RANKL promotes alveolar epithelial expansion

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, with progressive emphysema driven by repeated epithelial damage and impaired repair. Recently, we found that secretion of the osteokine “receptor agonist of nuclear factor κB signaling ligand” (RANKL) is higher in lung fibroblasts from patients with COPD compared to control and that RANKL represses lung epithelial cell death. However, the underlying mechanism, its cross-species conservation and the involved epithelial cell types remain unclear. To investigate how RANKL affects lung epithelial cells, we used primary lung organoids from human and mouse epithelial cells and showed that RANKL supplementation increased alveolar organoid forming capacity in these cultures compared to vehicle-treated controls. In elastase-treated mice, RANKL was able to rescue the elastase-induced loss of epithelial cells compared to vehicle-treated controls and it augmented the proportion of epithelial cells in transitional states expressing Krt8 and MHCII. Using A549 epithelial cells to investigate whether RANK or the alternative receptor for RANKL, “leucine-rich repeat-containing G-protein coupled receptor 4” (LGR4) were responding to RANKL treatment, we found that RANKL most likely acts through RANK These results suggest that RANKL may enhance stem cell survival of primarily alveolar epithelial cells in both mice and humans. We therefore conclude that RANKL is another osteokine, in addition to periostin, osteopontin, osteoglycin, and osteoprotegerin, that has a role in lung tissue repair and that its signaling pathway could be explored for therapeutic applications.