This study was funded by grants from the National Cancer Institute (R01CA166376 and R01CA191489 to D.X. Nguyen) and the Department of Defense (W81XWH-16-1-0227 to D.X. Nguyen).

All experiments were carried out in accordance with protocols approved by the Institutional Animal Care and Use Committee (IACUC) at Yale University.
1. Set Up / Preparation of the Reagents.
<ol>
	<li>Bleomycin 
	Caution: Based on the Globally Harmonized System (GHS) of Classification and Labelling of Chemicals, bleomycin is classified as a GHS08 health hazard.
	<ol>
		<li>Prepare bleomycin in a chemical hood. Resuspend 15 U into 5 mL of sterile phosphate buffered saline (PBS).</li>
		<li>Aliquot 100-200 &#181;L of the solution into glass vials and freeze them at -20 &#176;C for future use. Properly label the tubes with the date of resuspension. Use within 6 months from this date. 
		NOTE: Each mouse strain has a different sensitivity to bleomycin26. Testing different doses of bleomycin for each mouse strain is recommended. The mouse strains and the corresponding doses of bleomycin used in representative experiments are listed in Table 1.</li>
	</ol>
	</li>
	<li>Mice
	<ol>
		<li>Purchase mice needed for the experiment and allow mice 7 days to acclimate before injection. Perform infusions in a biosafety hood. Transfer animals housed in a non-BSL2 compliant room to a BSL2 room using standard institutional procedures prior to bleomycin infusion. Inject mice at 6-8 weeks of age. 
		Caution: Inject mice following institutional guidelines for hazardous agents, biosafety level 2 (BSL2) and IACUC approval. 
		NOTE: Mice purchased for the representative experiments are listed in the Table of Materials. Only male mice have been used.</li>
	</ol>
	</li>
	<li>Lung Cancer Cell Lines
	<ol>
		<li>Culture desired cell lines in their respective media. Before injections, perform short tandem repeat DNA profiling or genetic testing to ensure proper cell line identification. To facilitate in vivo and ex vivo imaging, infect cell lines with a lentivirus expressing the thymidine kinase, green fluorescent protein (GFP) and luciferase fusion reporter27, and sort reporter positive cells by fluorescence activated cell sorting (FACS) prior to engraftment. Test lines for mycoplasma every 6 months.
		<ol>
			<li>Culture H2030 human cancer cell line as recommended by the manufacturer using Roswell Park Memorial Institute medium (RPMI) with 10% Fetal Bovine Serum (FBS), penicillin-streptomycin, and amphotericin B.</li>
			<li>Culture 368T1 murine cell line (derived from a KrasG12D;p53-/- mouse) using Dulbecco&#39;s Modified Eagle&#39;s medium (DMEM) with 10% FBS, penicillin-streptomycin, and amphotericin B.</li>
			<li>Culture PC9 human cancer cell line using RPMI with 10% FBS, penicillin-streptomycin, and amphotericin B.</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
2. Bleomycin Treatment
<ol>
	<li>Plan to inject mice intratracheally with bleomycin 14 days prior to tumor cell engraftment.</li>
	<li>Thaw bleomycin stock on ice 2 h prior to injection.</li>
	<li>Once thawed, dilute bleomycin to the desired working concentration (0.02 U/50 &#181;L or 0.005 U/50 &#181;L), and keep it on ice. 
	NOTE: Concentration of bleomycin depends on the mouse strain used for the experiments (Table 1). Titration of bleomycin in mice should be performed to determine optimal dose.</li>
	<li>Prepare anesthesia by diluting ketamine and xylazine to a final concentration of 10 mg/mL and 1 mg/mL, respectively, Using a 1 mL syringe and 27 G needle, anesthetize each mouse by injecting intraperitoneally ketamine/xylazine solution at 100/10 mg/kg respectively.</li>
	<li>Monitor the breathing of mice and employ a toe pinch. Confirm proper anesthetization when mouse does not respond to toe pinch. Apply vet ointment on eyes to prevent dryness while under anesthesia.</li>
	<li>Place 1 mouse at a time on an intubation platform by hanging its front teeth with its back against the platform.</li>
	<li>Illuminate the upper chest using a fiber-optic illuminator to help with visualization of the trachea. Open the mouth of the mouse and pull the tongue out gently with sterile flat forceps.</li>
	<li>Use an intravenous catheter without the needle to avoid blocking breathing. Position the catheter over the white light emitted from the opening of the trachea.</li>
	<li>Insert the catheter into the trachea until the top of the catheter reaches the front teeth. Confirm proper placement of the catheter in the trachea by visualizing the white light shining through the opening of the catheter in the mouth.</li>
	<li>Using a pipette, dispense 50 &#181;L of bleomycin or vehicle (PBS) directly into the catheter to ensure that the entire volume is inhaled. Perform this step under sterile conditions.</li>
	<li>If the catheter is correctly inserted, the mouse will immediately inhale the contents of the catheter. Wait a few seconds until the entire volume travels down the catheter. Then remove the catheter from the trachea and dispose in 10% bleach solution. 
