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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Immunol.</journal-id>
<journal-title>Frontiers in Immunology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Immunol.</abbrev-journal-title>
<issn pub-type="epub">1664-3224</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fimmu.2017.00591</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Immunology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Hypercapnia Impairs ENaC Cell Surface Stability by Promoting Phosphorylation, Polyubiquitination and Endocytosis of &#x003B2;-ENaC in a Human Alveolar Epithelial Cell Line</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Gwo&#x0017A;dzi&#x00144;ska</surname> <given-names>Paulina</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/426325"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Buchbinder</surname> <given-names>Benno A.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Mayer</surname> <given-names>Konstantin</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Herold</surname> <given-names>Susanne</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<uri xlink:href="http://frontiersin.org/people/u/37278"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Morty</surname> <given-names>Rory E.</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author">
<name><surname>Seeger</surname> <given-names>Werner</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Vad&#x000E1;sz</surname> <given-names>Istv&#x000E1;n</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="cor1">&#x0002A;</xref>
<uri xlink:href="http://frontiersin.org/people/u/56714"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Internal Medicine, Justus Liebig University, Universities of Giessen and Marburg Lung Center, German Center for Lung Research</institution>, <addr-line>Giessen</addr-line>, <country>Germany</country></aff>
<aff id="aff2"><sup>2</sup><institution>Max Planck Institute for Heart and Lung Research</institution>, <addr-line>Bad Nauheim</addr-line>, <country>Germany</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Rudolf Lucas, Augusta University, USA</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Aaron Hanukoglu, Tel Aviv University, Israel; Juerg Hamacher, Lindenhof Hospital, Switzerland</p></fn>
<corresp content-type="corresp" id="cor1">&#x0002A;Correspondence: Istv&#x000E1;n Vad&#x000E1;sz, <email>istvan.vadasz&#x00040;innere.med.uni-giessen.de</email></corresp>
<fn fn-type="other" id="fn001"><p>Specialty section: This article was submitted to Inflammation, a section of the journal Frontiers in Immunology</p></fn>
</author-notes>
<pub-date pub-type="epub">
<day>23</day>
<month>05</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection">
<year>2017</year>
</pub-date>
<volume>8</volume>
<elocation-id>591</elocation-id>
<history>
<date date-type="received">
<day>26</day>
<month>02</month>
<year>2017</year>
</date>
<date date-type="accepted">
<day>04</day>
<month>05</month>
<year>2017</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2017 Gwo&#x0017A;dzi&#x00144;ska, Buchbinder, Mayer, Herold, Morty, Seeger and Vad&#x000E1;sz.</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Gwo&#x0017A;dzi&#x00144;ska, Buchbinder, Mayer, Herold, Morty, Seeger and Vad&#x000E1;sz</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<abstract>
<p>Acute lung injury is associated with formation of pulmonary edema leading to impaired gas exchange. Patients with acute respiratory distress syndrome (ARDS) require mechanical ventilation to improve oxygenation; however, the use of relatively low tidal volumes (to minimize further injury of the lung) often leads to further accumulation of carbon dioxide (hypercapnia). Hypercapnia has been shown to impair alveolar fluid clearance (AFC), thereby causing retention of pulmonary edema, and may lead to worse outcomes; however, the underlying molecular mechanisms remain incompletely understood. AFC is critically dependent on the epithelial sodium channel (ENaC), which drives the vectorial transport of Na<sup>&#x0002B;</sup> across the alveolar epithelium. Thus, in the current study, we investigated the mechanisms by which hypercapnia effects ENaC cell surface stability in alveolar epithelial cells (AECs). Elevated CO<sub>2</sub> levels led to polyubiquitination of &#x003B2;-ENaC and subsequent endocytosis of the &#x003B1;/&#x003B2;-ENaC complex in AECs, which were prevented by silencing the E3 ubiquitin ligase, Nedd4-2. Hypercapnia-induced ubiquitination and cell surface retrieval of ENaC were critically dependent on phosphorylation of the Thr615 residue of &#x003B2;-ENaC, which was mediated by the extracellular signal-regulated kinase (ERK)1/2. Furthermore, activation of ERK1/2 led to subsequent activation of AMP-activated protein kinase (AMPK) and c-Jun N-terminal kinase (JNK)1/2 that in turn phosphorylated Nedd4-2 at the Thr899 residue. Importantly, mutation of Thr899 to Ala markedly inhibited the CO<sub>2</sub>-induced polyubiquitination of &#x003B2;-ENaC and restored cell surface stability of the ENaC complex, highlighting the critical role of Nedd4-2 phosphorylation status in targeting ENaC. Collectively, our data suggest that elevated CO<sub>2</sub> levels promote activation of the ERK/AMPK/JNK axis in a human AEC line, in which ERK1/2 phosphorylates &#x003B2;-ENaC whereas JNK mediates phosphorylation of Nedd4-2, thereby facilitating the channel&#x02013;ligase interaction. The hypercapnia-induced ENaC dysfunction may contribute to impaired alveolar edema clearance and thus, interfering with these molecular mechanisms may improve alveolar fluid balance and lead to better outcomes in patients with ARDS.</p>
</abstract>
<kwd-group>
<kwd>carbon dioxide</kwd>
<kwd>epithelial sodium channel</kwd>
<kwd>sodium transport</kwd>
<kwd>ubiquitination</kwd>
<kwd>alveolar fluid clearance</kwd>
<kwd>alveolar epithelium</kwd>
<kwd>mitogen-activated protein kinase signaling</kwd>
</kwd-group>
<counts>
<fig-count count="5"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="55"/>
<page-count count="13"/>
<word-count count="7912"/>
</counts>
</article-meta>
</front>
<body>
<sec id="S1" sec-type="introduction">
<title>Introduction</title>
<p>Carbon dioxide (CO<sub>2</sub>) is formed as a by-product of cellular respiration and is eliminated from the body during breathing (<xref ref-type="bibr" rid="B1">1</xref>). In respiratory disorders that are associated with alveolar hypoventilation, retention of CO<sub>2</sub> is often detected, which leads to elevated CO<sub>2</sub> concentrations in the blood, also known as hypercapnia (<xref ref-type="bibr" rid="B2">2</xref>). For example, patients with severe acute respiratory distress syndrome (ARDS) frequently present with hypercapnia, which may be enhanced due to mechanical ventilation with low tidal volumes to minimize further ventilator-induced injuries to the lung (<xref ref-type="bibr" rid="B3">3</xref>). It is increasingly evident that the alveolar epithelium is capable of sensing of elevated CO<sub>2</sub> levels, which initiate specific signaling signatures and alter the function of alveolar epithelial and other cells (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B4">4</xref>). While some of these effects are anti-inflammatory, which may be beneficial in the context of excessive inflammation, others impair innate immunity, mitochondrial function, cellular repair, and alveolar epithelial barrier function, which are clearly detrimental in the setting of ARDS (<xref ref-type="bibr" rid="B5">5</xref>&#x02013;<xref ref-type="bibr" rid="B10">10</xref>).</p>
