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Published ahead of print on August 8, 2008, doi:10.1164/rccm.200803-455OC

Am. J. Respir. Crit. Care Med., Volume 178, Number 9, November 2008, 969-976

A more recent version of this article appeared on November 1, 2008
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Submitted on March 24, 2008
Accepted on August 7, 2008

Influenza A Virus Inhibits Alveolar Fluid Clearance in BALB/c Mice

Kendra E Wolk1, Eduardo R Lazarowski2, Zachary P Traylor1, Erin NZ Yu1, Nancy A Jewell3, Russell K Durbin4, Joan E Durbin3, and Ian C Davis1*

1 Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA, 2 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA, 3 Columbus Children's Research Institute, Columbus, OH, USA; Department of Pediatrics, The Ohio State University, Columbus, OH, USA, 4 Columbus Children's Research Institute, Columbus, OH, USA

* To whom correspondence should be addressed. E-mail: davis.2448{at}osu.edu.

Rationale: Pulmonary infections can impair alveolar fluid clearance (AFC), contributing to formation of lung edema. Effects of influenza A virus (IAV) on AFC are unknown. Objectives: To determine effects of IAV infection on AFC, and to identify intercellular signaling mechanisms underlying influenza-mediated inhibition of AFC. Methods: BALB/c mice were infected intranasally with influenza A/WSN/33 (10,000 or 2,500 FFU/mouse). AFC was measured in anesthetized, ventilated mice by instilling 5% BSA into the dependent lung. Measurements and Main Results: Infection with high-dose IAV resulted in a steady decline in arterial oxygen saturation and increased lung water content. AFC was significantly inhibited starting 1 hour after infection, and remained suppressed through day 6. AFC inhibition at early timepoints (1-4 hours after infection) did not require viral replication, while AFC inhibition later in infection was replication-dependent. Low-dose IAV infection impaired AFC for 10 days but induced only mild hypoxemia. High-dose IAV infection increased bronchoalveolar lavage fluid ATP and UTP levels. Impaired AFC at day 2 resulted primarily from reduced amiloride-sensitive AFC, mediated by increased activation of the pyrimidine-P2Y purinergic receptor axis. However, an additional component of AFC impairment was due to activation of A1 adenosine receptors and stimulation of increased CFTR-mediated anion secretion. Finally, IAV-mediated inhibition of AFC at day 2 could be reversed by addition of {beta}-adrenergic agonists to the AFC instillate. Conclusions: AFC inhibition may be an important feature of early IAV infection. Its blockade may reduce the severity of pulmonary edema and hypoxemia associated with influenza pneumonia.


Key words: orthomyxovirus infections; pneumonia, viral; pulmonary edema; ion transport; adenosine







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