ID: 159: IFN-dependent macrophage-epithelial crosstalk induces and sustains lung injury in viral pneumonia

Influenza A viruses (IAV) may cause lung injury and acute respiratory distress syndrome (ARDS) characterized by apoptotic injury to the alveolar epithelium and accumulation of excessive fluid (edema) in the alveolar airspaces resulting in loss of barrier function, respiratory failure, and death. We recently demonstrated that inflammatory macrophages recruited from the circulation into the alveoli substantially contribute to influenza-induced lung epithelial injury by IFN-dependent expression of pro-apoptotic factors such as TNF-related apoptosis-inducing ligand (TRAIL). Following severe injury, clearance of excess edema fluid, driven by the alveolar epithelial Na, K-ATPase, is crucial for survival of patients with ARDS. We demonstrate that, apart from causing direct injury to the delicate alveolar barrier, macrophage mediators significantly impair resolution of inflammation in terms of edema clearance from the infected lungs. Using ex vivo and in vivo infection models including transgenic mice and adoptive cell transfer strategies, we identify a paracrine cell communication network between alveolar epithelial cells and alveolar macrophages leading to decreased alveolar epithelial Na, K-ATPase plasma membrane abundance and inhibition of alveolar fluid clearance. Our data furthermore reveal that therapeutic blockade of this cellular cross-talk improves edema resolution which is of clinical significance to patients with IAV-induced lung injury.