The alveolus-on-chip model represents a multilayered tissue model of the human alveolus, integrating essential cell types of the lower respiratory tract, including lung epithelial cells, endothelial cells, and macrophages, cultured in an organotypic arrangement at an ALI with medium perfusion of the endothelial lining. Cells of different layers express specific cell marker proteins such as E-cadherin, a calcium-dependent adhesion molecule of lung epithelial cells, which is central in establishing intercellular epithelial barriers5,10. E-cadherin forms a physical barrier element and controls the immunological response to harmful pathogens and substances in the environment10,11. H441 epithelial cells further express surfactant protein A, which is also crucial in the first line of host defense against infection by mediating immunomodulatory and antibacterial activity8. Integrating immune cells in the alveolus model increases its cellular complexity, thereby better replicating the immune response to inflammatory triggers, i.e., during infection. In this context, the model was used to study the co-infection of influenza virus A and human opportunistic pathogen Staphylococcus aureus (S. aureus)5. In the study, a mechanism of co-infection in pneumonia was revealed in which viral infection of epithelial cells triggers a significant inflammatory response, which causes considerable damage to endothelial cells, leading to a loss of barrier function. In another study, the model was used to demonstrate that S. aureus infection reduces the extracellular levels of surfactant protein-A (SP-A), a crucial immune defense component in the lungs, likely due to bacterial proteases6. While the expression of SP-A is not directly affected by either S. aureus or influenza virus A, it is significantly down-regulated by TNF-α, a cytokine highly produced in response to bacterial infections, especially in the presence of macrophages. These results suggest that bacterial mono- and super-infections can lower SP-A levels in the lung, potentially worsening the outcome of bacterial pneumonia6. Further, the alveolus model has been used to study fungal infection of the alveolus with Aspergillus fumigatus and the efficacy of antifungal drugs by leveraging high-resolution microscopy and algorithm-based image analysis in combination with molecular biological assays, including immunofluorescence staining and cytokine profiling7. Modeling of invasive pulmonary aspergillosis in the alveolus-on-chip revealed key functions of human macrophages that could partially inhibit the growth of the fungus. Macrophages were central in releasing proinflammatory cytokines and chemokines, which correlated with an increased number of invasive fungal hyphae. Additionally, the study confirmed that the fungistatic drug caspofungin effectively limits fungal growth and induces morphological changes in the fungal structure, aligning with findings from other studies. These studies confirm the potential of the model platform for identifying cellular targets of infection and testing drugs at clinically relevant concentrations.
There are several aspects that need to be considered during the establishment of the alveolus-on-chip. Precise cell seeding is critical for achieving uniform cell distribution and layer formation. Make sure cells are seeded at the appropriate density to achieve confluence without overgrowing each other, which may compromise the cell layers' integrity and functionality. During the ALI establishment process, carefully remove the medium from the apical side and close the ports to prevent contamination. Maintaining optimal co-culture conditions, such as temperature, CO2 levels, and medium composition, is critical for the survival and interaction of both endothelial and epithelial cells. Always perform medium changes carefully to avoid disturbing the cell layers or introducing air bubbles. Pipette gently and ensure that all used equipment is sterile to minimize the risk of contamination. To prevent air bubbles, pipette slowly and tilt the chip during medium changes to allow bubbles to escape. Work in a clean, sterile, and controlled environment to minimize contamination. Consider the complexity and precision required to establish and maintain the 3D model for subsequent experiments with the model. If cell layers are not forming correctly, consider optimizing cell density and cell batches, as differences in cell growth can occur depending on the donor and batch.
While the model offers significant improvements over existing methods, it is also essential to acknowledge that some limitations must be considered. One such limitation is the complexity and cost associated with the operation of the microfluidic device. Running organ-on-chip models requires specialized equipment and expertise in microfluidics to adopt the alveolus-on-chip model. Additionally, while this model can successfully replicate many of the key features of the alveolar environment, it cannot fully replicate all of the cellular interactions and mechanical forces found in vivo. For instance, the model does not have a comprehensive immune system or the full range of cell types in the human lung, which could impact the accuracy of pathogen-host interaction studies.
Despite these limitations, the lung-on-chip model offers advancements compared to traditional 2D cell cultures such as Transwell systems. By incorporating an air-liquid interface, endothelial and epithelial cells, and immune components in a multilayered tissue within a dynamic, perfused environment, the model represents a more physiologically relevant approach for studying lung physiology, disease, and treatment responses in vitro. This is crucial for advancing our understanding of human respiratory infections and developing more effective therapies. The model's ability to precisely manipulate biophysical and biochemical cues represents an important feature for dissecting the mechanisms of disease progression and drug action. Using human cell material can further reduce interspecies-related differences seen in animal experiments. The integration of multiple biomarker analyses additionally further enhances the depth and breadth of data obtainable from a single experiment, which contributes to reducing the costs of in vitro experimentation. While acknowledging its limitations, the lung-on-chip model represents a significant step forward in respiratory disease research, offering a more accurate, ethical, and efficient alternative to traditional methods.