<p>A fully functional alveolar epithelial barrier is crucial for maintaining optimal fluid balance and gas exchange in the lung (<xref ref-type="bibr" rid="B11">11</xref>, <xref ref-type="bibr" rid="B12">12</xref>). In order to keep the alveolar space &#x0201C;dry,&#x0201D; excess alveolar liquid is reabsorbed from the air space into the interstitium by a well-characterized active sodium transport process in which Na<sup>&#x0002B;</sup> enters the alveolar epithelial type I and type II cells through the apically located epithelial sodium channel (ENaC) and is subsequently pumped out basolaterally by the Na,K-ATPase. This creates a Na<sup>&#x0002B;</sup> gradient, which drives paracellular movement of water leading to its clearance from the alveolar space (<xref ref-type="bibr" rid="B11">11</xref>, <xref ref-type="bibr" rid="B12">12</xref>). Importantly, it has been clearly demonstrated that in most patients with ARDS alveolar fluid clearance (AFC) is impaired and that those patients with ARDS and impaired AFC the mortality is significantly higher than in ARDS patients with normal AFC (<xref ref-type="bibr" rid="B13">13</xref>).</p>
<p>Other than in the alveolar epithelium, ENaC molecules are expressed in the apical surface of various tight epithelia including kidney, colon, and respiratory airways where ENaC is located along the entire length of motile cilia and regulate osmolarity of the periciliary fluid (<xref ref-type="bibr" rid="B14">14</xref>). ENaC usually consists of three subunits (&#x003B1; [or &#x003B4;, depending on the species, tissue, and cell type], &#x003B2;, and &#x003B3;) (<xref ref-type="bibr" rid="B15">15</xref>&#x02013;<xref ref-type="bibr" rid="B17">17</xref>). A functional ENaC complex requires at least one &#x003B1;- or &#x003B4;-subunit, whereas the &#x003B2;- and &#x003B3;-subunits are necessary for proper trafficking and activity of the channel (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B18">18</xref>). In line with this notion, mice lacking &#x003B1;-ENaC are unable to clear lung fluid from the alveoli and die nearly immediately after birth (<xref ref-type="bibr" rid="B19">19</xref>). The significance of &#x003B2;-ENaC in the regulation of channel activity has been highlighted in transgenic mice overexpressing this subunit in the lung (<xref ref-type="bibr" rid="B20">20</xref>). In these animals, an increase in alveolar epithelial Na<sup>&#x0002B;</sup> uptake due to &#x003B2;-ENaC overexpression, probably by promoting trafficking of ENaC to the cell surface and enhancing channel activity, leads to lung dehydration and causes a CF-like phenotype. Cell surface abundance of ENaC is modified by the E3 ubiquitin ligase Nedd4-2, which by interaction with the PY motif, located at the C-termini of each subunit of the channel, promotes ubiquitination and subsequent clathrin<italic>-</italic>mediated endocytosis of the channel (<xref ref-type="bibr" rid="B21">21</xref>&#x02013;<xref ref-type="bibr" rid="B23">23</xref>). Nedd4-2<sup>&#x02212;/&#x02212;</sup> mice have enhanced ENaC expression and function; however, this genetic manipulation has lethal consequences (<xref ref-type="bibr" rid="B24">24</xref>). In contrast, overexpression of the ligase causes a decrease in ENaC density at the plasma membrane (PM) and reduces Na<sup>&#x0002B;</sup> transport (<xref ref-type="bibr" rid="B25">25</xref>).</p>
<p>Previous studies have proposed the involvement of phosphorylation in the mechanisms regulating Nedd4-2 binding to ENaC (<xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B27">27</xref>). For example, extracellular signal-regulated kinase (ERK), c<italic>-</italic>Jun N<italic>-</italic>terminal kinase (JNK), and recently also the cellular energy sensor, AMP-activated protein kinase (AMPK), have been described as potential modulators of the ENaC/Nedd4-2 interaction by phosphorylating the E3 ligase or the target (<xref ref-type="bibr" rid="B28">28</xref>&#x02013;<xref ref-type="bibr" rid="B32">32</xref>). We have previously described that hypercapnia markedly impairs AFC and initiates a specific signaling pattern in the alveolar epithelium, including rapid activation of ERK, AMPK, and JNK and subsequent downregulation of the Na,K-ATPase (<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B33">33</xref>). Considering the pivotal role of ENaC in AFR and that several kinases, which have previously been suggested to alter ENaC/Nedd4-2 interaction, are activated by elevated CO<sub>2</sub> levels, in the current study we sought to determine whether ENaC is effected by hypercapnia and provide evidence that excess CO<sub>2</sub> initiates ERK-mediated &#x003B2;-ENaC phosphorylation and AMPK/JNK-dependent activation of Nedd4-2 leading to an enhancement of &#x003B2;-ENaC polyubiquitination and, thus, to endocytosis of the ENaC complex form the cell surface. Since ENaC activity is essential for optimal lung fluid balance, the hypercapnia-induced alterations in ENaC cell surface stability may cause further aggravation of lung injury.</p>
</sec>
<sec id="S2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="S2-1">
<title>Cell Culture</title>
<p>Human epithelial A549 cells (ATCC, CCL 185) were grown in DMEM supplemented with 10% fetal bovine serum and 100&#x02009;U/ml penicillin, 100&#x02009;&#x000B5;g/ml streptomycin as previously described (<xref ref-type="bibr" rid="B8">8</xref>). Experiments were performed on subconfluent monolayers of cells. Cells were incubated in a humidified atmosphere of 5% CO<sub>2</sub>/95% air at 37&#x000B0;C.</p>
</sec>
<sec id="S2-2">
<title>CO<sub>2</sub> Exposure</title>
<p>A549 cells were treated with 40 or 120&#x02009;mmHg CO<sub>2</sub> (normocapnia and hypercapnia, respectively). Before each experiment, fresh solutions were prepared with DMEM-Ham&#x02019;s F-12 medium and Tris base. The buffering capacity of the experimental media was modified by changing the initial pH using Tris base to obtain a pH of 7.4 at 40 and 120&#x02009;mmHg CO<sub>2</sub> (<xref ref-type="bibr" rid="B8">8</xref>). The desired CO<sub>2</sub> concentrations and pH levels were obtained by equilibrating the experimental media overnight in a humidified chamber from BioSpherix Ltd. (NY, USA). The C-Chamber&#x02019;s atmosphere was controlled with a PRO-CO<sub>2</sub> Carbon Dioxide controller (Biospherix Ltd.). In the chamber, cells were treated with a pCO<sub>2</sub> of 40 or 120&#x02009;mmHg while keeping 21% O<sub>2</sub> balanced with N<sub>2</sub>. Before and after CO<sub>2</sub> exposure, pH, pCO<sub>2</sub>, and pO<sub>2</sub> levels in the media were measured using a Rapidlab blood gas analyzer (Siemens, Erlangen, Germany).</p>
