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The three R’s of lung health and disease: repair, remodeling, and regeneration
Michael F. Beers, Edward E. Morrisey
Michael F. Beers, Edward E. Morrisey
Published June 1, 2011
Citation Information: J Clin Invest. 2011;121(6):2065-2073. https://doi.org/10.1172/JCI45961.
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Science in Medicine

The three R’s of lung health and disease: repair, remodeling, and regeneration

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Abstract

All tissues and organs can be classified according to their ability to repair and regenerate during adult homeostasis and after injury. Some exhibit a high rate of constant cell turnover, while others, such as the lung, exhibit only low-level cell regeneration during normal adult homeostasis but have the ability to rapidly regenerate new cells after injury. Lung regeneration likely involves both activation of progenitor cells as well as cell replacement through proliferation of remaining undamaged cells. The pathways and factors that control this process and its role in disease are only now being explored. In this Review, we will discuss the connection between pathways required for lung development and how the lung responds to injury and disease, with a particular emphasis on recent studies describing the role for the epithelium in repair and regeneration.

Authors

Michael F. Beers, Edward E. Morrisey

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Figure 4

Cell lineages involved in repair and regeneration of the adult lung epithelium.

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Cell lineages involved in repair and regeneration of the adult lung epit...
(A) In the adult proximal or bronchiolar epithelium, cells expressing Sox2, p63, and Krt5 are thought to be progenitors capable of regenerating injured or denuded airway epithelium. Whether these markers denote unique, distinct, or overlapping progenitor populations is unknown, but data show that p63 and Krt5 mark a more proximal population of cells than Sox2 alone, which is expressed throughout tracheal and bronchiolar regions (15, 70). Notch signaling is known to regulate the decision to generate secretory lineages (i.e., Scgb1a1+) versus neuroendocrine cells within the proximal airways. The secretory lineage has also been shown to generate both ciliated epithelium (β-tubulin IV+) as well as goblet cells (Muc5A/C+) after injury to the bronchiolar epithelium. (B) In the alveolar epithelium, less is known about the relationship between the two major cell types, AEC1 and AEC2 cells. There is some in vitro evidence that AEC2 cells can act as progenitors to repopulate lost AEC1 and AEC2 cells after injury (63). Additional genetic and molecular data are needed to assess whether there is a resident alveolar progenitor or whether AEC2 cells are facultative progenitors. Aqp5, aquaporin 5; CGRP, Calcitonin gene–related peptide; Pgp9.5, protein gene product 9.5; T1α, podoplanin.

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