smoke-induced lung injury [
7,
23].
The NF-κB inhibitory protein, IκB, masks the nuclear translocation signal of NF-κB, keeping it within the cytoplasm [
24]. In response to inflammation, IκB undergoes phosphorylation and degradation, releasing NF-κB for nuclear translocation and activation of inflammation-associated genes such as TNF-α, CINC-1, IL-6, and CXCL-1 [
13,
24]. Akt, a signaling protein, also contributes to NF-κB activation and subsequent transcriptional increase [
25]. Akt-dependent events are known to play a role in ALI development [
26]. Inhibition of NF-κB activation has been shown to alleviate IR-ALI severity in rats [
11,
13]. SR9009, an agonist of Rev-Erbα, has been found to inhibit NF-κB signaling in various cell types and diseases. Studies have demonstrated that SR9009 suppresses LPS-induced microglial activation, hippocampal neuroinflammation, and endometrial dysfunction via the NF-κB pathway [
17,
18,
27]. It also reduces cytokine production and promotes myocardial infarction survival by inhibiting the NF-κB pathway [
28]. In fibroblast-like synoviocytes from rheumatoid arthritis patients, SR9009 inhibits NF-κB activation and nuclear translocation of p65 [
29]. Activation of Rev-Erbα prevented colitis in mice by repressing NF-κB activity [
30] Our ongoing research confirms that SR9009 inhibits the NF-κB pathway, reducing pro-inflammatory cytokine production in rat lungs exposed to IR. In an in vitro experiment using MLE-12 cells exposed to HR, SR9009 prevented IκBα degradation, inhibited NF-κB p65 phosphorylation, and reduced KC production. Conversely, a Rev-Erbα antagonist and gene knockdown had opposite effects to SR9009, both
in vivo and in vitro.
A plethora of studies have provided compelling evidence linking apoptosis and the development of IR-ALI [
31]. The anti-apoptotic properties of the Bcl-2 protein play a vital role in cellular survival and protection against IR-induced damage. In contrast, caspase-3, an effector caspase, plays a pivotal role in promoting apoptosis [
32]. In the context of lung tissue, IR injury leads to a decrease in Bcl-2 levels and an increase in cleaved-caspase-3 levels, triggering apoptosis. Conversely, inhibiting apoptosis has shown promising results in ameliorating IR-ALI [
12,
16,
33]. There is substantial evidence supporting a direct correlation between targeting the circadian factor Rev-Erbα pharmacologically and the downregulation of apoptosis. Previous studies conducted by other researchers have demonstrated that GSK4112, an agonist of Rev-Erbα, effectively inhibits the activation of caspase-3 in SH-SH5Y cells treated with conditioned media derived from lipopolysaccharide (LPS)-treated BV2 cells [
27]. Additionally, Huang et al. have shown that SR9009 provides cardioprotection against myocardial IR injury, partly by reducing apoptosis [
21]. Furthermore, Yue et al. have reported that treatment with SR9009 leads to a decrease in TUNEL-positive cells and a significant reduction in cleaved caspase-3 levels in the hippocampus after status epilepticus [
34]. Consistent with these findings, our own study reveals that SR9009 effectively suppresses apoptosis in lung tissue by diminishing cleaved-caspase-3 levels and enhancing Bcl-2 expression.
The serine/threonine protein kinases known as MAPKs have been extensively studied, with p38, ERK, and JNK being the most well-known family members. These proteins actively participate in inflammatory signaling and contribute to various pathological processes associated with IR injury. Earlier studies have reported an abnormal increase in the phosphorylation of p38, ERK, and JNK in lung tissue following IR. Suppression of p38, ERK, or JNK activation has the potential to reduce IR and LPS-induced lung injury. Our investigation revealed that the administration of SR9009 effectively inhibits the effects of MAPK, thereby mitigating the extensive inflammation typically observed in IR-ALI. These findings are consistent with a study conducted by Stujanna et al., which demonstrated the ability of SR9009 to inhibit MAPK activation and improve post-myocardial infarction mortality [
28]. Furthermore, Liu et al. exhibited the ability of SR9009 to suppress the phosphorylation of p38 and JNK in IL-1β-stimulated fibroblast-like synoviocytes from rheumatoid arthritis [
29]. Further exploration is required to unravel the intricate mechanisms underlying the interaction between Rev-Erbα and the MAPK pathway.
Rev-Erbα, an orphan nuclear receptor, plays a crucial role in maintaining the circadian rhythm. Dysregulation of Rev-Erbα is implicated in immune and inflammatory responses triggered by environmental, inflammatory, and infectious agents [
35]. Various environmental factors, including tobacco smoke, LPS, hyperoxia, allergens, bleomycin, bacterial, and viral infections, can alter the levels of Rev-Erbα in lung tissue, potentially leading to an increased DNA damage response, cellular senescence, and inflammation [
35]. In our study, we observed a decline in Rev-Erbα protein levels in lung tissue following IR, while treatment with SR9009 stabilized Rev-Erbα protein expression in IR-ALI. Moreover, an in vitro experiment indicated that the protective effect of SR9009 was reversed when Rev-Erbα siRNA was used as a pretreatment. Therefore, the anti-inflammatory effect of SR9009 may be attributed to its influence on the Rev-Erbα pathway. Our results align with a previous study reporting decreased protein abundance of Rev-Erbα in cigarette smoke-induced lung inflammation, which was counteracted by SR9009 administration. Furthermore, reduced levels of Rev-Erbα have been observed in lung tissues associated with inflammatory responses in smokers, as well as in patients with chronic obstructive pulmonary disease and pulmonary fibrosis [
36,
37]. It is plausible that Rev-Erbα dysfunction enhances lung inflammatory responses to environmental stressors or agents. Synthetic ligands targeting Rev-Erbα, such as SR9009, have the ability to modulate lung clock function and improve respiratory function and inflammation in individuals with asthma and COPD [
36]. Consequently, Rev-Erbα initiates a series of downstream reactions that regulate host immunity and physiological processes. However, further investigation is required to uncover the precise molecular mechanisms through which Rev-Erbα affects signaling pathways.
While the involvement of Rev-Erbα in ALI pathogenesis shows promise, there are several limitations and challenges that need to be acknowledged. Firstly, it is important to note what is sex differences in the lung clock. Since we only used male rats in our experiments, our understanding of the effects of Rev-Erbα in female animals is limited. Secondly, the isolated lung model is limited in its ability to mimic the extremely complex process of ARDS in patients. Therefore, future studies should aim to verify the results in human. Thirdly, we only found links between Rev-Erbα, NF-κB or MAPK pathways. However, we did not examine the complex molecular interactions. Future experiments specifically designed to elucidate the precise mechanisms will be warranted.
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