Macrophage Rac2 Is Required to Reduce the Severity of Cigarette Smoke-induced Pneumonia.

RATIONALE: Cigarette smoking is prevalent in the U.S. and is the leading cause of preventable diseases. A prominent complication of smoking is an increase in lower respiratory tract infections (LRTI). Although LRTIs are known to be increased in subjects that smoke, the mechanism(s) by which this occurs is poorly understood.

OBJECTIVES: Determine how cigarette smoke (CS) reduced reactive oxygen species (ROS) production by the phagocytic NADPH oxidase (NOX2), which is essential for innate immunity in lung macrophages.

METHODS: NOX2-derived ROS and Rac2 activity were determined in BAL cells from WT and Rac2-/- mice exposed to cigarette smoke (CS) or cadmium and in BAL cells from subjects that smoke. Host defense to respiratory pathogens was analyzed in mice infected with S. pneumoniae.

MEASUREMENTS AND MAIN RESULTS: NOX2-derived ROS in BAL cells was reduced in mice exposed to CS via inhibition of the small GTPase Rac2. These mice had greater bacterial burden and increased mortality compared to air-exposed mice. Bronchoalveolar lavage fluid (BALF) from CS-exposed mice had increased levels of cadmium, which mediated the effect on Rac2. Similar observations were seen in human subjects that smoke. To support the importance of Rac2 in the macrophage immune response, overexpression of constitutively active Rac2 by lentiviral administration increased NOX2-derived ROS, decreased bacterial burden in lung tissue, and increased survival compared to CS-exposed control mice.

CONCLUSIONS: These observations suggest that therapies to maintain Rac2 activity in lung macrophages restore host defense against respiratory pathogens and diminish the prevalence of LRTIs in subjects that smoke.