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The Proceedings of the American Thoracic Society 2:206-213 (2005)
© 2005 The American Thoracic Society

Alveolar Epithelium

Role in Lung Fluid Balance and Acute Lung Injury

Michael A. Matthay, Laurent Robriquet and Xiaohui Fang

Cardiovascular Research Institute, University of California–San Francisco, San Francisco, California

Correspondence and requests for reprints should be addressed to Michael A. Matthay, M.D., 505 Parnassus Avenue, M-917, San Francisco, CA 94143-0624. E-mail: mmatt{at}itsa.ucsf.edu

ABSTRACT

The resolution of alveolar edema is regulated by active sodium and chloride transport across the pulmonary epithelium, including alveolar epithelial type I and II cells as well as distal airway epithelia. Catecholamine-dependent mechanisms can markedly upregulate alveolar fluid clearance even under pathological conditions, an effect that is mediated by both epithelial sodium channel (ENaC) and cystic fibrosis transmembrane conductance regulator (CFTR). Under pathological conditions, impaired alveolar fluid clearance is associated with worse survival in patients with acute lung injury. However, there is some experimental and clinical evidence that cAMP stimulation could accelerate the resolution of pulmonary edema in the presence of acute lung injury. Clinical trials are needed to test this potential therapeutic strategy in patients with acute lung injury.

Key Words: pulmonary edema • acute respiratory distress syndrome • alveolar fluid clearance • cystic fibrosis




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