Randomized trial investigates phosphatidylglycerol depletion and surfactant dysfunction in lung injury, suggesting potential therapeutic targets.
Anionic phospholipids are essential for surfactant function and phosphatidylglycerol (PG) is the most abundant. Increased secretory phospholipase A2 (sPLA 2 ) and disproportionate depletion of PG is consistently observed in patients with acute respiratory distress syndrome (ARDS), leading to speculation on their potential relationship. We hypothesized that a non-lethal murine model of acute lung injury (ALI) would demonstrate a temporal association between lung inflammation, surfactant dysfunction, PG depletion, and sPLA 2 activity at peak ALI. ALI was induced in BALB/c mice by intratracheal lipopolysaccharide (IT-LPS). Markers of ALI, surfactant (function, recovery, and composition), and sPLA 2 activity were assessed over a 240-h period encompassing peak ALI and resolution. During peak ALI, a separate cohort of IT-LPS mice received IT-varespladib, an sPLA 2 inhibitor, with surfactant outcomes analyzed 4 h later. IT-LPS induced features of ALI, including immune cell influx, protein leak, histological injury, and respiratory dysfunction, which peaked at 48–96 h and resolved by 240 h. Impaired surfactant function at peak ALI was associated with increased sPLA 2 -mediated PG hydrolysis and reduced PG content. All changes were absent post-ALI resolution. Varespladib reduced alveolar sPLA 2 activity, increased surfactant PG, and improved surfactant function compared to untreated LPS controls. At peak ALI after IT-LPS, depletion of PG is synchronously related to surfactant dysfunction and increased sPLA 2 hydrolysis. Pharmacologic inhibition of sPLA 2 at peak ALI improves PG content and surfactant function. Additional substudies to fully examine their relationships and mechanisms are warranted.
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Baer et al. (2026) studied this question.
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