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Quantitation of Nitrotyrosine Levels in Lung Sections of Patients and Animals with Acute Lung Injury Imad Y

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Quantitation of Nitrotyrosine Levels in Lung Sections of Patients and Animals with Acute Lung Injury Imad Y Quantitation of Nitrotyrosine Levels in Lung Sections of Patients and Animals with Acute Lung Injury Imad Y. Haddad,* Gyorgy Pataki,t Ping Hu,* Carlos Galliani,§ Joseph S. Beckman,t and Sadis Matalon**I1 Departments of *Pediatrics, *Anesthesiology, §Pathology, and IlPhysiology and Biophysics, University of Alabama at Birmingham, Birmingham, Alabama 35233-6810 Abstract aggregation and adhesion to endothelium by increasing cGMP. Because of the vasorelaxant properties of -NO and its rapid Activated alveolar macrophages and epithelial type II cells inactivation in the blood by its reaction with hemoglobin, -NO release both nitric oxide and superoxide which react at near inhalation has been advocated as a means of selectively reducing diffusion-limited rate (6.7 x 10' M -'s -) to form peroxyni- pulmonary hypertension and improving ventilation/perfusion trite, a potent oxidant capable of damaging the alveolar mismatching in patients with idiopathic pulmonary hyperten- epithelium and pulmonary surfactant. Peroxynitrite, but not sion and adult respiratory distress syndrome (1, 2). nitric oxide or superoxide, readily nitrates phenolic rings In spite of its therapeutic potential, -NO has significant cyto- including tyrosine. We quantified the presence of nitrotyro- toxicity. In high concentrations, -NO may inactivate critical sine in the lungs of patients with the adult respiratory dis- enzymes (such as mitochondrial aconitase, NADH:ubiquinone tress syndrome (ARDS) and in the lungs of rats exposed to oxidoreductase) by interacting with iron-sulfur centers to form hyperoxia (100% O2 for 60 h) using quantitative immuno- iron-sulfur-nitrosyl derivatives, and inhibit both DNA and pro- fluorescence. Fresh frozen or paraffin-embedded lung sec- tein synthesis (3, 4). Also, since *NO is a free radical, it can tions were incubated with a polyclonal antibody to nitrotyro- undergo a radical-radical reaction with superoxide at near dif- sine, followed by goat anti-rabbit IgG coupled to rhoda- fusion-limited rates to yield peroxynitrite, a potent oxidizing mine. Sections from patients with ARDS (n = 5), or from agent known to initiate lipid peroxidation in biological mem- rats exposed to hyperoxia (n = 4), exhibited a twofold in- branes, hydroxylation and nitration of aromatic amino acid resi- crease of specific binding over controls. This binding was dues, and sulfhydryl oxidation of proteins (5, 6). Furthermore, blocked by the addition of an excess amount of nitrotyrosine peroxynitrite may decompose homolytically to yield nitrogen and was absent when the nitrotyrosine antibody was re- dioxide, and species with hydroxyl radical-like reactivity, with- placed with nonimmune IgG. In additional experiments we out the need of metal catalysis (7). demonstrated nitrotyrosine formation in rat lung sections Stimulation by cytokines or lipopolysaccharide causes alve- incubated in vitro with peroxynitrite, but not nitric oxide olar macrophages, lung epithelial, endothelial, and interstitial or reactive oxygen species. These data suggest that toxic cells to produce large amounts of *NO and superoxide for pro- levels of peroxynitrite may be formed in the lungs of patients longed periods of time, creating foci for the intense and local- with acute lung injury. (J. Clin. Invest. 1994.94:2407-2413.) ized production of peroxynitrite and its toxic intermediates, in Key words: nitric oxide - peroxynitrite * reactive oxygen close proximity to all components of the blood gas barrier. species * quantitative immunofluorescence * hyperoxia - Our previous results indicate that peroxynitrite, or agents that adult respiratory distress syndrome generate -NO and superoxide simultaneously, damage alveolar type II cells and specific surfactant apoproteins to a much higher Introduction extent than supraphysiological concentrations of reactive oxy- gen species (8-10). These findings indicate the cytotoxic poten- The free radical nitric oxide (-NO)1 is the major form of the tial of peroxynitrite to the mamalian alveolar epithelium. How- endothelial-derived relaxing factor that is enzymatically synthe- ever, currently, there is controversy as to whether peroxynitrite sized from arginine oxidation by a NADPH-dependent nitric is being formed by mammalian lung cells in vivo. oxide synthase. Nitric oxide causes smooth muscle relaxation One way to demonstrate peroxynitrite fornation in vivo is by activating soluble guanylate cyclase, and inhibits platelet to detect the presence of stable by-products of its reaction with various biological compounds. 