</sec>
<sec id="S2-3">
<title>Plasmids, Constructs, Site-Directed Mutagenesis, Antibodies, and Inhibitors</title>
<p>pEYFP-C1-expressing &#x003B1;-ENaC was constructed by PCR amplifying &#x003B1;-ENaC gene using as a template pTNT-&#x003B1;-ENaC and oligonucleotide primers &#x003B1;-ENaC forward 5&#x02032;-GAATTCAATGGAGGGGAACAAGCTGGAGG-3&#x02032; and &#x003B1;-ENaC reverse 5&#x02032;-GGATCCCTTGTCATCGTCATCCTTGTAATCGGGCCCCCCCAGAGGAC-3&#x02032;. The resulting amplicon was digested with <italic>Eco</italic>RI/BamH1 and ligated to the multiple cloning site (MCS) of pEYFP-C1 plasmid. The pEYFP-C1 vector contained the epitope-tag eYFP at the N-terminus and a FLAG-tag at the C-terminus. Thus, anti-GFP or anti-FLAG antibodies recognize the &#x003B1;-ENaC construct at a predicted size of 118&#x02009;kDa, 1,073 amino acids [&#x003B1;-ENaC (90&#x02009;kDa) plus YFP (27&#x02009;kDa) and FLAG (1&#x02009;kDa)]. pcDNA3.1V5/His expressing &#x003B2;-ENaC was constructed by PCR amplifying &#x003B2;-ENaC gene using as a template cDNA transcribed from total mRNA isolated from A549 cells and oligonucleotide primers &#x003B2;-ENaC forward 5&#x02032;-CTCGGATCCACATGCACGTGAAGAAGTACCT-3&#x02032; and &#x003B2;-ENaC reverse 5&#x02032;-GCACTCGAGGATGGCATCACCCTCACTGT-3&#x02032;. The resulting amplicon was digested with Xho1/BamH1 and ligated to MCS of pcDNA3.1V5/His plasmid. Finally, <italic>E. coli</italic> DH5&#x003B1; were transformed using the constructed plasmid. Anti-V5 antibodies recognize the &#x003B2;-ENaC construct at a predicted size of 96&#x02009;kDa, 872 amino acids [&#x003B2;-ENaC plus V5 at the C-terminus (1&#x02009;kDa)]. pCMV-HA-C-expressing &#x003B3;-ENaC was constructed by PCR amplifying &#x003B3;-ENaC gene using as a template pTNT-&#x003B3;ENaC and oligonucleotide primers &#x003B3;-ENaC forward 5&#x02032;-AGGCCCGAATTCATGGCACCCGGAGAGAAGAT-3&#x02032; and &#x003B3;-ENaC reverse 5&#x02032;-GTAGCCGGTACCGAGCTCATCCAGCATCTGGG-3&#x02032;. The resulting amplicon was digested and ligated to MCS of pCMV-HA-C plasmid. The pCMV-HA-C vector contained the epitope-tag myc at the N-terminus and an HA-tag at the C-terminus. Anti-HA antibodies recognize &#x003B3;-ENaC at a predicted size of 97&#x02009;kDa, 881 amino acids [&#x003B3;-ENaC plus myc (1&#x02009;kDa) and HA (1&#x02009;kDa)]. pRK5-HA-ubiquitin was a gift from Ted Dawson [Addgene 17608 (<xref ref-type="bibr" rid="B34">34</xref>)] and the pCI HA NEDD4L plasmid was a gift from Joan Massague [Addgene 27000 (<xref ref-type="bibr" rid="B35">35</xref>)]. Site-directed mutagenesis was used to perform point mutation of T899A in human Nedd4-2 using Quick Change Mutagenesis Kit from Stratagene (La Jolla, CA, USA) in accordance to the manufacturer&#x02019;s instructions. The primer sequences were as follows: Nedd4-2 forward: 5&#x02032;-ACTGCAGTTTGTCGCAGGGACATCGCGAG-3&#x02032;, Nedd4-2 reverse: 5&#x02032; CTCGCGATGTCCCTGCGACAAACTGCAGT-3&#x02032;. Immunoblot analysis of epitope-tagged ENaC expressed in A549 cells were performed with a mouse anti-GFP antibody from Roche (Basel, Switzerland), a mouse anti-HA antibody (Covance, Princeton, NJ, USA), a mouse anti-V5 antibody and a mouse antibody against transferrin receptor used as loading control of biotinylated proteins from Invitrogen (Waltham, MA, USA; Figure S1 in Supplementary Material). A rabbit antibody directed against &#x003B2;-actin was used as loading control of cytoplasmic ENaC and was purchased from Sigma Aldrich (Saint Louis, MO, USA). The inhibitor of AMPK, Compound C, was from Merck Millipore (Darmstadt, Germany). The inhibitor of MEK, U0126 was from Promega (Fitchburg, WI, USA). siRNA against AMPK-&#x003B1;1 and Nedd4-2 and scrambled siRNA control were purchased from Santa Cruz Biotechnology (Dallas, TX, USA).</p>
</sec>
<sec id="S2-4">
<title>Transient Transfection</title>
<p>A549 cells were transiently transfected with eYFP-&#x003B1;-ENaC, &#x003B2;-ENaC-V5, HA-ubiquitin, HA-Nedd4-2 wild type, or mutant by using nucleofection, as previously described (<xref ref-type="bibr" rid="B36">36</xref>). Briefly, cells were resuspended in 100&#x02009;&#x000B5;l of the nucleofection solution SF (Lonza, Cologne, Germany), and 4&#x02013;6&#x02009;&#x000B5;g of DNA was added. Cells were placed in a cuvette and pulsed with the specified cell-type nucleofector program. After 10&#x02009;min of incubation time, cells were cultured in DMEM supplemented with 10% FBS, 100&#x02009;U/ml penicillin, and 100&#x02009;&#x000B5;g/ml streptomycin. In some studies, 24&#x02009;h before nucleofection with ENaC plasmids, cells were transfected with siRNA using Lipofectamine RNAiMAX (Invitrogen, Waltham, MA, USA) according to the instructions of the manufacturer. Experiments were performed 48&#x02009;h later.</p>
</sec>
<sec id="S2-5">
<title>Cell Surface Biotinylation</title>
<p>A549 cells were labeled for 20&#x02009;min using 1&#x02009;mg/ml EZ-Link <italic>N</italic>HS-SS-biotin (Pierce Biotechnology, Waltham, MA, USA) and lysed in lysis buffer (50&#x02009;mM HEPES, 150&#x02009;mM NaCl, 1&#x02009;mM EGTA, 10% glycerol, 1% TritonX100). Surface proteins were pulled down with streptavidin-agarose beads from Pierce Biotechnology (Waltham, MA, USA) and analyzed by SDS-PAGE and immunoblot, as described previously (<xref ref-type="bibr" rid="B8">8</xref>).</p>
</sec>
<sec id="S2-6">
<title>Ubiquitination Studies</title>
<p>A549 cells were transfected with ENaC plasmids (2&#x02009;&#x000B5;g of each) and HA-ubiquitin (3&#x02009;&#x000B5;g). In some studies, cells were co-transfected with a plasmid coding HA-Nedd4-2 (wild type or mutant T899A, 2&#x02009;&#x000B5;g) or siRNAs (against AMPK-&#x003B1;1, Nedd4-2, or scrambled). Cells were exposed to 40&#x02009;mmHg CO<sub>2</sub> (Ctrl) or to 120&#x02009;mmHg CO<sub>2</sub> (CO<sub>2</sub>) for 15 or 30&#x02009;min and lysed on ice in lysis buffer (50&#x02009;mM HEPES, 150&#x02009;mM NaCl, 1&#x02009;mM EGTA, 10% glycerol, 1% TritonX100), containing a protease inhibitor cocktail from Roche. After lysing the samples, proteins were resolved in 8% polyacrylamide gel, transferred to nitrocellulose membrane (Optitran; Schleicher &#x00026; Schuell, Dassel, Germany) using a semidry apparatus from Bio-Rad (Hercules, Berkeley, CA, USA). Membranes were blocked in 5% fat-free dried milk powder and immunoblotted with anti-GFP or anti-V5 to detect &#x003B1;- or &#x003B2;-ENaC, respectively. Films were overexposed to detect ENaC ubiquitin conjugates.</p>
</sec>
<sec id="S2-7">
<title>Phosphorylation Experiments</title>
<p>Phosphorylation studies of ERK1/2, AMPK-&#x003B1;1, and c-Jun were performed using antibodies from Cell Signaling (Danvers, MA, USA). The anti-phospho-&#x003B2;-ENaC (T615) antibody was from Abcam (Cambridge, UK). A549 cells were treated with normal or elevated CO<sub>2</sub> concentrations (40 or 120&#x02009;mmHg, respectively) for the desired times, and then were washed with PBS twice and were lysed on ice in lysis buffer (50&#x02009;mM HEPES, 150&#x02009;mM NaCl, 1&#x02009;mM EGTA, 10% glycerol, 1% TritonX100). Samples having the same amount of protein were resuspended in Laemmli sample buffer and boiled for 10&#x02009;min at 98&#x000B0;C and immunoblotted with specific antibodies.</p>
