TNALP promotes epithelial oxidative stress and fibrosis via SIRT3-dependent mechanisms in tracheal injury

Zhiqiang Liu; Hailang Peng; Mingyu Peng; Jiaxin Liao; Bin Liu; Rongjuan Zhuang; Hongwei Yang; Li Xu; Yishi Li; Lei Gao; Shuliang Guo

doi:10.1016/j.cellsig.2025.111943

TNALP promotes epithelial oxidative stress and fibrosis via SIRT3-dependent mechanisms in tracheal injury

Cell Signal. 2025 Jun 15:134:111943. doi: 10.1016/j.cellsig.2025.111943. Online ahead of print.

Authors

Zhiqiang Liu¹, Hailang Peng¹, Mingyu Peng¹, Jiaxin Liao¹, Bin Liu², Rongjuan Zhuang¹, Hongwei Yang¹, Li Xu¹, Yishi Li¹, Lei Gao³, Shuliang Guo⁴

Affiliations

¹ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
² Department of Respiratory and Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan, China.
³ Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. Electronic address: gl@cqmu.edu.cn.
⁴ Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. Electronic address: GUOSL999@sina.com.

PMID: 40527358
DOI: 10.1016/j.cellsig.2025.111943

Abstract

Benign tracheal stenosis (BTS) remains a clinical challenge due to high postoperative restenosis rates and the absence of effective pharmacological treatments. Although fibrosis has traditionally been attributed to fibroblast activation, epithelial injury is increasingly recognized as an early initiating event. This study identified tissue-nonspecific alkaline phosphatase (TNALP) as a key mediator of epithelial damage and fibrotic progression in BTS. Analyses of patient specimens, animal models, and cultured epithelial cells revealed that TNALP suppressed SIRT3 expression level, a mitochondrial deacetylase that can regulate oxidative stress and apoptosis. Pharmacological inhibition of TNALP with tetramisole restored SIRT3 expression level, attenuated oxidative damage, reduced epithelial cell death, and mitigated tissue fibrosis. These preclinical findings highlight TNALP as a potential therapeutic target and support further investigation into the repurposing of TNALP inhibitors as antifibrotic agents to reduce restenosis following tracheal surgery.

Keywords: Benign tracheal stenosis; Fibrosis; Reactive oxygen species; Sirtuin 3; Tissue-nonspecific alkaline phosphatase.