Choline Triggers Exacerbations of Chronic Obstructive Pulmonary Disease in Patients Infected with Pseudomonas aeruginosa

Background: Although exacerbations of chronic obstructive pulmonary disease produced by Pseudomonas aeruginosa infections are a major cause of death, the molecular mechanism that produces them is not well known. Here we focused on the energetic basis of dyspnoea, hypercapnia and acidosis symptoms. Methods and Findings: We used an in vivo exacerbation model exposing mice to cigarette smoke and LPS, to mimic emphysema and infections, and choline challenges to trigger exacerbations, that showed 31% increased in the airway resistance for naive mice and 250% for smoke/LPS treatment. Tissue resistance was increased 32%, in naive mice, and 169% for smoke/LPS treatment. A decreased tissue elastance, was confirmed by decreased collagen content and increased alveoli chord length. Consequently, the O-2 demanded was 260% greater for smoke/ LPS treated mice, to provide the energy required to pump the same volume of air then for naive mice. The extra CO2 produced per ml of air pumped caused hypercapnia and acidosis by 4% decrease in pH. In addition, the bacteria grown with choline had a decrease of 67% in phosphate, 23% ATP and 85% phospholipids with an increase of 57% in polyphosphates, 50% carbohydrates, 100% LPS, consuming 45% less energy relative to the bacteria grown with succinate. Conclusion: choline, released by P. aeruginosa, triggers exacerbation symptoms by increasing lung resistance, O-2 consumption and producing more pCO(2) in blood with dyspnea, hypercapnia and acidosis. The energetic shift of decreased O-2 bacterial demand and increased lung demand benefits the infection, thus restoring the energetic balance on the host will favor P. aeruginosa eradication.