H3K18 lactylation-regulated ATG10 is involved in the acute respiratory distress syndrome induced by acute exposure to hydrogen sulfide through activation of autophagy in lung epithelial cells

Hydrogen sulfide (H 2 S) is a colorless, toxic, asphyxiant gas. In recent years, industrial accidents involving H 2 S exposure have frequently resulted in fatalities and disabilities. Acute respiratory distress syndrome (ARDS) poses a substantial burden on healthcare systems worldwide. The syndrome's heterogeneity and multifaceted pathogenesis, combined with a paucity of effective treatments, contribute to a persistently high mortality rate, which currently stands at 30–35%. The present study utilized metabolomics, transcriptomics, and CUT&Tag sequencing to explore ARDS pathogenesis, providing insights into its mechanisms and therapeutic targets for its treatment. Serum metabolomics for individuals with H 2 S-induced ARDS identified lactate accumulation as a pivotal metabolic event that mediates changes in H 2 S-induced ARDS biomarkers. Lactate, a potential biomarker of H 2 S-induced ARDS, is associated with a poor prognosis. However, whether elevated lactate directly promotes H 2 S-induced ARDS and the mechanisms underlying this effect remain unclear. Here, we demonstrate that lactate disrupts the alveolar epithelial barrier, thereby facilitating the development of ARDS. Mechanistically, lactate promotes histone H3K18 lactylation at the promoter for ATG10, a gene involved in the process of autophagy, driving its transcription and upregulating autophagy in alveolar epithelial cells, which results in disruption of the epithelial barrier. For rats, the reduction of lactate generation by a glycolytic inhibitor mitigates H 2 S-induced ARDS, as evidenced by attenuated pulmonary edema. Our results show that the lactate-autophagy axis mediates H 2 S-induced ARDS. Therefore, targeting the regulation of lactate production and/or autophagy is a therapeutic strategy for patients with H 2 S-induced ARDS.