Alpha-1 Antitrypsin Antisense Oligonucleotide Modulates Protease-Antiprotease Imbalance without Further Aggravating Smoke-induced Lung Injury

Abstract Alpha-1 antitrypsin (AAT) is a serum protease inhibitor that prevents lung injury from protease production during cigarette smoking but causes severe liver disease once mutated. A custom AAT antisense oligonucleotide (ASO) was found to be beneficial for the AATD liver disease by blocking the mutated AAT transcripts. Here we hypothesized that knock-down of AAT aggravates murine lung injury during smoke exposure and acute exacerbations of chronic obstructive pulmonary disease (COPD). C57BL/6J mice were randomly divided into 4 groups for each of the injury models, smoking (inhale for 3 months at 150mg/m 3 ) and smoke-flu (inhale for 2 weeks and intranasal influenza virus). The ASO and control (No-ASO) were injected subcutaneously at 10ml/kg of body weight, starting with smoking or four days prior to influenza infection weekly at 50mg/kg. ASO treatment during a 3 month smoke exposure significantly increased the expression of Cela1 mRNA and decreased the serum and lung AAT expression. However, despite the decrease in AAT, neither the inflammatory cell counts in the bronchoalveolar lavage fluid (BALF) nor the lung structural changes were significantly affected by ASO treatment. We observed significant differences in inflammation and emphysema due to smoke exposure alone. With the smoke-flu model, similarly the major differences were found between smoke-flu and room air control, with no additional effect with ASO treatment. Off-target effects or compensatory mechanisms may account for this finding. Alternatively, the reduction of AAT with ASO treatment was not robust enough to lead to lung injury. The result also suggest that the AAT ASO approach for treating liver disease is relatively safe at the specified dose as it did not lead to detrimental outcomes in the lung. These potential mechanisms need to be further investigated in order to fully understand the impact of AAT inhibition on protease-antiprotease imbalance in the murine smoke exposure model.