</sec>
<sec id="S2-8">
<title>Statistics</title>
<p>Data are presented as mean&#x02009;&#x000B1;&#x02009;SEM and were analyzed using one-way analysis of variance (ANOVA) followed by a multiple comparison with the Dunnet test. <italic>p</italic> values of less than 0.05 were considered significant. GraphPad prism 6 (GraphPad software, San Diego, CA, USA) was used for the analysis and presentation of data.</p>
</sec>
</sec>
<sec id="S3">
<title>Results</title>
<sec id="S3-1">
<title>Acute Exposure to Elevated CO<sub>2</sub> Levels Leads to ENaC Endocytosis by Promoting Polyubiquitination of &#x003B2;-ENaC</title>
<p>To test whether high CO<sub>2</sub> levels promote endocytosis of ENaC, A549 cells were co-transfected with plasmids encoding the human &#x003B1;- and &#x003B2;-subunit of ENaC and the PM abundance of these proteins was measured after exposure of cells to physiological (pCO<sub>2</sub> 40&#x02009;mmHg; normocapnia) or elevated (pCO<sub>2</sub> 120&#x02009;mmHg; hypercapnia) CO<sub>2</sub> concentrations at a pH<sub>e</sub> of 7.4 for 30&#x02009;min. Exposure of cells to elevated CO<sub>2</sub> levels decreased &#x003B1;- and &#x003B2;-ENaC cell surface abundance by approximately 60% (Figure <xref ref-type="fig" rid="F1">1</xref>A), whereas the total protein level remained unaffected (Figure <xref ref-type="fig" rid="F1">1</xref>B). To determine whether elevated CO<sub>2</sub> levels lead to ubiquitination of either ENaC subunit, A549 cells were co-transfected with &#x003B1;- or &#x003B2;-ENaC and ubiquitin containing HA-tag (HA-Ub) and exposed the cells to 40 or 120&#x02009;mmHg CO<sub>2</sub> for 15&#x02009;min. Whereas no ubiquitination of &#x003B1;-ENaC in response to hypercapnia was evident (Figure <xref ref-type="fig" rid="F1">1</xref>C), a marked increase in &#x003B2;-ENaC ubiquitination in total cell lysates was observed when cells were treated with elevated CO<sub>2</sub> and immunoblotted with an antibody against V5 (Figure <xref ref-type="fig" rid="F1">1</xref>D). We detected a &#x0201C;polyubiquitin smear&#x0201D; above the molecular size of ENaC suggesting the presence of &#x003B2;-ENaC ubiquitin conjugates. This observation suggested that &#x003B2;-ENaC is a substrate of CO<sub>2</sub>-induced ubiquitination.</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p><bold>Acute exposure to elevated CO<sub>2</sub> levels leads to epithelial sodium channel (ENaC) endocytosis by promoting polyubiquitination of &#x003B2;<italic>-</italic>ENaC</bold>. <bold>(A)</bold> A549 cells were co-transfected with &#x003B1;- and &#x003B2;-ENaC and were exposed to 40&#x02009;mmHg CO<sub>2</sub> (Ctrl) or 120&#x02009;mmHg CO<sub>2</sub> (CO<sub>2</sub>) for 30&#x02009;min at a pH<sub>e</sub> of 7.4. Plasma membrane (PM) proteins were determined by streptavidin pull-downs and immunoblotting with anti-GFP to detect &#x003B1;-ENaC and anti-V5 to detect &#x003B2;-ENaC. Representative immunoblots of &#x003B1;-, &#x003B2;-ENaC, and transferrin receptor (TfR) at the PM are shown. <bold>(B)</bold> A549 cells were co-transfected with &#x003B1;- and &#x003B2;-ENaC and were treated as described above. Protein abundance in whole cell lysate (WCL) was measured by immunoblotting. Representative immunoblots of &#x003B1;-, &#x003B2;-ENaC, and &#x003B2;-actin are shown. Bars represent mean&#x02009;&#x000B1;&#x02009;SEM [<italic>n</italic> (number of independent experiments)&#x02009;&#x0003D;&#x02009;3; &#x0002A;&#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.001]. <bold>(C,D)</bold>, A549 cells were co-transfected with ubiquitin containing HA-tag (HA-Ub) and &#x003B1;-ENaC <bold>(C)</bold> or &#x003B2;-ENaC <bold>(D)</bold> and were exposed to 40 or 120&#x02009;mmHg CO<sub>2</sub> for 15&#x02009;min. Total ubiquitinated &#x003B1;-ENaC and &#x003B2;-ENaC was detected by immunoblots with anti-GFP or anti-V5 antibody.</p></caption>
<graphic xlink:href="fimmu-08-00591-g001.tif"/>
</fig>
</sec>
<sec id="S3-2">
<title>Nedd4-2 Mediates the Hypercapnia-Induced ENaC Polyubiquitination and Endocytosis</title>
<p>In subsequent studies, we silenced the endogenous Nedd4-2 with a specific siRNA to study whether Nedd4-2 mediates &#x003B2;-ENaC polyubiquitination during hypercapnia. Of note, the elevated CO<sub>2</sub>-induced ENaC ubiquitination was prevented by Nedd4-2 silencing (Figure <xref ref-type="fig" rid="F2">2</xref>A). To further test whether Nedd4-2 silencing altered ENaC PM stability, we measured cell surface ENaC abundance in A549 cells co-transfected with a scrambled siRNA (si-Scr.) or siRNA against Nedd4-2. Importantly, cells exposed to increased CO<sub>2</sub> concentrations treated with siRNA targeting Nedd4-2 had increased ENaC &#x003B1;- and &#x003B2;-subunit density at the PM (Figure <xref ref-type="fig" rid="F2">2</xref>B). Thus, upon hypercapnia, Nedd4-2 targets &#x003B2;-ENaC, leading to polyubiquitination of the &#x003B2;-subunit of the channel, which results in decreased abundance of the &#x003B1;/&#x003B2;-ENaC complex at the cell surface.</p>
<fig id="F2" position="float">
<label>Figure 2</label>
<caption><p><bold>Nedd4-2 mediates hypercapnia-induced epithelial sodium channel (ENaC) polyubiquitination and endocytosis</bold>. <bold>(A)</bold> A549 cells were co-transfected with &#x003B2;-ENaC, HA-ubiquitin, and siRNA against Nedd4-2 or a scrambled siRNA (si-Scr.) and were treated with 40 or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min and &#x003B2;-ENaC polyubiquitinated isoforms were determined. <bold>(B)</bold> A549 cells were co-transfected with &#x003B1;-, &#x003B2;-ENaC, and siRNA targeting Nedd4-2 or scrambled siRNA. Biotinylated ENaC proteins were detected by immunoblotting. Representative immunoblots of &#x003B1;-, &#x003B2;-ENaC, and transferrin receptor (TfR) at the plasma membrane (PM) and total protein abundance [whole cell lysate (WCL)] of ENaC proteins, &#x003B2;-actin, and Nedd4-2 are shown. Bars represent mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;&#x0002A; <italic>p</italic>&#x02009;&#x0003C;&#x02009;0.01).</p></caption>
<graphic xlink:href="fimmu-08-00591-g002.tif"/>
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<sec id="S3-3">
<title>Hypercapnia Induces ERK1/2-Dependent Phosphorylation of &#x003B2;-ENaC at Thr615 and Downregulates Surface Abundance of the Channel by Facilitating &#x003B2;-ENaC Polyubiquitination and Endocytosis of the &#x003B1;/&#x003B2;-ENaC Complex</title>
