Project description:Limiting fluid in lung is critical for efficient gas exchange. Here we discovered a mechanism of neuropeptidergic control of lung fluid balance by pulmonary neuroendocrine cells (PNECs), potent sensors of chemical and mechanical cues. We studied the first animal model of neuroendocrine cell hyperplasia of infancy (NEHI), which faithfully recapitulated patient phenotypes including PNEC hyperplasia and impaired gas exchange. Double mutants showed that increased PNECs and excess PNEC products such as CGRP are responsible for poor gas exchange, acting through downregulating endothelial junctions, increasing vessel leakage and fluid accumulation. Endothelium-specific inactivation of CGRP receptor, or treatment with CGRP receptor antagonist reduced fluid and improved gas exchange. In lungs with acute respiratory distress syndrome (ARDS), including those caused by COVID-19, there was a striking increase of CGRP-expressing PNECs. These findings raise the possibility that increased neuropeptides would contribute to excess extravascular lung fluid and antagonizing their function may improve gas exchange.