3-nitro-tyrosine, the product of the addition of a nitro group (NO2) to the ortho position of the Address correspondence to Sadis Matalon, PhD, Department of Anes- hydroxyl group of tyrosine, is such a stable compound. Herein thesiology, University of Alabama at Birmingham, 619 South 19th we report the presence of 3-nitro-tyrosine (nitrotyrosine) in (a) Street, Birmingham, AL 35233-6810. the lungs of pediatric patients with adult respiratory distress Received for publication 6 May 1994 and in revised form 29 July syndrome (ARDS), and (b) in the lungs of rats exposed 100% 1994. 02 for 60 h. This exposure protocol has been shown to damage both the pulmonary capillary endothelium and the alveolar epi- 1. Abbreviations used in this paper: ARDS, adult respiratory distress thelium and results in noncardiogenic pulmonary edema (11). syndrome; -NO, nitric oxide; NTAb, polyclonal antibody against nitroty- Thus, the pathophysiology of hyperoxic injury to the mamma- rosine; SNAP, S-nitroso-N-acetylpenicillamine. lian lung resembles closely the pulmonary manifestations of J. Clin. Invest. human adult respiratory distress syndrome. The presence of © The American Society for Clinical Investigation, Inc. nitrotyrosine was demonstrated by incubating tissue sections, 0021-9738/94/12/2407/07 $2.00 obtained from the lungs of both patients and animals, with a Volume 94, December 1994, 2407-2413 polyclonal antibody to nitrotyrosine (12), followed by a sec- Lung Nitrotyrosine in ARDS 2407 Table l. Characteristics of ARDS Patients Table II. Characteristics of Non-ARDS Patients Clinical Tissue prep./lung Tissue prep./lung Patient Age/sex Diagnosis phase pathology Patient Age/sex Diagnosis pathology 1 C.D. 14 yr/F Lymphoma Late f.f.&par./fibro 6 T.H. 12 yr/F MD/heart failure f.f./Lung edema autopsy proliferative autopsy 2 A.P. 9 yr/F Sepsis ARF par./cellular 7 C.M. 2 wk/M IVH f.f./Normal autopsy proliferative autopsy 3 A.R. 3 mo/M Sepsis cARF par./exudative 8 C.H. 1 mo/F Sepsis f.f./Lung edema autopsy autopsy 4 T.H. 23 mo/F Near ARF par./cellular 9 M.C. 14 yr/M Marfan's/cardiac f.f./Normal autopsy drowning proliferative autopsy tamponade 5 J.J. 19 mo/M Upper airway Late par./fibro 10 JJ. 3 yr/M Upper airway par./consistent biopsy obstruction proliferative biopsy obstruction with healed BPD M, male; F, female; ARF, acute respiratory failure; f.f., fresh frozen; par., paraffin embedded. M, male; F, female; f.f., fresh frozen; par., paraffin; MD, muscular dystrophy; IVH, intraventricular hemorrhage; BPD, bronchopulmonary dysplasia. ondary fluorescently labeled antibody, and quantifying the de- gree of specific fluorescence. We also show evidence indicating that nitrotyrosine formation is caused by peroxynitrite, and not sis. The chest was then opened, and 10 ml of Tissue-Tek omithine nitric oxide or reactive oxygen species generated by xanthine carbamyl transferase compound was instilled into the lungs via a syringe. oxidase plus Fe3+EDTA. Coupled with our previous measure- The lungs and heart were removed from the thoracic cavity en bloc, ments these results indicate the presence of significant amounts and immediately frozen at -20°C. Cryo-sections (6 ,um) were cut at of nitrotyrosine in lungs with ARDS, and establish that peroxy- -30°C and mounted on glass slides. Immunofluorescent measurements. Paraffin-embedded sections were nitrite, or its reactive by-products, may play a significant role deparaffinized by dipping in successive solutions containing alcohol and in the pathology of ARDS. xylene. These sections, along with the fresh frozen ones, were then fixed and permeabilized by immersion in pure methanol at -20°C for Methods 7 min, followed by immersion in 1% cold (4°C) bovine serum albumin in PBS for 3 h to block nonantigenic sites. They were then incubated Human lung sections. Lung tissue samples from five pediatric patients with a polyclonal antibody raised against nitrotyrosine (NTAb; 1:200 with clinical diagnosis of ARDS (age 3 mo to 14 yr), triggered by a dilution), followed by a secondary antibody, goat anti-rabbit IgG con- variety of predisposing factors, were obtained either during autopsy (n jugated to rhodamine (1:300 dilution). The NTAb was raised in rabbits = 4) or during surgical biopsy (n = 1; to rule out infection). Lung by injecting them with peroxynitrite treated keyhole limpet hemocyanin tissue samples were also obtained during autopsy (n = 4) or surgical (KLH; Pierce, Rockford, IL), in the presence of Fe3` EDTA (12), biopsy (n = 1) from the lungs of five non-ARDS patients without which should drive the peroxynitrite modification towards nitration of histologic evidence of pulmonary inflammation. Characteristics of these the 3- position of the tyrosine residues, rather than hydroxylation. Phe- patients and their primary diagnosis are shown in Tables I and II. When- nylalanine is poorly nitrated by peroxynitrite, because it lacks the acti- ever possible, pieces of lung tissue were obtained specifically for this vating hydroxyl group in its
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