<p>In agreement with a previous report describing increased ERK1/2 activity in alveolar epithelial cells (AECs) exposed to hypercapnia (<xref ref-type="bibr" rid="B33">33</xref>), we found a rapid and transient phosphorylation of ERK1/2 in A549 cells exposed to elevated CO<sub>2</sub> (Figure <xref ref-type="fig" rid="F3">3</xref>A). Moreover, ERK1/2 activation was paralleled by phosphorylation of &#x003B2;-ENaC at the Thr 615 residue (Figure <xref ref-type="fig" rid="F3">3</xref>B). To test whether ERK-dependent &#x003B2;-ENaC phosphorylation was sufficient to promote polyubiquitination of &#x003B2;-ENaC in response to high CO<sub>2</sub>, we co-transfected A549 cells with &#x003B2;-ENaC and HA-ubiquitin. Cells were pre-treated with the MEK (upstream of ERK) inhibitor U0126 and exposed to elevated CO<sub>2</sub> concentrations for 30&#x02009;min. Inhibition of ERK prevented phosphorylation and polyubiquitination of the ENaC &#x003B2;-subunit (Figure <xref ref-type="fig" rid="F3">3</xref>C). To further prove that the hypercapnia-induced ENaC cell surface retrieval is dependent on ERK1/2, A549 cells were co-transfected with ENaC plasmids, and exposed to normo- or hypercapnia as described above and observed that inhibition of ERK1/2 markedly increased the number of the ENaC molecules at the cell surface upon hypercapnia exposure (Figure <xref ref-type="fig" rid="F3">3</xref>D). Together, these data indicate that the hypercapnia-induced ERK1/2 activation promotes ENaC internalization by phosphorylation-dependent ubiquitination of the &#x003B2;-subunit of the channel.</p>
<fig id="F3" position="float">
<label>Figure 3</label>
<caption><p><bold>Hypercapnia induces extracellular signal-regulated kinase (ERK)1/2-dependent phosphorylation of &#x003B2;-ENaC at T615 facilitating &#x003B2;-ENaC polyubiquitination and endocytosis of the &#x003B1;/&#x003B2;-ENaC complex</bold>. <bold>(A)</bold> A549 cells were exposed to 40&#x02009;mmHg CO<sub>2</sub> (Ctrl) for 15&#x02009;min or to 120&#x02009;mmHg CO<sub>2</sub> (CO<sub>2</sub>) for 5&#x02013;45&#x02009;min at a pH<sub>e</sub> of 7.4. Phosphorylation of ERK1/2 and the total amount of ERK1/2 were measured. The graph represents the p-ERK1/2/ERK1/2 ratio. Representative immunoblots of p-ERK1/2 and total ERK1/2 are shown. <bold>(B)</bold> A549 cells were co-transfected with &#x003B2;-ENaC and were treated with 40&#x02009;mmHg CO<sub>2</sub> for 15&#x02009;min or 120&#x02009;mmHg CO<sub>2</sub> for 5 and 15&#x02009;min at a pH<sub>e</sub> of 7.4. Phosphorylation of &#x003B2;-ENaC at T615 (p-&#x003B2;-ENaC) and total &#x003B2;-ENaC were determined by immunoblotting. Graphs represent p-&#x003B2;-ENaC/&#x003B2;-ENaC ratio. Representative immunoblots of p-&#x003B2;-ENaC and &#x003B2;-ENaC are shown. Values are expressed as mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.05; &#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.01). <bold>(C)</bold> A549 cells were transfected with &#x003B2;-ENaC, HA-ubiquitin, and were exposed to 40&#x02009;mmHg CO<sub>2</sub> or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min at a pH<sub>e</sub> of 7.4 in the presence or absence of U0126 (10&#x02009;&#x000B5;M, 30&#x02009;min pretreatment). Total ubiquitinated &#x003B2;-ENaC was detected by immunoblotting with anti-V5 antibody. <bold>(D)</bold> A549 cells were co-transfected with &#x003B1;- and &#x003B2;-ENaC and were exposed to CO<sub>2</sub> as described above. ENaC subunits at the plasma membrane (PM) were determined by biotin-streptavidin pull-downs and immunoblotting. Representative immunoblots of &#x003B1;- and &#x003B2;-ENaC at the PM, total protein abundance of epithelial sodium channel (ENaC) and p-ERK 1/2 are shown. Bars represent mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.05; &#x0002A;&#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.001).</p></caption>
<graphic xlink:href="fimmu-08-00591-g003.tif"/>
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<sec id="S3-4">
<title>JNK1/2-Dependent Nedd4-2 Phosphorylation at Thr899 Facilitates &#x003B2;-ENaC Polyubiquitination and Endocytosis</title>
<p>Because JNK activation has been implicated in the CO<sub>2</sub>-induced signaling pattern in AEC, which led to inhibition of the Na,K-ATPase (<xref ref-type="bibr" rid="B7">7</xref>), we next investigated the effects of JNK phosphorylation in AEC exposed to hypercapnia on ENaC. Activity of JNK1/2 was assessed by phosphorylation of c-Jun, a downstream target of JNK1/2. In line with the previously published data, we observed a rapid and time-dependent JNK activation induced by hypercapnia, which returned to baseline within 30&#x02009;min of exposure to elevated CO<sub>2</sub> levels (Figure <xref ref-type="fig" rid="F4">4</xref>A). To further investigate whether increased activity of Nedd4-2 is crucial to decrease hypercapnia-induced ENaC cell surface abundance, we next mutated a single amino acid in the catalytic domain of Nedd4-2 (T899A). The Thr899 residue within the HECT domain of the E3 ligase has previously been reported to be involved in the Nedd4-2-mediated ubiquitination of &#x003B1;-ENaC (<xref ref-type="bibr" rid="B37">37</xref>). A549 cells were co-transfected with HA-Ub and HA-Nedd4-2 wild type (WT) or HA-Nedd4-2 mutant (T899) constructs and exposed to 40 or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min. Of note, we found that phosphorylation of Thr899 played a central role in the hypercapnia-induced ubiquitination of &#x003B2;-ENaC, as in A549 cells expressing the Nedd4-2 in which the Thr899 has been mutated to an alanine (T899A), which cannot be phosphorylated, the level of &#x003B2;-ENaC polyubiquitination significantly decreased (Figure <xref ref-type="fig" rid="F4">4</xref>B). To further investigate whether this decrease in the ubiquitination of &#x003B2;-ENaC due to the lack of phosphorylation at the Thr899 residue of Nedd4-2 correlated with an increase in ENaC cell surface stability, cell surface biotinylation studies were performed. Importantly, overexpression of the Nedd4-2 mutant (T899A) also prevented endocytosis of the &#x003B1;/&#x003B2;-ENaC complex during hypercapnia (Figure <xref ref-type="fig" rid="F4">4</xref>C). Moreover and further confirming the central role of Nedd4-2 phosphorylation at Thr899 in the ubiquitination and subsequent endocytosis of ENaC, we observed increased levels of ENaC proteins at the cell surface after overexpression of the Nedd4-2 T899A mutant. Finally and in line with the above described findings, pretreatment of A549 cells with the potent and specific JNK inhibitor, SP600125, also fully prevented the hypercapnia-induced endocytosis of ENaC (Figure <xref ref-type="fig" rid="F4">4</xref>D).</p>
<fig id="F4" position="float">
<label>Figure 4</label>
