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Deficient retinoid-driven angiogenesis may contribute to failure of adult human lung regeneration in emphysema
  1. John-Poul Ng-Blichfeldt1,
  2. Joana Alçada1,2,
  3. M Angeles Montero3,
  4. Charlotte H Dean1,
  5. Uta Griesenbach4,
  6. Mark J Griffiths1,2,
  7. Matthew Hind1,2
  1. 1Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, UK
  2. 2Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  4. 4Department of Gene Therapy, National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Matthew Hind, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK; m.hind{at}


Background Molecular pathways that regulate alveolar development and adult repair represent potential therapeutic targets for emphysema. Signalling via retinoic acid (RA), derived from vitamin A, is required for mammalian alveologenesis, and exogenous RA can induce alveolar regeneration in rodents. Little is known about RA signalling in the human lung and its potential role in lung disease.

Objectives To examine regulation of human alveolar epithelial and endothelial repair by RA, and characterise RA signalling in human emphysema.

Methods The role of RA signalling in alveolar epithelial repair was investigated with a scratch assay using an alveolar cell line (A549) and primary human alveolar type 2 (AT2) cells from resected lung, and the role in angiogenesis using a tube formation assay with human lung microvascular endothelial cells (HLMVEC). Localisation of RA synthetic (RALDH-1) and degrading (cytochrome P450 subfamily 26 A1 (CYP26A1)) enzymes in human lung was determined by immunofluorescence. Regulation of RA pathway components was investigated in emphysematous and control human lung tissue by quantitative real-time PCR and Western analysis.

Results RA stimulated HLMVEC angiogenesis in vitro; this was partially reproduced with a RAR-α agonist. RA induced mRNA expression of vascular endothelial growth factor A (VEGFA) and VEGFR2. RA did not modulate AT2 repair. CYP26A1 protein was identified in human lung microvasculature, whereas RALDH-1 partially co-localised with vimentin-positive fibroblasts. CYP26A1 mRNA and protein were increased in emphysema.

Conclusions RA regulates lung microvascular angiogenesis; the endothelium produces CYP26A1 which is increased in emphysema, possibly leading to reduced RA availability. These data highlight a role for RA in maintenance of the human pulmonary microvascular endothelium.

  • COPD ÀÜ Mechanisms
  • Emphysema

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  • CHD, UG, MJG and MH contributed equally to this paper

  • Contributors JPNB undertook acquisition, analysis and interpretation of data, and manuscript writing. JA undertook acquisition, analysis and interpretation of data for figure 5. MAM undertook acquisition and categorisation of lung tissue samples and provided images of tissue sections for online supplementary material. CHD, MJG, UG and MH contributed to the study design. All authors contributed to manuscript revision and final approval. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This project was funded and supported by the NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.