Reversal of Persistent Fibrosis in Aging by Targeting Nox4-Nrf2 Redox Imbalance

摘要

The incidence and prevalence of pathological fibrosis increase with advancing age, although mechanisms for this association are unclear. We assessed the capacity for repair of lung injury in young (2 months) and aged (18 months) mice. While the severity of fibrosis was not significantly different between these groups, aged mice demonstrated an impaired capacity for fibrosis resolution. Persistent fibrosis in lungs of aged mice is characterized by the accumulation of senescent and apoptosis-resistant myofibroblasts. These cellular phenotypes are sustained by alterations in cellular redox homeostasis resulting from elevated expression of the reactive oxygen species (ROS)-generating enzyme, NADPH oxidase-4 (Nox4), and an impaired capacity to induce the NFE2-related factor 2 (Nrf2) antioxidant response. Lung tissues from human subjects with idiopathic pulmonary fibrosis (IPF), a progressive and fatal lung disease, also demonstrate this Nox4-Nrf2 imbalance. Nox4 mediates senescence and apoptosis resistance in IPF fibroblasts. Genetic and pharmacologic targeting of Nox4 in aged mice with established fibrosis attenuated the senescent, anti-apoptotic myofibroblast phenotype and led to a reversal of persistent fibrosis. These studies support the concept that loss of cellular redox homeostasis promotes pro-fibrotic myofibroblast phenotypes that result in persistent fibrosis associated with aging. Importantly, our studies suggest that restoration of Nox4-Nrf2 redox balance in myofibroblasts may be an effective therapeutic strategy in age-associated fibrotic disorders, potentially to resolve persistent fibrosis or even reverse its progression.