Nrf2 () The detoxification of ROS and electrophiles is important to prevent cellular injury. The transcription factor nuclear factor, erythroid 2 related factor 2 (Nrf2) regulates the inducible expression of a group of detoxification enzymes, such as glutathione S-transferase and NAD(P)H:quinone oxidoreductase, via antioxidant response elements (ARE). Under normal circumstances, Nrf2 is retained in the cytoplasm by a repressor protein Kelch-like ECH-associated protein 1 (Keap1). Exposure to xenobiotics and oxidants leads to the dissociation of Nrf2 from Keap1, which allows the free Nrf2 to translocate to the nucleus where it heterodimerizes with c-Jun, an activator protein-1 (AP-1) family protein (
20). The consensus binding sequence of Nrf2 shows high similarity to the ARE/electrophile-responsive element (EpRE) sequence previously identified (
21-
23). Nrf2 can also heterodimerize with small Maf proteins to regulate ARE-mediated gene expression (
24). These Maf proteins are so named because of their structural similarity to the founding member, the oncoprotein v-Maf. They include a characteristic basic region linked to a leucine zipper (b-Zip) domain which mediate DNA binding and subunit dimerization respectively (
25).
Lung Nrf2 responds to hyperoxia (
26). Linkage analysis identified Nrf2 as an important mediator of protection against lung hyperoxic injury (
27) and mice deficient in Nrf2 exhibit aggravated lung injury and a lack of upregulation of ARE-mediated phase 2 detoxifying and antioxidant enzymes (
28). Further gene array analysis of wild type versus Nrf2 deficient mice revealed discordance in multiple genes, thus identifying potential downstream targets of this important transcription factor (
29). In fact, a single nucleotide polymorphism found in the Nrf2 promoter increases the risk of acute lung injury in human subjects (
30). This evidence provides an important translational correlate and may lead to the development of therapeutic strategies.
AP-1 Activator protein-1 was first identified as a transcriptional factor that binds to an essential
cis-element of the human metallothionein II gene (
31). It is composed of fos and jun protein dimers which bind via hydrophobic interactions of their leucine-zipper regions (
32). The jun/jun and jun/fos dimers form the AP-1 complex. This transcription factor controls genes involved in cellular proliferation and death in response to various stimuli including hyperoxia. The consensus AP-1-binding site is embedded in the ARE where fos and jun proteins may heterodimerize to Nrf2 in the presence of electrophiles and oxidants as discussed above (
33). Blocking AP-1 activation enhances hyperoxia-induced cell death in murine lung epithelial cells (
34,
35). One specific target of hyperoxia-induced JNK1/AP-1 activation in A549 cells is the IL-8 promoter (
36). This could modulate inflammatory responses with hyperoxic exposure. It is interesting to note that neonatal mice exposed to hyperoxia show no increase in lung AP-1 consensus sequence binding (
37) in contrast to their adult counterparts (
37,
38). However, in the brain, increased AP-1 consensus sequence binding occurs in the forebrain and hippocampus of both adult and younger rats exposed to hyperoxia (
39,
40). These data suggest both maturational differences and tissue specificity of AP-1 activation.
p53 The transcription factor p53 regulates the expression of a large number of target genes including those related to cell cycle arrest, cell death and DNA repair (
41). Since its discovery in 1979, p53 has been identified as a tumor suppressor and its role in human cancer has become clearer (
42). Under basal conditions, p53 resides in the cytoplasm and is subjected to ubiquitin-mediated proteolysis. However, in response to stimuli such as DNA damage, p53 is phosphorylated, stabilized and enters the nucleus (
41). Under conditions of cellular stress, activated p53 initiates growth arrest and induces proapoptotic gene expression (
42). Hyperoxia increases p53 gene transcription, protein levels and activity (
43-
46). In preterm baboons, exposure to hyperoxia results in increased p53 protein levels in airway epithelium (
47,
48). However, in p53
-/- mice exposed to hyperoxia, lung injury and lethality did not differ from similarly exposed wild-type animals (
44,
49). These data indicate that the exact role of p53 in modulating the cellular response to hyperoxia remains to be elucidated.
NF-κB () The nuclear factor kappa B (NF-κB) family is composed of highly conserved dimeric proteins, which activate genes that regulate apoptosis, inflammation and oxidative stress (
50-
52). This factor regulates gene expression and was first described by Baltimore and Sen (
53). In quiescent cells, NF-κB dimers remain sequestered in the cytoplasm bound to a member of the IκB family of inhibitory proteins (
51). IκBα is the prototypical member of this family and the most well studied. With inflammatory or oxidant stress, IκBα is phosphorylated, resulting in dissociation and unmasking of the nuclear localization sequence of NF-κB (
52). Following inflammatory stimuli, such as TNF-α activation, IκBα is phosphorylated on serine 32/36 and degraded through the proteosomal pathway (
52). In addition to this canonical pathway, an atypical pathway of NF-κB activation results from specific phosphorylation of IκBα on tyrosine 42 (
54). This occurs after stimulation with pervanadate, nerve growth factor, hydrogen peroxide and ischemia-reperfusion (
54-
56) and, as most recently demonstrated, with hyperoxia (
57). This latter pathway represents an intriguing molecular target for modulating the pulmonary response to hyperoxia.
