Further, we point out that apoptosis is also observed in the early phase of endotoxin stimulation. Therefore, apoptosis seems to be present independently of the time of LPS stimulation. This statement can also be applied to tracheobronchial epithelial cells. In a previous work from our group, we were able to demonstrate that the intrinsic apoptosis pathway is activated at 24 h of LPS stimulation [10]. Results

of the current study show that the process of apoptosis is already initiated at earlier time-points upon stimulation with LPS. In accordance with epithelial cells, alveolar macrophages experience the same process of apoptosis, with increased activity of caspase-3 in acute and subacute situations of LPS exposure. Another study underlining these findings was performed by Bingisser et al. [17]. This group showed that LPS induced Enzalutamide the apoptosis rate only of human alveolar macrophages,

but not cytokines. An important aspect of apoptosis in epithelial cells of the respiratory compartment, and in alveolar macrophages is the cellular signalling pathway. While tracheobronchial epithelial cells undergo apoptosis over the intrinsic pathway, intrinsic and extrinsic signalling is activated in alveolar macrophages. For alveolar epithelial cells the pathway is not clear, as neither caspases-8 nor JQ1 clinical trial -9, respectively, are involved. Further experiments need to be performed to determine the exact pathway in these cells. A possible explanation might be the modification of the cell line compared to primary culture of alveolar epithelial cells. Interestingly, while no change in caspase-3 activity of neutrophils was detected at 4 h of LPS stimulation, it decreased significantly

at 8 h. At the time-point of subacute injury at 24 h, however, a fivefold increase of apoptosis rate was detected. These results are in accordance with previous studies. Upon stimulation with various concentrations of LPS (1–100 ng/ml), apoptosis rate decreased concentration-dependently after 12 h of stimulation [18]. Hirata et al. also found a depressed apoptosis rate in neutrophils upon LPS stimulation [19]. A study performed in patients with severe sepsis showed Methane monooxygenase that spontaneous neutrophil apoptosis seemed to be inhibited in these patients compared to healthy volunteers [20]. Keel et al. isolated neutrophils from healthy humans and patients with severe sepsis and stimulated them with LPS for 16 h, showing a decrease in apoptosis rate in neutrophils from healthy individuals, while apoptosis did not change upon stimulation in neutrophils from septic patients. In a model of ALI, induced by intravascular injection of oleic acid to simulate pulmonary fat embolism-induced ALI, a massive neutrophil response at 1 and 4 h following oleic acid injection was found in the lung, without any evidence of apoptosis [21].