Influenza remains a major cause of death and disability with limited treatment options. Studies of
acute lung injury have identified
angiopoietin-2 (Ang-2) as a key prognostic marker and a potential mediator of
Acute respiratory distress syndrome. However, the role of Ang-2 in
viral pneumonia remains poorly defined. This study characterized the time course of lung Ang-2 expression in severe
influenza pneumonia and tested the therapeutic potential of Ang-2 inhibition. We inoculated adult mice with
influenza A (PR8 strain) and measured
angiopoietin-1 (Ang-1), Ang-2, and Tie2 expressions during the evolution of inflammatory
lung injury over the first 7 days post-
infection (dpi). We tested a
peptide-antibody inhibitor of Ang-2, L1-7, administered at 2, 4, and 6 dpi and measured arterial oxygen saturation, survival,
pulmonary edema, inflammatory
cytokines, and viral load. Finally, we infected primary human alveolar type II epithelial (AT2) cells grown in air-liquid interface culture with
influenza and measured Ang-2
RNA expression.
Influenza caused severe
lung injury between 5 and 7 dpi in association with increased Ang-2 lung
RNA and a dramatic increase in Ang-2
protein in bronchoalveolar lavage. Inhibition of Ang-2 improved oxygenation and survival and reduced
pulmonary edema and alveolar-capillary barrier permeability to
protein without major effects on
inflammation or viral load. Finally,
influenza increased the expression of Ang-2
RNA in human AT2 cells. The increased Ang-2 levels in the airspaces during severe
influenza pneumonia and the improvement in clinically relevant outcomes after Ang-2 antagonism suggest that the Ang-1/Ang-2 Tie-2 signaling axis is a promising therapeutic target in
influenza and potentially other causes of
viral pneumonia.