	NOTE: The average time per mouse of steps 2.7-2.11 is around 5 min.</li>
	<li>If the mouse is not inhaling the liquid, carefully monitor breathing and adjust the catheter position. If the mouse stops breathing, remove the catheter immediately and allow the mouse to resume breathing normally before re-inserting the catheter.</li>
	<li>Place the injected mouse on an IACUC approved heating pad on their back on a flat surface for recovery. The whole procedure will take 10 min per mouse. Do not return an animal that has undergone injection to the company of other animals until fully recovered.</li>
	<li>Place a &#34;Hazardous Chemical in Use&#34; Card on the cage for 24 h.</li>
</ol>
3. Monitoring Mice Post-Intubation
<ol>
	<li>Monitor the mice for respiratory distress immediately after intubation and then every 15 min until mice wake up from anesthesia. Do not leave mice unattended until they have regained sufficient consciousness to maintain sternal recumbency.</li>
	<li>Inject ketoprofen (5 mg/kg) intraperitoneally to alleviate pain.</li>
	<li>Examine the mice 24 h post intubation and 3 times a week for any signs of morbidity.</li>
	<li>Keep a record of the date of procedure, animal identification, type of procedure, type of anesthetic, and post-operative monitoring observations with times.</li>
	<li>Monitor the mice for weight loss, respiratory distress, behavioral abnormalities, and a body condition score &#60;2 (segmentation of vertebral column evident/dorsal pelvic bones are palpable) bi-weekly following injection of bleomycin.</li>
	<li>Euthanize mice under respiratory distress or mice that have experienced 15% loss of body mass by CO2 or by ketamine/xylazine followed by cervical dislocation. Confirm euthanasia by conducting palpation for respiratory activity.</li>
</ol>
4. Engraftment of Lung Adenocarcinoma Cell Lines.
NOTE: Perform engraftment of cells 14 days after the injection of bleomycin (step 2.1).
<ol>
	<li>Allow cells to grow in 75 cm2 flasks undisturbed for 3 days prior to the day of injection with corresponding media as stated in step 1.3. 
	NOTE: They should be 80% confluent at the day of injection (which corresponds to 2-3 x 106 in each flask depending on the cell line).</li>
	<li>Wash the cells growing on 75 cm2 flasks with 5 mL of PBS at room temperature.</li>
	<li>Aspirate PBS and add 1.5 mL of trypsin to the cells and incubate the cells at 37 &#176;C until the cells detach (typically 2-5 min). 
	NOTE: We recommend checking every 2 min for cell detachment from the plastic by simple visualization of the bottom of the flask or under a light microscope. Do not exceed 5 min of incubation with trypsin.</li>
	<li>Neutralize trypsin by adding 4 mL of media containing 10% FBS (same media as step 4.1). Collect the cells into a 15 mL tube and centrifuge it at 200 x g for 3 min at room temperature.</li>
	<li>Aspirate the media and resuspend the cell pellet in 5 mL of PBS to wash cells. Centrifuge the cells at 200 x g for 3 min at room temperature to pellet cells. Repeat this 1 time.</li>
	<li>Aspirate the PBS and resuspend the pellet in 1.5 mL of PBS per flask.</li>
	<li>Mix 50 &#181;L of cell mixture with 50 &#181;L of trypan blue and count the cells using a Cell Counter/Hemocytometer chamber28.</li>
	<li>Prepare cell suspension by diluting the cells in PBS to inject 1 x 105 cells (or other amount indicated) in 50 &#181;L per mouse. Keep the cells on ice prior to injection. 
