Adenosine and hyaluronan promote lung fibrosis and pulmonary hypertension in combined pulmonary fibrosis and emphysema

Dis Model Mech. 2019 May 15;12(5):dmm038711. doi: 10.1242/dmm.038711.


Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome that predominantly affects male smokers or ex-smokers and it has a mortality rate of 55% and a median survival of 5 years. Pulmonary hypertension (PH) is a frequently fatal complication of CPFE. Despite this dismal prognosis, no curative therapies exist for patients with CPFE outside of lung transplantation and no therapies are recommended to treat PH. This highlights the need to develop novel treatment approaches for CPFE. Studies from our group have demonstrated that both adenosine and its receptor ADORA2B are elevated in chronic lung diseases. Activation of ADORA2B leads to elevated levels of hyaluronan synthases (HAS) and increased hyaluronan, a glycosaminoglycan that contributes to chronic lung injury. We hypothesize that ADORA2B and hyaluronan contribute to CPFE. Using isolated CPFE lung tissue, we characterized expression levels of ADORA2B and HAS. Next, using a unique mouse model of experimental lung injury that replicates features of CPFE, namely airspace enlargement, PH and fibrotic deposition, we investigated whether 4MU, a HAS inhibitor, was able to inhibit features of CPFE. Increased protein levels of ADORA2B and HAS3 were detected in CPFE and in our experimental model of CPFE. Treatment with 4MU was able to attenuate PH and fibrosis but not airspace enlargement. This was accompanied by a reduction of HAS3-positive macrophages. We have generated pre-clinical data demonstrating the capacity of 4MU, an FDA-approved drug, to attenuate features of CPFE in an experimental model of chronic lung injury.This article has an associated First Person interview with the first author of the paper.

Keywords: Adenosine; Airspace enlargement; Group III PH; Hyaluronan; Hyaluronan synthases; Lung fibrosis; Macrophages; Pulmonary hypertension.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine / adverse effects*
  • Adenosine A2 Receptor Agonists / pharmacology
  • Adenosine Deaminase / metabolism
  • Animals
  • Cell Line
  • Chronic Disease
  • Disease Models, Animal
  • Extracellular Matrix / metabolism
  • Humans
  • Hyaluronan Synthases / metabolism
  • Hyaluronic Acid / adverse effects*
  • Idiopathic Pulmonary Fibrosis / complications*
  • Idiopathic Pulmonary Fibrosis / pathology*
  • Lung Injury / complications
  • Lung Injury / pathology
  • Macrophages / metabolism
  • Mice
  • Pulmonary Emphysema / complications*
  • Pulmonary Emphysema / pathology*
  • Receptor, Adenosine A2B / metabolism


  • Adenosine A2 Receptor Agonists
  • Receptor, Adenosine A2B
  • Hyaluronic Acid
  • Has3 protein, mouse
  • Hyaluronan Synthases
  • Adenosine Deaminase
  • Adenosine