Coexpression of RTI40 with alveolar epithelial type II cell proteins in lungs following injury:: identification of alveolar intermediate cell types

Injured alveolar epithelial type (AT) I cells are replaced following the proliferation and transformation of ATII cells to new ATI cells. RTI40 is an ATI cell-specific protein required for normal lung development. We hypothesized that intermediate cell types in the ATII-to-ATI cell transformation would coexpress RTI40 and ATII cell-selective proteins. To test this hypothesis, we used a rat model of Staphylococcus aureus-induced acute lung injury and a panel of ATI and ATII cell-specific and -selective antibodies. S. aureus induced an acute inflammatory reaction that was resolving by day 3 postinoculation. At day 3 postinoculation, the alveolar wall was thickened secondary to ATII cell hyperplasia. With the use of confocal microscopy, there was a fivefold increase in the fractional surface area of alveolar walls stained with ATII cell membrane proteins (RTII70 and MMC4) and a decrease in the fractional surface area associated with RTI40- expressing cells. S. aureus-treated lungs also contained unique cell types that coexpressed the RTI40 and ATII markers RTI40/MMC4/RTII70- and RTI40/MMC4- positive cells. These cells were not observed in control lungs. RTI40/ MMC4-positive cells were also found in cultured ATII cells before they transformed to an ATI-like phenotype. Our data suggest that RTI40/MMC4/RTII70- and RTI40/MMC4-positive cells are intermediates in the ATII-to-ATI cell transformation. These data also suggest that the coexpression of RTI40 with ATII cell proteins may be used to identify and investigate ATII cell transdifferentiation to ATI cells following injury.