	NOTE: Prepare at least two times more cells for injection to avoid running out of cell suspension.</li>
	<li>Prepare anesthesia by diluting ketamine and xylazine to a final concentration of 10 mg/mL and 1 mg/mL, respectively, Using a 1 mL syringe and 27 G needle, anesthetize each mouse by injecting intraperitoneally ketamine/xylazine solution at 100/10 mg/kg respectively.</li>
	<li>Monitor the breathing of mice and employ a toe pinch. Confirm proper anesthetization when mouse does not respond to toe pinch. Apply vet ointment on eyes to prevent dryness while under anesthesia.</li>
	<li>Place 1 mouse at a time on an intubation platform by hanging its front teeth with its back against the platform.</li>
	<li>Illuminate the upper chest using a fiber-optic illuminator to help with visualization of the trachea.</li>
	<li>Resuspend the cells gently using a p200 pipette to make sure they do not form clumps. Open the mouth of the mouse and pull the tongue out gently with sterile flat forceps.</li>
	<li>Use an intravenous catheter with the needle removed to avoid blocking breathing. Position the catheter over the white light emitted from the opening of the trachea.</li>
	<li>Insert the catheter into the trachea until the top of the catheter reaches the front teeth. Confirm proper placement of the catheter in the trachea by visualizing the white light shining through the opening of the catheter in the mouth.</li>
	<li>Using a pipette, dispense 50 &#181;L of cells directly into the catheter to ensure that the entire volume is inhaled. Perform this step under sterile conditions. 
	NOTE: If the catheter is correctly inserted, the mouse will immediately inhale the contents of the catheter.</li>
	<li>Wait a few seconds until the entire volume travels down the catheter, and then remove the catheter from the trachea and dispose in 10% bleach solution.</li>
	<li>If the mouse is not inhaling the liquid, carefully monitor breathing and adjust the catheter position. If the mouse stops breathing, remove the catheter immediately and allow the mouse to resume breathing normally before re-inserting the catheter. 
	NOTE: The average time per mouse of steps 4.11-4.18 is around 5 min.</li>
	<li>Place the injected mouse on an IACUC approved heating pad on their back on a flat surface for recovery. 
	NOTE: The whole procedure will take 10 min per mouse. Do not return an animal that has undergone injection to the company of other animals until fully recovered.</li>
	<li>Shave the entire rib area both ventrally and dorsally of B6129SF1/J and other mouse strains with dark hair using an electric shaver prior to imaging.</li>
	<li>2-3 min after cell injection, inject 100 &#181;L of luciferin retro-orbitally (15 mg/mL) using an insulin needle. Alternate the eye used for injection every imaging session.</li>
	<li>After at least 2 min, place up to 5 mice in an animal bioluminescence imager in the dorsal recumbency position and acquire a ventral picture using luminescence settings29.</li>
	<li>Under the control panel adjust the resolution and sensitivity settings to measure luminescence of a given cell line. For most applications, start with 3 min (or &#34;Auto&#34; if saturated), binning=Medium (4), F/Stop=1, Field of View=D, Subject Height=1.50. 
	NOTE: If the injection is successful, luminescence signal is detected in the upper chest area, in one lung or both lungs.</li>
	<li>Flip mice onto sternal recumbency position and acquire a dorsal picture as above. 
	NOTE: If cell injection is not performed properly, cells may cluster at the entrance of the trachea or in the neck.</li>
	<li>Inject ketoprofen 5 mg/kg intraperitoneally to alleviate pain.</li>
	<li>Move mice back to their cage and place a &#34;BSL-2 Agent in Use&#34; Card on the cage.</li>
	<li>Monitor mice for respiratory distress immediately after intubation, and then every 15 min until mice wake up from anesthesia. Do not leave mice unattended until they have regained sufficient consciousness to maintain sternal recumbency.</li>
	<li>Examine the mice 24 h post intubation and three times a week for any signs of morbidity.</li>
	<li>Keep record in the logbook of the date of procedure, animal identification, type of procedure, type of anesthetic and post-operative monitoring observations and times.</li>
	<li>Monitor mice for weight loss, respiratory distress, behavioral abnormalities, and a body condition score &#60;2 (segmentation of vertebral column evident/dorsal pelvic bones are palpable) bi-weekly following inoculation of bleomycin. 
