Wilcox, R. M.; Ngu, A. K.; Jiang, I.; Nielsen, G. K.; Pellegrino, P. R.; Wang, H.

Background Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are frequently associated with cardiac complications, including myocardial injury and right ventricular dysfunction. However, the mechanisms linking pulmonary injury to cardiac dysfunction remain incompletely understood. In this study, we investigated ventricular mitochondrial respiratory function during the acute phase of bleomycin-induced ALI. Methods ALI was induced in male and female rats by intratracheal bleomycin (2.5 mg/kg); saline served as a control. Circulating cardiac troponin I (cTnI) was measured as an indicator of myocardial injury. Mitochondrial respiration was assessed in permeabilized ventricular fibers using high-resolution respirometry (HRR). The mitochondrial respiration rate of the H9C2 cardiomyoblast cell line was performed using Seahorse Xfe96 Cell Mitochondrial Stress Test. Cells were treated with pro-inflammatory cytokine cocktails (PRO; IL1{beta} plus TNF plus IL6), anti-inflammatory cytokine cocktails (ANTI; IL4 plus IL10), a mixture of PRO and ANTI (BOTH), and norepinephrine (NE) in either hypoxic (1% oxygen) or normoxic conditions. Results Bleomycin-induced ALI increased circulating cTnI levels in male rats, indicating early cardiac stress following lung injury. Mitochondrial respiration in the LV appeared to show modest alterations, with preserved oxidative phosphorylation (OXPHOS) and electron transport (ET) capacity. In contrast, the RV of male animals demonstrated marked reductions in absolute respiratory flux and substrate-supported OXPHOS capacity, indicating impaired mitochondrial oxidative capacity. Female animals exhibited greater preservation of mitochondrial respiratory function, particularly in the RV, with higher OXPHOS capacity and greater Complex I gain than males. H9C2 cells treated with PRO showed a significant increase in uncoupled respiration following 6 and 24 hour incubation periods, under normoxic conditions. Maximal respiration and spare respiratory capacity were increased following 24 hours under hypoxia. No significant changes were observed following treatment with NE alone and in combination with PRO under normoxia or hypoxia for 24 hours. Conclusions ALI induces ventricle-specific and sex-dependent alterations in cardiac mitochondrial bioenergetics, with pronounced impairment in males and relative mitochondrial resilience in females. In H9C2 cardiomyoblasts, short-term exposure (6 to 24 hours) to pro-inflammatory cytokines enhances uncoupled mitochondrial respiration under normoxic conditions, while short-term hypoxic exposure independently increases maximal respiration and spare respiratory capacity.