Research: Overactivated Epithelial NF-κB Disrupts Lung Development in Congenital Diaphragmatic Hernia

Am J Respir Cell Mol Biol

. 2023 Aug 8.

 doi: 10.1165/rcmb.2023-0138OC. Online ahead of print.

Overactivated Epithelial NF-κB Disrupts Lung Development in Congenital Diaphragmatic Hernia

Florentine Dylong 1Jan Riedel 2Gaurang M Amonkar 3Nicole Peukert 2Paula Lieckfeldt 2Katinka Sturm 2Benedikt Höxter 2Wai Hei Tse 4Yuichiro Miyake 2Maria Moormann 1Lena Marie Bode 1Steffi Mayer 2Richard Keijzer 4Martin Lacher 5Xingbin Ai 3Jan-Hendrik Gosemann 2Richard Wagner 6

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Abnormal lung development is the main cause of morbidity and mortality in neonates with congenital diaphragmatic hernia (CDH), a common birth defect (1:2500) of largely unknown pathobiology. Recent studies discovered that inflammatory processes, and specifically NF-κB associated pathways are enriched in human and experimental CDH. However, the molecular signaling of NF-κB in abnormal CDH lung development and its potential as a therapeutic target requires further investigation. Using sections and hypoplastic lung explant cultures from the nitrofen rat model of CDH and human fetal CDH lungs, we demonstrate that NF-κB and its downstream transcriptional targets are hyperactive during abnormal lung formation in CDH. NF-κB activity was especially elevated in the airway epithelium of nitrofen and human CDH lungs at different developmental stages. Fetal rat lung explants had impaired pseudoglandular airway branching after exposure to nitrofen, together with increased phosphorylation and transcriptional activity of NF-κB. Dexamethasone, the broad and clinically applicable anti-inflammatory NF-κB antagonist, rescued lung branching and normalized NF-κB signaling in hypoplastic lung explants. Moreover, specific NF-κB inhibition with curcumenol similarly rescued ex vivo lung hypoplasia and restored NF-κB signaling. Lastly, we showed that prenatal intraperitoneal dexamethasone administration to pregnant rat dams carrying fetuses with hypoplastic lungs, significantly improves lung branching and normalizes NF-κB in vivo. Our results indicate that NF-κB is aberrantly activated in human and nitrofen CDH lungs. Anti-inflammatory treatment with dexamethasone and/ or specific NF-κB inhibition should be investigated further as a therapeutic avenue to target lung hypoplasia in CDH.

Keywords: Congenital Diaphragmatic Henria; Lung hypoplasia; NF-kB; Nitrofen Rat Model; Prenatal Inflammation.

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