ARDS is characterized by refractory hypoxemia due to infiltration of inflammatory cells and accumulation of lung water due to impaired Na, K-ATPase function and impaired tight junction of lung epithelium.32 Despite advances in intensive care, it is associated with a high in-hospital mortality rate of approximately 40% .33 Severe ARDS patients had a mortality rate of 63.9%.34 Yet there is no effective drug treatment approved by Food and Drug Administration.35 Moreover, few biomarkers can be used to predict the onset and progression of ARDS, to stratify the risk factors, or to predict prognosis.36 The poor efficacy of traditional drugs may be related to the complicated pathogenic factor of ARDS.2
The most common causes of ARDS are bacterial pneumonia and sepsis, wherein Gram-negative bacteria are a prominent cause. LPS, the major constituent of the outer membrane of all Gram-negative bacteria, can easily cause the injury of epithelial cells along with resident alveolar macrophages in the airway, thereby further resulting in a cascade of events including production of cytokines and chemokines, recruitment of neutrophils, monocytes and lymphocytes into the alveolar space and finally lead to ARDS.37,38
Proteomic methods can not only study the whole set of proteins of ARDS, and find out the key targets as the entry point of drug treatment, but also verify the drugs that may be effective in the treatment of ARDS, and study the possible mechanism of its intervention in the treatment of ARDS.11,39 Although the application of proteomics technology in the pathogenesis of ARDS has just begun, its great potential in deepening the understanding of protein expression patterns, discovering new damage mediators and developing new therapeutic drugs has emerged.40 Whereas, there are several ways, not just one, that cause ARDS when researchers focused on their limited specialized areas. Therefore, the traditional methods to find biomarkers are too limited, and proteomic research should be applied.
Na, K-ATPase α1 plays an important role in the regulation of fluid volume under various physiological and pathological conditions of ARDS. To our knowledge, this study is the first to determine the binding proteins of Na, K-ATPase α1 in ARDS by proteomic technologies. Several reviews have introduced and summarized the detailed technologies and methods of non-targeted proteomics.12,16,41−45
Our quantitative discovery-based proteomic approach identified commonalities as well as significant differences in the binding proteins of Na, K-ATPase α1 between A549 cells and LPS-induced A549 cells. Identification and validation of these proteins in ARDS patients are thus warranted, and strategies aimed to enhance these related pathways could form effective preventive measures or treatment options for ARDS patients. Before the experiment started, we found that Na, K-ATPase α 1 antibody successfully pulled down the binding proteins of Na, K-ATPase α 1 by Co-IP. Next, using proteomic analysis, we identified 1598 proteins. Of them, 89 were differentially expressed proteins (Table 2 and Fig. 4) between LPS-A549 cells and Control-A549 cells. We utilized PPI network analysis to select PPI and gene co-expression proteins that were linked to Na, K-ATPase α1. Furthermore, we conducted function and pathway analysis to seek biological pathways that may have an impact on ARDS.
Intriguingly, although protein concentration was not significantly increased in LPS-induced A549 cells, the protein expression profiles of the LPS-A549 group were significantly different from those of the controls with 29 up-regulated and 60 down-regulated proteins in LPS-A549 compared to control-A549 (Fig. 4). The present study highlights the ability of proteomic analysis to detect differential proteins in an A549 cell model of ARDS induced by LPS. And these proteins are expected to play specific roles in the pathogenesis of ARDS and may serve as useful biomarkers or potential therapeutic targets.
We screened these proteins interacted with Na, K-ATPase α1, and carried out the related GO/KEGG analysis. According to the GO analysis, we found that almost all of the most enriched and meaningful BP terms were related to biosynthetic process in the LPS-A549 group. The mainly enriched terms were closely related to enzymatic activity and protein binding. KEGG analysis showed that the proteins were primarily enriched in RNA transport and Fatty acid metabolism. The PPI network was built on the binding proteins that was analyzed by STRING website. We observed that there were 43 significant enriched interactions among 29 proteins in the LPS-A549 group. Besides, we found that there were obvious ubiquitination and deubiquitination phenomena, as well as the pathways related to autophagy.
Based on these results, we chose some proteins with expression levels that were significantly expressed for further verification by LC-MS/MS. Among the most expressed proteins, there were several intriguing proteins, including the deubiquitinase (OTUB1), the tight junction protein zonula occludens-1 (ZO-1), the scaffold protein in CUL4B-RING ubiquitin ligase (CRL4B) complexes (CUL4B) and the autophagy-related protein SQSTM1.
Ubiquitination is a type of protein post-translational modification.46 Ubiquitination and deubiquitination ensure the stability of cell and body physiological function, which attaches great significance to the study of this dynamic process. Our GO analysis of Na, K-ATPase α1 interaction protein showed that ubiquitination and deubiquitination were significantly enriched, and both were related to OTUB1(Table 5). OTUB1, known as a deubiquitinases, can protect the protein from degradation and belongs to the ovarian cancer proteases family. Zhu D et al. found OTUB1 as a deubiquitinating enzyme that influences cancer immunosuppression via regulation of PD-L1 stability and may be a potential therapeutic target for cancer immunotherapy.47 Mulas et al. found that OTUB1 was a potent novel regulator of dendritic cells (DCs) during infectious and inflammatory diseases.48 Zhang W et al. found that OTUB1 performed as a molecular indicator of poor prognosis in digestive cancers, regulated the infiltration of tumor immunocytes, and exerted a significant influence on apoptosis and autophagy.49 Our study found that LPS reduced the expression of OTUB1, which may act directly with Na, K-ATPase α1. Therefore, LPS may decrease the level of Na, K-ATPase α1 to lessen its protection by decreasing OTUB1. Combined with the previous conclusion, we speculate that up-regulating OTUB1 can protect Na, K-ATPase α1 from E3 ubiquitin ligase degradation, thus increasing Na, K-ATPase abundance and enzyme activity. More studies are needed to confirm whether OTUB1 can be a therapeutic site for ARDS in the future.
