The activation of TLR5 by flagellum initiates an inflammatory response that includes the up-regulation of hBD-2 via a nuclear factor (NF)-κB dependent pathway in airway see more epithelial cells [21]. The loss of flagella expression during the transition to the mucoid phenotype allows P. aeruginosa to evade the antimicrobial activity of hBD-2 through decreased TLR5 stimulation, contributing to P. aeruginosa’s pathogenesis in the CF lung Emricasan chemical structure [21, 35]. Some bacterial virulence factors remain

expressed throughout different stages of infection. Although P. aeruginosa isolates from the chronic stage of pulmonary infection are flagella-deficient, other virulence factors, which are TLR agonists and stimulate hBD-2 expression, remain expressed. For example, lipopolysaccharide (LPS) is an

endotoxin attached to the outer membrane of Gram-negative bacteria that is an agonist of TLR 4 [36]. Although LPS expression does not decrease as pulmonary infection shifts from the acute to chronic stage, the cellular responsiveness to LPS decreases. A study involving the exposure of airway epithelial cells to a regime of two discrete bacterial infections demonstrated reduced TLR AP26113 concentration responsiveness in the second bacterial challenge due to down-regulation of the IRAK1 signaling protein, which is involved in NF-κB activation [37]. IRAK1 phosphorylation leads to the activation of NF-κB and AP-1, which are two transcription factors that induce the up-regulation of IL-8 and hBD-2 in airway epithelial cells [38]. Although this in vitro model only measured the production of IL-8, not hBD-2, these results provide a mechanistic explanation for the reduced levels of hBD-2 expression in the chronic stage of pulmonary infection in CF patients [39]. Furthermore, the reduced expression of hBD-2 in the lung in advanced chronic pulmonary

infection (owing to decreased TLR responsiveness) provides further insight as to why P. aeruginosa only colonizes the lung post-S. aureus and H. influenzae infection. Moreover, this underscores the potential influence of hBD-2 in the progression of chronic pulmonary infection in CF patients. The down-regulation of TLR4 expression in the airway epithelia in response to acute infection may result in reduced hBD-2 expression, promoting Rebamipide P. aeruginosa colonization [40]. Neutrophil and Macrophage Infiltration Contribute to Degradation of hBD-2 in the CF Lung Inflammation is a protective tissue response to infection or injury. In the context of the CF lung, the inflammatory responses induced by P. aeruginosa severely damage the pulmonary epithelium. Exposure of the airway epithelium to P. aeruginosa induces the expression of the potent neutrophil chemokine IL-8, initiating neutrophil infiltration [41]. Neutrophils are granulocytic polymorphonuclear leukocytes that play a key role in innate defense [42].