Original Article
 

Nebulized Dexmedetomidine Alleviates Oxidative Stress in Ventilator-induced Lung Injury via Keap1-Nrf2-ARE Pathway

Abstract

This study aimed to explore the underlying mechanism of nebulized dexmedetomidine (DEX) in ameliorating ventilator-induced lung injury (VILI)-induced oxidative stress in rats.
Forty 7 to 8-week-old Sprague-Dawley rats at the specific pathogen-free level were randomized into the control group, model group, nebulized dexmedetomidine (WH-YM) group, and dexmedetomidine intravenous infusion (JM-YM) group, each containing 10 rats. Except for the control group, rats in the other groups underwent mechanical ventilation (tidal volume,  40 mL/kg; respiratory rate, 70 breaths per minute; inspiratory-to-expiratory ratio, 1:2; fraction of inspired oxygen, 21%; positive end-expiratory pressure, 0 cmH2O). Nebulized DEX (6.3 µg/kg), and isodose intravenous DEX  were given to rats of WH-YM and JM-YM groups prior to ventilation. Post 4-hour ventilation, rats were euthanized. Lung tissue wet-to-dry weight ratio, H&E staining for assessing diffuse alveolar damage (DAD), and expression levels of Nrf2 and Keap1 detected by qRT-PCR and Western blot were compared. Inflammatory markers TNF-α, IL-2, and IL-6, and oxidative stress indices malondialdehyde (MDA) and superoxide dismutase (SOD), were quantified in lung tissues and serum samples using commercial kits. 
Rats in the WH-YM and JM-YM groups demonstrated significant ameliorations in the wet-to-dry weight ratio and DAD score, decreased Keap1, TNF-α, IL-2, and IL-6 levels in lung tissues and serum samples, but increased Nrf2 and SOD level than those of controls. These changes were more pronounced in the WH-YM group than in the JM-YM group.
DEX effectively alleviates VILI-induced oxidative stress and inflammation via the Keap1-Nrf2-ARE signaling pathway., especially in the nebulized administration.

