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Aspects of inflammation in acute lung injury: experimental and clinical explorations
Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
2026 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Om inflammation vid akut lungskada : experimentella och kliniska undersökningar (Swedish)
Abstract [en]

Background:

Acute respiratory distress syndrome (ARDS) represents a syndrome of acutely failing lung function that, by definition, requires intensive care efforts to maintain adequate oxygenation of the patient’s blood. In established ARDS, treatment options are severely limited, although previous work in rodents have shown positive effects of pharmacological treatment with soluble epoxide hydrolase inhibitors (sEH) in an experimental model of acute lung injury. Clinically, the most important treatment for ARDS is reduction of harm or complications, primarily in the form of ventilator-induced lunginjury (VILI). Mechanical ventilation has positive and negative effects, where avoidance of VILI induction may necessitate ventilatory settings that lead to significant patient discomfort. We do not currently have biomarkers that identify patients with inappropriate or suboptimal positive pressure ventilatory support settings.

Aims:

This thesis mainly aims to describe lung injury biomarker patterns and effects of pharmacological treatment with soluble epoxide hydrolase inhibitors (sEH) in acute lung injury.

Methods:

A pig model of VILI was used to identify biomarkers among oxylipins and extracellular vesicles (EVs) in plasma and inbronchoalveolar lavage fluid (BALF), and also in exhaled breath condensate (EBC). Plasma samples from a cohort of intensive care unit (ICU) subjects were used to describe the kinetics of oxylipins after intubation and in sepsis compared to non-septic cases. We also established a pig model of long-term venous access to allow for determination of pharmacokinetic properties of a potential new anti-inflammatory medication in the form of an inhibitor of sEH. Finally, sEH inhibition was tested in a lipopolysaccharide (LPS) model of lung injury in pigs.

Results:

Several oxylipins increased in BALF in response to VILI induction. Some of these were also noted to increase in plasma. As a preliminary finding, a number of oxylipins could also be detected in EBC. Regarding EVs, those containing nucleic acids increased over time in response to VILI in BALF but not in plasma. In humans, lower levels of some oxylipins were observed after one day of mechanical ventilation and in septic patients compared to non-septic controls. Long-term cannulation of pigs was performed with satisfactory vascular access. Inhibition of sEH did not attenuate lung injury development after LPS challenge in pigs.

Conclusions:

Some oxylipins and EVs may be markers of experimental lung injury, most clearly seen in BALF. In ICU patients, oxylipins in plasma seem to decrease after intubation and were lower among sepsis cases compared to non-septic cases in this cohort. Finally, sEH inhibition does not appear to attenuate lung injury in pigs.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2026. , p. 101
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2413
Keywords [en]
Acute respiratory distress syndrome, Ventilator-induced lung injury, Inflammation, Soluble epoxide hydolase inhibitor, Biomarkers
National Category
Respiratory Medicine and Allergy Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:umu:diva-251331ISBN: 978-91-8070-956-9 (electronic)ISBN: 978-91-8070-955-2 (print)OAI: oai:DiVA.org:umu-251331DiVA, id: diva2:2047504
Public defence
2026-04-17, Lecture hall Betula, By 6M, Norrlands universitetssjukhus, Umeå, 12:30 (English)
Opponent
Supervisors
Available from: 2026-03-27 Created: 2026-03-20 Last updated: 2026-03-24Bibliographically approved
List of papers
1. Plasma and bronchoalveolar lavage fluid oxylipin levels in experimental porcine lung injury
Open this publication in new window or tab >>Plasma and bronchoalveolar lavage fluid oxylipin levels in experimental porcine lung injury
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2022 (English)In: Prostaglandins & other lipid mediators, ISSN 1098-8823, E-ISSN 2212-196X, Vol. 160, article id 106636Article in journal (Refereed) Published
Abstract [en]

Inflammatory signaling pathways involving eicosanoids and other regulatory lipid mediators are a subject of intensive study, and a role for these in acute lung injury is not yet well understood. We hypothesized that oxylipin release from lung injury could be detected in bronchoalveolar lavage fluid and in plasma. In a porcine model of surfactant depletion, ventilation with hyperinflation was assessed. Bronchoalveolar lavage and plasma samples were analyzed for 37 different fatty acid metabolites (oxylipins). Over time, hyperinflation altered concentrations of 4 oxylipins in plasma (TXB2, PGE2, 15-HETE and 11-HETE), and 9 oxylipins in bronchoalveolar lavage fluid (PGF, PGE2, PGD2, 12,13-DiHOME, 11,12-DiHETrE, 13-HODE, 9-HODE, 15-HETE, 11-HETE). Acute lung injury caused by high tidal volume ventilation in this porcine model was associated with rapid changes in some elements of the oxylipin profile, detectable in lavage fluid, and plasma. These oxylipins may be relevant in the pathogenesis of acute lung injury by hyperinflation.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Biomarkers, Inflammation, Lung injury, Mechanical ventilation, Oxylipins, Swine
National Category
Cell Biology Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-193703 (URN)10.1016/j.prostaglandins.2022.106636 (DOI)000792010100002 ()35307566 (PubMedID)2-s2.0-85127156336 (Scopus ID)
Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2026-03-20Bibliographically approved
2. Extracellular vesicle release in an experimental ventilator-induced lung injury porcine model
Open this publication in new window or tab >>Extracellular vesicle release in an experimental ventilator-induced lung injury porcine model
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2025 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 20, no 4, article id e0320144Article in journal (Refereed) Published
Abstract [en]

