Bromine Inhalation Induced Lung Injury: Novel Mechanisms and Treatment Strategies

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 DESCRIPTION (provided by applicant): Bromine (Br2) is a highly toxic dark-reddish liquid, which evaporates readily to a red vapor with a suffocating odor. World production of Br2 exceeds 300,000 tons per year. Exposure to Br2 causes acute lung injury, death from respiratory failure, and fibrosis. Because of the potential for industrial and transportation accidents to release of large amounts of Br2 in populated areas, Br2 presents a clear and present danger to public health. Few published studies have evaluated the acute and chronic sequelae of Br2 inhalation; treatment remains symptomatic and no effective countermeasures exist. Similar to human pathology, exposure of mice to Br2 causes reactive airway disease syndrome (RADS), increased permeability of the blood gas barrier to plasma proteins, and inflammation followed by sub-epithelial airway fibrosis and significant mortality. The overall purpose of this application is to identify the biochemical and molecular mechanisms responsible for these events and develop appropriate countermeasures. We propose that Br2 and hypobromous acid (HOBr-) interact with and fragment high molecular weight hyaluronan (H-HA), a ubiquitous matrix glycosaminoglycan, to generate highly inflammatory low molecular weight hyaluronan fragments (L-HA). L- HA binds to CD44 and Toll like receptor (TLR)-4, increases intracellular Ca+2 and activates TGF-1, and RhoA in lung epithelial and airway smooth muscle cells. These events lead to RADS, increased epithelial permeability to plasma proteins, epithelial-mesenchymal cell transition (EMT) of airway cells, sub-epithelial fibrosis, an death from respiratory failure. In addition, we demonstrate for the first time the formation of brominated lipids in the lungs and plasma of mice exposed to Br2. These compounds, formed by the interaction of Br2 with lung plasmalogens, mediate and amplify Br2 lung injury and act as biomarkers of Br2 exposure. Based on solid data we posit that post-Br2 exposure administration of aerosolized Yabro (a form of H-HA, currently in clinical trials in Europe for asthma), attenuates lung damage, enhances repair and decreases mortality. Experiments proposed in the first specific aim will assess physiological, biochemical, and morphological changes in mice exposed to Br2 and returned to room air for up to three weeks and test the effectiveness of aerosolized Yabro administered post exposure to decrease lung injury and mortality. We will then identify the mechanisms by which Br2 damages rodent and human airway smooth muscle (ASM), bronchial and alveolar type II (ATII) cells. We posit that Br2, brominated lipids, and L-HA increase intracellular Ca2+ and activate RhoA, which lead to increased airway contractility and epithelial permeability. Experiments will: (i) determine membrane potentials by patch clamp; (ii) intracellular Ca+2 by fura-2 fluorescence; (iii) RhoA and ROCK activation; (iv) myosin light chain phosphorylation; and (v) (for epithelial cells) permeability to fluorescent dextrans. Finally, we wll isolate mouse tracheal rings at 1, 24, and 72 hr. post Br2 exposure and measure smooth muscle contraction in response to methacholine.