<caption><p><bold>c-Jun N-terminal kinase (JNK)1/2-dependent Nedd4-2 phosphorylation at Thr899 facilitates &#x003B2;-ENaC polyubiquitination and endocytosis</bold>. <bold>(A)</bold> A549 cells were exposed to 40&#x02009;mmHg CO<sub>2</sub> (Ctrl) for 15&#x02009;min or to 120&#x02009;mmHg CO<sub>2</sub> (CO<sub>2</sub>) for 1 to 30&#x02009;min at a pH<sub>e</sub> of 7.4 and the phosphorylation of c-Jun and the total amount of JNK1/2 were measured by immunoblotting. Graph represents the p-c-Jun/JNK1/2 ratio. Representative immunoblots of p-c-Jun and total JNK1/2 levels are shown. Values are expressed as mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.05; &#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.01). <bold>(B)</bold> A549 cells were co-transfected with &#x003B2;-ENaC, HA-ubiquitin, and HA-Nedd4-2 wild type (WT) or mutant (T899A). Cells were treated with 40&#x02009;mmHg CO<sub>2</sub> or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min at a pH<sub>e</sub> of 7.4. Total ubiquitinated &#x003B2;-ENaC was detected by immunoblotting with anti-V5 antibody. <bold>(C)</bold> A549 cells were co-transfected with &#x003B1;- and &#x003B2;-ENaC and Nedd4-2 wild type or mutant and were exposed to CO<sub>2</sub> as described above. Epithelial sodium channel (ENaC) at the plasma membrane (PM) was determined by biotin-streptavidin pull-downs and immunoblotting. Representative immunoblots of &#x003B1;- and &#x003B2;-ENaC at the PM, total protein abundance of ENaC, Nedd4-2, and &#x003B2;-actin are shown. Mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.05). <bold>(D)</bold> A549 cells were co-transfected with &#x003B1;- and &#x003B2;-ENaC exposed to 40&#x02009;mmHg CO<sub>2</sub> or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min at a pH<sub>e</sub> of 7.4 in the presence or absence of SP600125 (25&#x02009;&#x000B5;M, 30&#x02009;min pretreatment). ENaC at the PM was determined by biotin-streptavidin pull-downs and immunoblotting. Representative immunoblots of &#x003B1;- and &#x003B2;-ENaC at the PM, total protein abundance of ENaC, p-c-Jun, JNK1/2, and &#x003B2;-actin are shown. Bars represent mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;5; &#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.01; &#x0002A;&#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.001).</p></caption>
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<graphic xlink:href="fimmu-08-00591-g004b.tif"/>
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</sec>
<sec id="S3-5">
<title>Hypercapnia Induces ENaC Endocytosis by ERK1/2-Dependent AMPK-&#x003B1;1 Activation</title>
<p>AMP-activated protein kinase, which has been shown to activate Nedd4-2 and inhibit ENaC (<xref ref-type="bibr" rid="B29">29</xref>), has also been described as one of the central mediators of the hypercapnia-induced alveolar epithelial dysfunction and a downstream target of ERK upon CO<sub>2</sub> exposure (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B33">33</xref>). Furthermore, we have previously observed that AMPK activates JNK1/2 in AEC when exposed to elevated CO<sub>2</sub> levels (<xref ref-type="bibr" rid="B7">7</xref>). In line with these previously published observations, we measured a rapid and transient phosphorylation of AMPK-&#x003B1;1 in A549 cells exposed to hypercapnia (Figure <xref ref-type="fig" rid="F5">5</xref>A), which was dependent on activation of ERK (Figure <xref ref-type="fig" rid="F5">5</xref>B) and upstream of JNK (Figure S2 in Supplementary Material). To determine whether activation of AMPK was necessary for the hypercapnia-induced polyubiquitination of &#x003B2;-ENaC, A549 cells were co-transfected with &#x003B2;-ENaC, HA-ubiquitin, and a specific siRNA against AMPK-&#x003B1;1 (or a scrambled siRNA) and were exposed to normal or elevated CO<sub>2</sub> levels and observed a significant decrease in polyubiquitination of &#x003B2;-ENaC after CO<sub>2</sub> exposure (Figure <xref ref-type="fig" rid="F5">5</xref>C). As a second approach, endogenous AMPK was inhibited by compound C after co-transfection of A549 cells with &#x003B2;-ENaC and HA-ubiquitin. Similar to our data that we obtained with AMPK silencing, exposure of the cells to hypercapnia in the presence of the inhibitor markedly decreased the hypercapnia-induced &#x003B2;-ENaC polyubiquitination (Figure <xref ref-type="fig" rid="F5">5</xref>D). To further confirm the role of AMPK-&#x003B1;1 in the CO<sub>2</sub>-induced downregulation of ENaC, we transfected A549 cells with &#x003B1;- and &#x003B2;-ENaC and exposed to elevated CO<sub>2</sub> levels for 30&#x02009;min in the presence or absence of the above mentioned siRNA against AMPK-&#x003B1;1 (Figure <xref ref-type="fig" rid="F5">5</xref>E) or compound C (Figure S3 in Supplementary Material) and observed that silencing or inhibition of AMPK stabilized ENaC proteins at the PM upon hypercapnia. Taken together, these latter studies suggest that AMPK by activation of JNK and subsequent phosphorylation of Nedd4-2 plays a central role in the hypercapnia-induced ubiquitination and endocytosis of ENaC.</p>
<fig id="F5" position="float">
<label>Figure 5</label>
<caption><p><bold>Hypercapnia induces epithelial sodium channel (ENaC) endocytosis <italic>via</italic> extracellular signal-regulated kinase (ERK)1/2-dependent AMPK-&#x003B1;1 activation</bold>. <bold>(A)</bold> A549 cells were exposed to 40&#x02009;mmHg CO<sub>2</sub> (Ctrl) for 15&#x02009;min or to 120&#x02009;mmHg CO<sub>2</sub> (CO<sub>2</sub>) for 15&#x02013;45&#x02009;min at a pH<sub>e</sub> of 7.4. The phosphorylation of AMPK-&#x003B1;1 at Thr172 and the total amount of AMPK-&#x003B1;1 were measured by immunoblotting. Graph represents the p-AMPK-&#x003B1;1/AMPK-&#x003B1;1 ratio. Representative immunoblots of p-AMPK-&#x003B1;1 and total AMPK-&#x003B1;1 are shown. <bold>(B)</bold> A549 cells were treated with 40&#x02009;mmHg CO<sub>2</sub> (Ctrl) or with 120&#x02009;mmHg CO<sub>2</sub> (CO<sub>2</sub>) for 15&#x02009;min at a pH<sub>e</sub> of 7.4 in the presence or absence of 10&#x02009;&#x000B5;M U0126 (30&#x02009;min pretreatment). Phosphorylation of AMPK-&#x003B1;1 at Thr172, p-ERK1/2, and the total amount of both proteins were determined by immunoblotting. Graph represents the p-AMPK-&#x003B1;1/AMPK-&#x003B1;1 ratio. Representative immunoblots of p-AMPK-&#x003B1;1, p-ERK1/2 and total level of AMPK-&#x003B1;1 and ERK1/2 are shown. Values are expressed as mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.05; &#x0002A;&#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.001). <bold>(C)</bold> A549 cells were co-transfected with &#x003B2;-ENaC, HA-ubiquitin, and siRNA targeting AMPK-&#x003B1;1 or a scrambled siRNA and were treated with 40 or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min. &#x003B2;-ENaC polyubiquitinated isoforms were determined with anti-V5 antibody. Representative immunoblots of &#x003B2;-ENaC, AMPK-&#x003B1;1, and &#x003B2;-actin are shown. <bold>(D)</bold> A549 cells were co-transfected with &#x003B2;-ENaC and HA-ubiquitin and were treated with 40&#x02009;mmHg CO<sub>2</sub> or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min at a pH<sub>e</sub> of 7.4 in the presence or absence of compound C (20&#x02009;&#x000B5;M, 30&#x02009;min pretreatment). Total ubiquitinated &#x003B2;-ENaC was detected as described above. Representative immunoblots of &#x003B2;-ENaC, p-AMPK-&#x003B1;1, and total AMPK-&#x003B1;1 are shown. <bold>(E)</bold> Cells were co-transfected with &#x003B1;- and &#x003B2;-ENaC and siRNA targeting AMPK-&#x003B1;1 or a scrambled siRNA and exposed to 40&#x02009;mmHg CO<sub>2</sub> or 120&#x02009;mmHg CO<sub>2</sub> for 30&#x02009;min at a pH<sub>e</sub> of 7.4. Biotinylated ENaC proteins were detected by immunoblotting. Representative western blots of &#x003B1;- and &#x003B2;-ENaC at the plasma membrane (PM) and total protein abundance of ENaC, p-AMPK-&#x003B1;1, and AMPK-&#x003B1;1 are shown. Bars present mean&#x02009;&#x000B1;&#x02009;SEM (<italic>n</italic>&#x02009;&#x0003D;&#x02009;3; &#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.05; &#x0002A;&#x0002A;<italic>p</italic>&#x02009;&#x0003C;&#x02009;0.01).</p></caption>