Harmful effects of mechanical ventilation with large tidal volumes, volutrauma, may contribute much to diffuse acute lung injury. Extracellular vesicles have been noted in the context of vital organ injury. We hypothesized that extracellular vesicles from acutely injured lung can be found in both lung and blood. In a two-hit experimental porcine model, we tested if extracellular vesicles could be detected in bronchoalveolar lavage fluid and in plasma over a six-hour period of large tidal volume ventilation after surfactant depletion. After 2 hours of volutrauma, bronchoalveolar lavage fluid showed increased levels of extracellular vesicles containing nucleic acids (stained by SYTO 13) and those positive for both SYTO 13 and HMGB1. No such increase was detected in plasma at any timepoint during the six-hour experiments. This shows that nucleic acid-containing extracellular vesicles appear to be involved in progression of lung injury, possibly indicating cellular damage, but their potential to serve as diagnostic biomarkers of acute lung injury progression, based on plasma sampling, and in the very early phase, is not confirmed by these findings.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2025
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-238339 (URN)10.1371/journal.pone.0320144 (DOI)001464256600041 ()40202940 (PubMedID)2-s2.0-105002409586 (Scopus ID)
Funder
Region VästerbottenUmeå University
Available from: 2025-05-23 Created: 2025-05-23 Last updated: 2026-03-20Bibliographically approved
3. Oxylipin profiles during the first day of mechanical ventilation in an intensive care unit cohort: research letter
Open this publication in new window or tab >>Oxylipin profiles during the first day of mechanical ventilation in an intensive care unit cohort: research letter
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2023 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 138, no 5, p. 561-563Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-206880 (URN)10.1097/ALN.0000000000004518 (DOI)000989777900012 ()36857438 (PubMedID)2-s2.0-85152244324 (Scopus ID)
Available from: 2023-04-20 Created: 2023-04-20 Last updated: 2026-03-20Bibliographically approved
4. Percutaneously inserted long-term central venous catheters in pigs of different sizes
Open this publication in new window or tab >>Percutaneously inserted long-term central venous catheters in pigs of different sizes
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2015 (English)In: Laboratory Animals, ISSN 0023-6772, E-ISSN 1758-1117, Vol. 49, no 3, p. 215-219Article in journal (Refereed) Published
Abstract [en]

Pigs are used for long-term biomedical experiments requiring repeated injections, infusions and collections of blood samples. Thus, it is necessary for vascular catheters to be indwelling to avoid undue stress to the animals and the use of restraints. We propose a refined model of percutaneous insertion of long-term central venous catheters to minimize the surgical trauma and postoperative complications associated with catheter insertion. Different sizes of needles (18 Ga versus 21 Ga) for initial puncture of the veins were compared. In conventional pigs weighing less than 30 kg, catheter insertion may be facilitated by using a microintroducer set with a 21 Ga needle. In pigs weighing 50 kg, a standard 18 Ga needle may be preferable.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keywords
seldinger technique, microintroducer, refinement, swine, vascular access
National Category
Anesthesiology and Intensive Care Surgery Zoology
Identifiers
urn:nbn:se:umu:diva-102330 (URN)10.1177/0023677215575222 (DOI)000357538000006 ()25732575 (PubMedID)2-s2.0-84937879266 (Scopus ID)
Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2026-03-20Bibliographically approved
5. Inhibition of soluble epoxide hydrolase in endotoxin induced pig lung injury
Open this publication in new window or tab >>Inhibition of soluble epoxide hydrolase in endotoxin induced pig lung injury
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2025 (English)In: Frontiers in Pharmacology, E-ISSN 1663-9812, Vol. 16, article id 1652349Article in journal (Refereed) Published
Abstract [en]

Pharmacological inhibition of soluble epoxide hydrolase has been shown to attenuate lung injury development in rodents exposed to bacterial lipopolysaccharide. To investigate if these effects can be reproduced in larger animals, we tested soluble epoxide hydrolase (sEH) inhibition using an sEH inhibitor 1-adamantanyl-3-{5-[2-(ethylethoxy)ethoxy]pentyl}urea (AEPU) in a porcine model of lipopolysaccharide-induced acute lung injury. AEPU was selected from 23 sEH inhibitors based on IC50 values and metabolic stability profiles established by a fluorescent based activity assay and porcine liver microsomal test, respectively. Hydrolysis of fatty acid epoxides to their corresponding diols is catalyzed by sEH. Inhibition of sEH reduces this conversion, leading to an accumulation of epoxides relative to diols. Hence, AEPU-treated subjects (n = 9) showed metabolic signs of effective in vivo inhibition of the target enzyme reflected in an increased epoxide/diol ratio of 12 (13)-epoxyoctadecenoic acid to 12,13-dihydroxyoctadecenoic acid compared to placebo-treated controls (p = 0.026). However, there was no difference in lung injury development or survival in subjects treated with the rapidly metabolized AEPU compared to placebo-treated controls (n = 10). In conclusion, administration of the soluble epoxide hydrolase inhibitor AEPU did not attenuate endotoxin induced lung injury with lipopolysaccharide in pigs under the severe conditions tested here.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2025
Keywords
acute respiratory distress syndrome, AEPU, lipid mediators, lung injury, soluble epoxide hydrolase
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-245372 (URN)10.3389/fphar.2025.1652349 (DOI)001576832600001 ()41001346 (PubMedID)2-s2.0-105016791757 (Scopus ID)
Funder
Swedish Research Council, 2014–6354
Available from: 2025-10-10 Created: 2025-10-10 Last updated: 2026-03-20Bibliographically approved

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