Lung permeability is determined by intercellular junctions such as gap junctions, adhesion junctions, and tight junctions. Tight junction is one of the important components of capillary-alveolar barrier, which plays an important role in reducing lung water production and stabilizing lung microenvironment.50 ZO-1, a tight junction protein, regulates signal transduction, transcription, and cellular communication.51,52 The down-regulation of its expression or activity can affect the formation of tight junctions between cells. Ni JJ et al. found that plasma ZO-1 proteins appear to be a valuable prognostic biomarker for the severity of sepsis and a predictor of 30-day mortality for patients with sepsis.53 Li C et al. found that upregulating ZO-1/occludin/claudin-1 expression mitigates the inflammatory response and maintains intestinal barrier function in sepsis, providing a good experimental basis for its clinical treatment of sepsis.54 And Lee TJ et al. found that ZO-1 on the exotoxin LPS of P. aeruginosa-induced diseases could be critical in the development of novel therapeutics.55 It is interesting that, Na, K-ATPase β1 promotes the expression of key proteins such as ZO-1, ZO-2, occludin and claudin-18 in tight junction complex and reduces the production of lung water.56 Ouabain, a specific inhibitor of Na, K-ATPase α1, induced the decrease of Na, K-ATPase α1/β1 in canine renal epithelial cells, and then induced the degradation of claudin-2, claudin-4, occludin and ZO-1 through EGFR-cSrc-ERK1/2 signaling pathway.57 In our study, the level of ZO-1 mRNA in lung tissue of ARDS rats induced by LPS was significantly lower than that in control group.58 Accordingly, we speculate that increasing the level of Na, K-ATPase α1/β1 may enhance the tight junction of lung epithelium and reduce the production of lung water. The follow-up experiments are needed to verify our theory .
CUL4B, which acts as a scaffold protein in CUL4B-RING ubiquitin ligase (CRL4B) complexes, participates in a variety of biological processes, including embryonic development, cell cycle progression, DNA damage response, chromatin remodeling, and signaling transduction.59 Li Y et al. suggested that in the development and progression of diffuse large B-cell lymphoma, CUL4B may act as a useful biomarker and a novel therapeutic target.60 Song Y et al. reported that CUL4B functions to restrict TLR-triggered inflammatory responses through regulating the AKT-GSK3β pathway.61 Our proteomic results show that CUL4B may bind to Na, K-ATPase α1 (Fig. 9), and the therapeutic target site of ARDS may extend to the effect of Na, K-ATPase α1 on CUL4B in subsequent studies.
SQSTM1, also known as sequestosome-1, is a multifunctional protein and is known as an autophagy protein that is destined for autophagic turnover by regulating the protein aggregates formation and facilitating the degradation of cargo protein through the process of autophagy.62 SQSTM1 regulates multiple signaling pathways by binding to different proteins to form important signaling centers in cells.63 SQSTM1 is involved in ubiquitin-proteasome and autophagy-lysosome degradation processes, and is an important regulatory molecule connecting ubiquitinated proteins to autophagy mechanism.62 Liu Y et al. revealed that the relationship between Na, K-ATPase and autophagy-lysosome pathway requires the involvement of α1 subunit, and Na, K-ATPase α1 and AMPK may act as the “on” and “off” switch of autophagy pathway.64 More importantly, Na, K-ATPase can be degraded through the ubiquitin-proteasome pathway and the autophagy-lysosome pathway. Autophagy defects can lead to SQSTM1 accumulation and induce cell stress and disease. In our study, we found that Na, K-ATPaseα1 could bind to SQSTM1 by protein profiling, which was verified by endogenous protein interaction analysis (Fig. 9). Consequently, the decrease of SQSTM1 mRNA expression may be helpful to reduce the transport of polyubiquitinated Na, K-ATPase α1 to autophagy-lysosome system for degradation. In summary, few studies have been conducted on the degradation pathways of Na, K-ATPase and autophagy protein SQSTM1, but the effect of their interaction on the abundance and enzyme activity of Na, K-ATPase α1, the improvement of lung water removal ability of alveolar cells, and the improvement of the prognosis of ARDS is worth extensive attention and discussion in the future.
Consideration differentially expressed proteins as biomarkers for ARDS have provided valuable insight into the pathogenesis. This is a new hope of identifying new biomarkers for prediction, prognostication, and diagnosis of ARDS.
Nevertheless, one of the limitations of this study is that the significant expression of these proteins occurred in LPS induced ARDS A549 cells model. We need to design a further study to investigate whether these changes also present in ARDS animal model.