Hyperoxia-induced NF-κB activation appears to be stimulus and cell type specific. It is important to note that NF-κB nuclear translocation and DNA binding can either enhance or suppress target gene expression. The subunit composition of the NF-κB dimer likely confers specificity to the expression of target genes following activation (
58). The most abundant NF-κB protein is the p65-p50 dimer (
59). The p65 subunit contains a transactivation domain that interacts with other transcription proteins to increase gene expression (
60). The p50 subunit lacks this transactivation domain, and can repress transcription when bound to DNA as a p50-p50 homodimer (
60,
61). Furthermore, the ability of NF-κB to alter gene expression is affected by post-translational modifications including phosphorylation and acetylation (
60).
Nuclear translocation of NF-κB was shown in A549 lung adenocarcinoma cells exposed to hyperoxia-induced but this activation did not protect against cell death (
62). Also, in adult mice exposed to hyperoxia, NF-κB activated pro-inflammatory markers in pulmonary lymphocytes (
63). Furthermore, in fetal mouse lung explants, hyperoxia-induced NF-κB activation was associated with increased apoptosis which was reversed by blocking NF-κB activation (
64). In contrast, inhibition of hyperoxia-induced NF-κB activation accelerated nonapoptotic cell death in primary and transformed lung epithelial cells, resulting in decreased levels of MnSOD (
65). Additionally, A549 cells pre-treated with hyperoxia showed less apoptosis following exposure to hydrogen peroxide, an effect reversed by inhibiting NF-κB activation (
66). In other examples, NF-κB was not activated in response to hyperoxic exposure (
67,
68), suggesting that this signaling pathway is cell specific. The lung contains over forty different cell types (
69), and the response to hyperoxia is cell type specific. Endothelial cells are very sensitive to oxygen toxicity, while type II epithelial cells are resistant and proliferate in the recovery phase (
70). Furthermore, in the developing lung, exposure to hyperoxia prevents the normal differentiation of type II cells to type I cells in the developing lung (
71). Further studies are necessary to fully dissect the specificity and complexity of hyperoxia-induced NF-κB activation. Nevertheless, these findings suggest that interventions to either inhibit or enhance NF-κB activation in hyperoxia could be of therapeutic benefit.
Various clinical interventions can affect NF-κB activation. Adrenalectomized adult mice exposed to hyperoxia had less lung injury and had improved survival due to increased NF-κB activation (
72). Glucocorticoids are known to inhibit NF-κB activation (
73-
76). Thus, hyperoxia-induced NF-κB activation, when not limited by endogenous glucocorticoids, protects the adult lung from oxygen toxicity (
72). Interestingly, following glucocorticoid therapy for BPD, cells obtained from tracheobronchial lavage fluid of premature neonates showed inhibition of NF-κB activation (
77). Nitric oxide, which may prevent BPD in some infants(
78), also inhibits NF-κB activity (
79). The clinical implications of these findings remain to be explored in humans.
Of particular interest to pediatricians are the maturational differences found in NF-κB activation. Multiple models have shown increased NF-κB activation in neonates compared to adults following exposure to inflammatory and oxidant stimuli (
80-
82). In rat fetal alveolar type II cells, NF-κB translocates to the nucleus and binds DNA after hyperoxic exposure (
83). This binding peaks soon after birth and gradually decreases postnatally, suggesting that NF-κB regulates genes involved in the transition from the relative hypoxic environment seen
in utero (
83). This activation may have important downstream effects as shown in hyperoxia exposed fetal lung fibroblasts where NF-κB activation prevented apoptosis through the suppression of pro-apoptotic genes (
57). In contrast, this hyperoxic activation of NF-κB was not seen in adult lung fibroblasts (
57). In the only published study evaluating hyperoxia-induced NF-κB activation in a neonatal
in vivo model, Yang and colleagues showed that hyperoxia-induced NF-κB occurred in the lungs of neonatal but not adult mice (
82). This activation was associated with the relative tolerance to hyperoxic injury in the neonatal animals when compared with adults, and this tolerance was reversed when hyperoxia-induced NF-κB activation was inhibited (
82). In contrast, clinical studies show that enhanced NF-κB activation is linked to respiratory distress syndrome and an increased risk of developing BPD in preterm infants (
84-
86). Thus, it is not yet clear whether inhibition of lung NF-κB is beneficial or harmful in human neonates.
The hyperoxic activation of NF-κB has also been investigated in tissues other than the lung. Using a bioluminescent NF-κB reporter mouse line, Dohlen and colleagues showed increased NF-κB activity in the brain after resuscitation with 100% O
2 (
87). In other studies, hyperoxia without preceding ischemia decreased NF-κB activation in the basal forebrain, with a more pronounced effect in aged versus young mice (
88).
It is clear that the NF-κB mediated response to oxygen is influenced by maturation. Whether these changes are beneficial or detrimental remains to be seen. Understanding the maturational differences in hyperoxia-induced NF-κB activation could help guide interventions aimed to modulate this response in neonates.