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<sec id="S4" sec-type="discussion">
<title>Discussion</title>
<p>In the present study, we show that elevated CO<sub>2</sub> levels initiate a specific signaling pattern leading to ubiquitination-mediated retrieval of ENaC from the PM, thereby reducing cell surface abundance of the channel in a human AEC line. Hypercapnia is associated with a number of acute and chronic pulmonary diseases; however, it is not evident to what extent and by which mechanisms these elevated levels of CO<sub>2</sub> may further impact on disease states. While hypercapnia and the associated acidosis have been shown to have anti-inflammatory effects, which might be advantageous at sites of excessive inflammation, recently, it has been clearly demonstrated that by impairing innate immunity, cellular repair, and alveolar epithelial function, elevated CO<sub>2</sub> may play a role in the pathogenesis of ARDS and COPD (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B5">5</xref>, <xref ref-type="bibr" rid="B9">9</xref>, <xref ref-type="bibr" rid="B10">10</xref>, <xref ref-type="bibr" rid="B38">38</xref>). Furthermore, it is increasingly evident that patients with ARDS and COPD who present with hypercapnia have worse outcomes (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B39">39</xref>, <xref ref-type="bibr" rid="B40">40</xref>).</p>
<p>A major function of the alveolar epithelium is the clearance of excess alveolar fluid, thereby promoting effective gas exchange. This clearance is mediated by the concerted action of various sodium transporters, among which the apically located ENaC and the basolateral Na,K-ATPase have been identified as key players. Indeed, we have previously shown that the Na,K-ATPase is downregulated by hypercapnia; however, a potential regulation of ENaC by carbon dioxide has not been previously investigated. Various factors have been shown to affect ENaC cell surface abundance and function, including interleukin-1&#x003B2;, interleukin-4, transforming growth factor-&#x003B2;, LPS, or hypoxia (<xref ref-type="bibr" rid="B41">41</xref>&#x02013;<xref ref-type="bibr" rid="B45">45</xref>), which similar to hypercapnia are often observed in patients with respiratory failure. As reducing hypercapnia without further damaging the lung is challenging, a better understanding of the molecular patterns initiated by elevated CO<sub>2</sub> levels may help us to interfere with the deleterious signals, thereby rescuing or at least not further aggravating lung damage.</p>
<p>Ubiquitination is a posttranslational modification that regulates trafficking and stability of proteins (<xref ref-type="bibr" rid="B46">46</xref>). Numerous studies described that depending on the stimulus ENaC subunits may undergo multimono- or polyubiquitination leading to channel retrieval from the cell surface or degradation of ENaC (<xref ref-type="bibr" rid="B47">47</xref>&#x02013;<xref ref-type="bibr" rid="B49">49</xref>). It is also well documented that the phosphorylation status of target molecules and the E3 ubiquitin ligase often play a pivotal role in the initiation of ubiquitination (<xref ref-type="bibr" rid="B50">50</xref>, <xref ref-type="bibr" rid="B51">51</xref>). Previous findings established the significance of mitogen-activated protein kinase (MAPK) in the hypercapnia-induced impairment of AFC (<xref ref-type="bibr" rid="B7">7</xref>, <xref ref-type="bibr" rid="B33">33</xref>). Moreover, it has also been described that ERK and JNK, two prominent members of the MAPK family, may alter the phosphorylation status of ENaC and the E3 ligase of the channel, Nedd4-2, respectively (<xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B37">37</xref>).</p>
<p>Thus, we first investigated whether elevated CO<sub>2</sub> concentrations affect ENaC cell surface stability by a mechanism involving ubiquitination of the channel and whether the MAPK pathway is involved in the hypercapnia-induced signaling events. Of note, a remarkable and rapid increase in polyubiquitination of &#x003B2;-ENaC and a significant reduction of the cell surface abundance of the &#x003B1;/&#x003B2;-ENAC complex were observed in AEC exposed to hypercapnia, as early as 30&#x02009;min after CO<sub>2</sub> exposure, suggesting that ENaC function is probably sensitive to changes in CO<sub>2</sub> levels. In contrast, in the first half an hour after CO<sub>2</sub> exposure, total intracellular levels of ENaC remained unchanged, suggesting that CO<sub>2</sub> influenced the trafficking of the channel rather than protein degradation. Furthermore, no significant changes in the ubiquitination status of &#x003B1;-ENaC have been detected upon hypercapnic treatment, highlighting and further confirming the central regulatory role of &#x003B2;-ENaC in the trafficking of the channel (<xref ref-type="bibr" rid="B52">52</xref>).</p>
<p>Our data demonstrate that elevated CO<sub>2</sub> levels cause a rapid and time-dependent ERK1/2 activation followed by phosphorylation of &#x003B2;-ENaC at the Thr615 residue. Moreover, genetic inhibition of Nedd4-2, the E3 ubiquitin ligase that drives ubiquitination of the various ENaC subunits (<xref ref-type="bibr" rid="B49">49</xref>), by a specific siRNA reduced &#x003B2;-ENaC polyubiquitination and prevented the hypercapnia-induced redistribution of &#x003B1;- and &#x003B2;-ENaC from the PM to the intracellular store, indicating a central role for Nedd4-2 in ENaC ubiquitination and endocytosis in AEC exposed to hypercapnia. Indeed, ERK1/2 has previously been described as a negative regulator of ENaC. For example, Eaton et al. showed that protein kinase C-&#x003B4; drives ERK activation leading to ENaC internalization (<xref ref-type="bibr" rid="B30">30</xref>). Another study established that the ERK-mediated ENaC downregulation is promoted by phosphorylation &#x003B2;- and &#x003B3;-ENaC, resulting in enhancement of Nedd4-2/ENaC interaction and thus, decreased Na<sup>&#x0002B;</sup> transport (<xref ref-type="bibr" rid="B31">31</xref>). Therefore, hypercapnia by enhancing ERK activity promotes phosphorylation of the ENaC &#x003B2;-subunit, which may increase the affinity of the E3 ubiquitin ligase to ENaC.</p>