Fan E, Villar J, Slutsky AS. Novel approaches to minimize ventilator-induced lung injury. BMC Med. 2013;11:85.
2. Li W, Zhao X, Yu TT, Hao W, Wang GG. Knockout of PKC θ gene attenuates oleic acid-induced acute lung injury via reduction of inflammation and oxidative stress. Iran J Basic Med Sci. 2021; 24(7):986-91.
3. Gu J, Chen J, Xia P, Tao G, Zhao H, Ma D. Dexmedetomidine attenuates remote lung injury induced by renal ischemia-reperfusion in mice. Acta Anaesthesiol Scand. 2011;55(10):1272-8.
4. Shi QQ, Wang H, Fang H. Dose response and mechanism of protective function of selective alpha-2 agonist dexmedetomidine on acute lung injury in rats. Saudi Med J. 2012;3(4):375--81.
5. Si Y, Bao H, Han L, Shi H, Zhang Y, Xu L, et al. Dexmedetomidine protects against renal ischemia and reperfusion injury by inhibiting the JAK/STAT signaling activation. J Transl Med. 2013;11(2):141
6. Afonso J, Reis F. Dexmedetomidine : current role in anes-thesia and intensive care. Rev Bras Anestesiol. 2012;62( 1):118-33.
7. Hu H, Shi D, Hu C, Yuan X, Zhang J, Sun H. Dexmedetomidine mitigatesCLP-stimulated acute lung injury via restraining the RAGEpathway. Am J Transl Res. 2017;9(12):5245-58.
8. Zhu CH, Yu J, Wang BQ, Nie Y, Wang L, Shan SQ. Dexmedetomidine reducesventilator-induced lung injury via ERK1/2 pathway activation. Mol Med Rep. 2020;22(6):5378-84.
9. Xu B, Gao H, Li D, Hu C, Yang J. Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial. Peer J. 2020;8:e9247.
10. Tu W, Wang H, Li S, Liu Q, Sha H. The anti-inflammatory and anti-oxidant mechanisms of the Keap1/Nrf2/ARE signaling pathway in chronic diseases. Aging and disease. 2019;10(3):637.
11. Fukutomi T, Takagi K, Mizushima T, Ohuchi N, Yamamoto M. Kinetic, thermodynamic, and structural characterizations of the association between Nrf2-DLGex degron and Keap1. Mol Cell Biol. 2014;34(5):832-46.
12. Lu MC, Ji JA, Jiang ZY, You QD. The Keap1–Nrf2–ARE pathway as a potential preventive and therapeutic target: an update. Med Res Rev. 2016;36(5):924-63.
13. Ahn CB, Je JY, Kim YS, Park SJ, Kim BI. Induction of Nrf2-mediated phase II detoxifying/antioxidant enzymes in vitro by chitosan-caffeic acid against hydrogen peroxide-induced hepatotoxicity through JNK/ERK pathway. Mol Cell Biochem. 2017;424(12):79-86.
14. Tonetti T, Vasques F, Rapetti F, Maiolo G, Collino F, Romitti F, et al. Driving pressure and mechanical power: new targets for VILI prevention. Ann Transl Med. 2017;5(14):286.
15. Fan E, Villar J, Slutsky AS. Novel approaches to minimize ventilator-induced lung injury. BMC Med. 2013;11:85.
16. Feng Z, Wang JW, Wang Y, Dong WW, Xu ZF. Propofol Protects Lung Endothelial Barrier Function by Suppression of High-Mobility Group Box 1 (HMGB1) Release and Mitochondrial Oxidative Damage Catalyzed by HMGB1. Med Sci Monit. 2019;25:3199-11.
17. Jiang L, Zhang Y, Lu D, Huang T, Yan K, Yang W. Mechanosensitive Piezo1 channel activation promotes ventilator-induced lung injury via disruption of endothelial junctions in ARDS rats. Biochem Biophys Res Commun. 2021;556:79-86.
18. Yang Z, Yin Q, Olatunji OJ, et al. Activation of cholinergic anti-inflammatory pathway involved in therapeutic actions of α-mangostin on lipopolysaccharide-induced acute lung injury in rats. Int J Immunopathol Pharmacol. 2020;34:2058738420954941.
19. Hassanein EHM, Sayed AM, Hussein OE, Mahmoud AM. Coumarins as modulators of the Keap1/Nrf2/ARE signaling pathway. Oxid Med Cell Longev. 2020;22:1675957.
20. Liu S, Pi J, Zhang Q. Signal amplification in the KEAP1-NRF2-ARE antioxidant response pathway. Redox Biol. 2022:102389.
21. Abreu CC, Cardozo L, Mafra D. Could physical exercises modulate Nrf2-Keapl pathway in chronic kidney disease. Med Hypotheses. 2015;152(84):44-6.
22. Wang J, Yi X, Jiang L, Dong H, Feng W, Wang S, et al. Protective effects of dexmedetomidine on lung in rats with one‑lung ventilation. Exp Ther Med. 2019;17(1):187-92.
23. Lee SH, Kim N, Lee CY, Ban MG, Oh YJ. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: a randomised double-blinded trial. Eur J Anaesthesiol. 2016;33(4):275.
24. Zhu CH, Yu J, Wang BQ, Nie Y, Wang L, Shan SQ. Dexmedetomidine reduces ventilator-induced lung injury via ERK1/2 pathway activation[J]. Mol Med Rep. 2020;22(6):5378-84.
25. Huang CY, Deng JS, Huang WC, Jiang WP, Huang GJ. Attenuation of lipopolysaccharide-induced acute lung injury by hispolon in mice, through regulating the TLR4/PI3K/Akt/mTOR and Keap1/Nrf2/HO-1 pathways, and suppressing oxidative stress-mediated ER stress-induced apoptosis and autophagy. Nutrients. 2020;12(6):1742.
26. Zeng L, Zhao C, Cui C. Dexmedetomidine improves DM-induced oxidative stress injury to protect liver function through Nrf2 pathway. Am J Transl Res. 2023;15(3):1715-29.
27. Li J, Chen Q, He X, Alam A, Ning J, Yi B, et al. Dexmedetomidine attenuates lung apoptosis induced by renal ischemia–reperfusion injury through α 2 AR/PI3K/Akt pathway. J Transl Med. 2018;16:1-11.
28. Wang Y, Mao X, Chen H, et al. Dexmedetomidine alleviates LPS-induced apoptosis and inflammation in macrophages by eliminating damaged mitochondria via PINK1 mediated mitophagy. Int Immunopharmacol. 2019;73:471-81.
29. Wang Y, Mao X, Chen H, Feng J, Yan M, Wang Y, et al. Activation of the KEAP1‑NRF2‑ARE signaling pathway reduces oxidative stress in Hep2 cells[J]. Molecular Medicine Reports, 2018, 18(3): 2541-2550.
30. Zhang ZT, Xie K, Luo RJ, Zhang DY, He ZW, Li KF, et al. Dexmedetomidine alleviates acute lung injury by promoting Tregs differentiation via activation of AMPK/SIRT1 pathway. Inflammopharmacology. 2023;31(1):423-38.
31. Yu X, Chi X, Wu S, Jin Y, Yao H, Wang Y, et al. Dexmedetomidine pretreatment attenuates kidney injury and oxidative stress during orthotopic autologous liver transplantation in rats. Oxid Med Cell Longev. 2016,4675817.
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IssueVol 23 No 3 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijaai.v23i3.15642
Keywords
Dexmedetomidine Inflammation Nebulization Ventilator-induced lung injury

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How to Cite
1.
Zha J, Yu Y, Zhu J, Li G, Deng X, Xie H. Nebulized Dexmedetomidine Alleviates Oxidative Stress in Ventilator-induced Lung Injury via Keap1-Nrf2-ARE Pathway. Iran J Allergy Asthma Immunol. 2024;23(3):330-338.