• Heather E Merry, Patrick Phelan, Mathew R Doak, Minqing Zhao, Billanna Hwang, and Michael S Mulligan.
• Department of Surgery, Division of Thoracic Surgery, University of Washington, Seattle, Washington.
• Ann. Thorac. Surg. 2015 Apr 1;99(4):1193-9.

BackgroundToll-like receptor-4 has been implicated in modulating ischemia-reperfusion injury in cardiac, hepatic, renal, and cerebral models. However, its role in lung ischemia-reperfusion injury is unknown. We hypothesize that toll-like receptor-4 has a key role in initiating the inflammatory cascade in lung ischemia-reperfusion injury.MethodsWe used toll-like receptor-4 specific short interference RNA to achieve toll-like receptor-4 knockdown in rats prior to undergoing ischemia and reperfusion. Lungs were explanted and studied for protein expression and markers of lung injury. Additional animals were evaluated for cellular uptake of toll-like receptor-4 short interference RNA. Toll-like receptor-4 short interference RNA localized to the alveolar macrophage.ResultsIn animals pretreated with toll-like receptor-4 short interference RNA, toll-like receptor-4 expression and mitogen-activated protein kinase phosphorylation were suppressed. Markers of lung injury including permeability index, myeloperoxidase content, and bronchoalveolar lavage inflammatory cell counts were all reduced with toll-like receptor-4 knockdown.ConclusionsToll-like receptor-4 is critical in the development of lung ischemia-reperfusion injury and its activation in the alveolar macrophage may be the initiating step.Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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