<p>We have previously shown that JNK is also implicated in CO<sub>2</sub> responses and that phosphorylation of the kinase is required for the CO<sub>2</sub>-induced inhibition of the Na,K-ATPase in the alveolar epithelium (<xref ref-type="bibr" rid="B7">7</xref>). The significance of JNK in cellular adaptation to stress has been shown by several studies (<xref ref-type="bibr" rid="B53">53</xref>). Of note, the possible role of JNK in modulating Nedd4-2 activity and ENaC current has been reported in polarized kidney epithelial cells (<xref ref-type="bibr" rid="B28">28</xref>). Remarkably, this study also showed that the Thr899 residue in the HECT (homologous to the E6-AP carboxyl terminus) domain of Nedd4-2 may be phosphorylated by JNK1, which was required for ubiquitination of &#x003B1;-ENaC (<xref ref-type="bibr" rid="B28">28</xref>). To assess the potential involvement of JNK-mediated Nedd4-2 phosphorylation in the hypercapnia-induced downregulation of ENaC, we mutated Thr899 to Ala to prevent phosphorylation of the E3 ligase at this residue. Importantly, this point mutation largely prevented the CO<sub>2</sub>-induced polyubiquitination of &#x003B2;-ENaC although activation of JNK was evident and stabilized &#x003B1;- and &#x003B2;-ENaC at the cell surface. Thus, our data together with the previously published literature suggest that phosphorylation of Nedd4-2 by JNK at the Thr899 residue is critical for the hypercapnia-induced ubiquitination of &#x003B2;&#x02013;ENaC, which drives endocytosis of the ENaC complex from the PM in AEC.</p>
<p>We have previously shown that AMPK, a cellular metabolic sensor that inhibits several ion transporters including the cystic fibrosis transmembrane conductance regulator, Na,K-ATPase, and ENaC, is rapidly activated by hypercapnia (<xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B29">29</xref>, <xref ref-type="bibr" rid="B54">54</xref>). Regarding the regulation of ENaC, it has been shown that chemical stimulation of AMPK by 5-aminoimidazole-4-carboxamide-1-beta-4-ribofuranoside inhibited ENaC activity in lung epithelial cells (<xref ref-type="bibr" rid="B55">55</xref>). Moreover, enhanced abundance of ENaC channels at the cell surface was reported in the distal airways in AMPK-&#x003B1;1<sup>&#x02212;/&#x02212;</sup> mice (<xref ref-type="bibr" rid="B28">28</xref>). Interestingly, AMPK has also been reported to regulate Nedd4-2 activity (<xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B29">29</xref>). In the current study, treatment of AEC with a specific siRNA against AMPK-&#x003B1;1 or an AMPK-&#x003B1; inhibitor, compound C markedly decreased CO<sub>2</sub>-induced &#x003B2;-ENaC polyubiquitination and endocytosis of &#x003B1;-, and &#x003B2;-ENaC, which is consistent with previous findings showing that in human embryonic kidney cells, AMPK activation promoted Nedd4-2/ENaC association (<xref ref-type="bibr" rid="B26">26</xref>). Furthermore, and in line with a previously published study (<xref ref-type="bibr" rid="B7">7</xref>), we also show that in the context of hypercapnia, AMPK is an upstream regulator of JNK. Thus, it is probable that the AMPK-regulated effects of CO<sub>2</sub> on Nedd4-2 and ENaC are indirect and mediated by JNK. Moreover, although AMPK is an early element of the CO<sub>2</sub>-induced signaling pattern, its activation appears to be downstream of ERK upon hypercapnic exposure. This is of particular importance as ERK appears two have a dual role in the hypercapnia-induced downregulation of ENaC. On the one hand, it rapidly phosphorylates the &#x003B2;-subunit of the channel and by activating AMPK and JNK, it indirectly promotes phosphorylation of the E3 ligase Nedd4-2 as well. Of note, both of these phosphorylation events seem to be critically required for the CO<sub>2</sub>-induced ubiquitination and subsequent endocytosis of ENaC, probably by enhancing the association of the E3 ligase and the target molecule.</p>
<p>Our study has some clear limitations. Although we show a rapid activation of ERK and a subsequent phosphorylation of &#x003B2;-ENaC at the Thr615 residue, which is a known target of ERK, we have not investigated the potential rescue of &#x003B2;-ENaC ubiquitination or trafficking of the ENaC complex after preventing phosphorylation at this specific site. A mutation of this residue will be necessary to definitely prove that ERK-promoted phosphorylation of &#x003B2;-ENaC at this residue drives the downregulation of the channel upon hypercapnia. Moreover, the current study was performed exclusively in AECs and further <italic>in vivo</italic> investigations will be necessary to establish the role of the hypercapnia-induced signaling events identified in the current manuscript in ENaC-driven AFC and alveolar epithelial barrier dysfunction in an animal model of hypercapnic acute lung injury.</p>
<p>Taken together, our study shows for the first time that upon exposure to elevated CO<sub>2</sub> levels, ENaC cell surface abundance is rapidly downregulated in a human AEC line by a specific, CO<sub>2</sub>-induced and ERK-, AMPK-, and JNK-mediated signaling pathway, which promotes phosphorylation of both &#x003B2;-ENaC and Nedd4-2, leading to ubiquitination of &#x003B2;-ENaC and subsequent internalization of the &#x003B1;/&#x003B2;-ENaC complex. This novel signaling pathway may contribute to the persistence of alveolar edema and thus, interfering with these molecular mechanisms may improve alveolar fluid balance and lead to better outcomes in patients with ARDS and hypercapnia.</p>
</sec>
<sec id="S5" sec-type="author-contributor">
<title>Author Contributions</title>
<p>Conception or design of the work: PG and IV; acquisition, analysis, or interpretation of data: PG, BB, KM, SH, RM, WS, and IV; drafting the work: PG and IV; revising it critically for important intellectual content: PG, BB, KM, SH, RM, WS, and IV. All the authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.</p>
</sec>
<sec id="S6">
<title>Conflict of Interest Statement</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
</body>
<back>
<ack>
<p>The authors thank Mrs. Miriam Wessendorf (Universities of Giessen and Marburg Lung Center) for her excellent technical assistance.</p>
</ack>
<fn-group>
<fn fn-type="financial-disclosure">
<p><bold>Funding.</bold> This work was supported by grants from the Excellence Cluster &#x0201C;Cardio Pulmonary System&#x0201D; (ECCPS), the German Center for Lung Research (DZL), the Landes-Offensive zur Entwicklung Wissenschaftlich-&#x000F6;konomischer Exzellenz (LOEWE) of the Hessen State Ministry of Higher Education, Research and the Arts, and the Deutsche Forschungsgemeinschaft (Clinical Research Unit KFO309/1) (for KM, SH, RM, WS, and IV). IV was supported by a Clinical Scientist Career Program grant from the ECCPS.</p></fn>
</fn-group>
<sec id="S8" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at <uri xlink:href="http://journal.frontiersin.org/article/10.3389/fimmu.2017.00591/full&#x00023;supplementary-material">http://journal.frontiersin.org/article/10.3389/fimmu.2017.00591/full&#x00023;supplementary-material</uri>.</p>
<supplementary-material xlink:href="Presentation_1.PDF" id="SM1" mimetype="applicationn/PDF" xmlns:xlink="http://www.w3.org/1999/xlink"/>
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