	NOTE: Mice with lung tumors may exhibit respiratory irritation, weight loss, cachexia, and/or death.</li>
	<li>Euthanize mice under respiratory distress or mice that have experienced 15% loss of body mass by CO2 or by ketamine/xylazine followed by cervical dislocation if collecting tissues. Confirm euthanasia by conducting palpation for respiratory activity.</li>
</ol>
5. Monitoring of Tumor Growth by Bioluminescence Imaging
<ol>
	<li>Repeat imaging of the mice at day 3 post-engraftment and weekly thereafter.</li>
	<li>Anesthetize mice by injecting ketamine/xylazine (as described in steps 2.4-2.5) or by inhaled isoflurane (2%). Monitor breathing of mice and employ a toe pinch to confirm proper anesthetization. Apply vet ointment on eyes to prevent dryness while under anesthesia.</li>
	<li>Shave the entire rib area both ventrally and dorsally of B6129SF1/J and other mouse strains with dark hair using an electric shaver prior to imaging.</li>
	<li>Once the mice are under anesthesia, inject 100 &#181;L of luciferin retro-orbitally (15 mg/mL) using an insulin needle. Wait 2 min. Alternate the eye used for injection every imaging session.</li>
	<li>Place mice in the imager and acquire dorsal and ventral images as described in steps 4.22-4.24.</li>
	<li>Place mice back into the cage after imaging, on their back on a flat surface for recovery. 
	NOTE: The whole procedure will take 5 min per group of 5 mice. Do not leave mice unattended until they have regained sufficient consciousness to maintain sternal recumbency.</li>
	<li>Analyze the images using the imager/bioluminescence analysis software.
	<ol>
		<li>Select the appropriate images and load them as a group in the bioluminescence analysis software.</li>
		<li>Click ROI tool | square to add a square region of interest (ROI). Place the ROI over the upper chest area, covering the entire lung image. Repeat this for each mouse image.</li>
		<li>Right click and select Copy all ROI function to apply the same ROI to all images in the group and position them in the upper chest of the mice, both ventral and dorsal views.</li>
		<li>In the upper left corner of the image window, select the Photons function. Click the Measure control panel function to measure the ROIs. Copy and paste the output table containing total flux (photons/s) into a software of choice to analyze the data further.</li>
		<li>Normalize the daily ROI value of each mouse to its ROI value measured on day 0.</li>
	</ol>
	</li>
</ol>
6. Tissue Isolation and Processing.
<ol>
	<li>Anesthetize mice by injecting ketamine/xylazine (as described in steps 2.4-2.5 or by inhaled isoflurane (2%). Monitor breathing of mice and employ a toe pinch. Confirm proper anesthetization when mouse does not respond to toe pinch. Apply vet ointment on eyes to prevent dryness while under anesthesia.</li>
	<li>Inject 100 &#181;L of luciferin retro-orbitally (15 mg/mL) using an insulin needle. Wait 2 min.</li>
	<li>Image mice following steps 4.22-4.24 from this protocol.</li>
	<li>Inject into the other eye from step 6.2 another 100 &#181;L of luciferin retro-orbitally using an insulin needle prior to euthanasia.</li>
	<li>Euthanize the mice by intraperitoneal injection of ketamine/xylazine (see step 2.4 for details) followed by cervical dislocation if mice are under deep anesthesia in accordance with guidelines provided by IACUC. Confirm euthanasia by conducting palpation for respiratory activity.</li>
	<li>Using sterile surgical scissors make a skin incision below the sternum. Open the muscle layer along the diaphragm using forceps and surgical scissors and expose the thoracic cavity by cutting through the rib cage on either of the lateral sides avoiding the internal thoracic arteries.</li>
	<li>Perfuse the mouse by making a small incision in the right atrium of the heart and inject 5 mL of PBS through the left ventricle. The color of lung tissue will go from red to pale pink-white if the blood perfusion is done properly.</li>
	<li>Excise the lungs from the thoracic cavity carefully by grabbing the esophagus or heart with forceps. Gently pull the tissue and use surgical scissors to carefully cut connecting tissue avoiding puncture of the lung tissue. Preserve the trachea as much as possible for inflation of the lung airways at a later step.</li>
	<li>Wash the lung by submerging and swirling the tissue 3 times in a 6 well plate filled with 3 mL of PBS to remove excess blood.</li>
	<li>Place the lung onto the lid of a 6 well plate, and place the lid containing the tissue in the bioluminescent imager and acquire a luminescent image30. 
	NOTE: We recommend selecting the following settings from the &#34;Acquisition control panel&#34; &#34;Field of view=A&#34; and &#34;Subject Height=0.75 cm&#34; and then &#34;Auto exposure&#34; to avoid getting saturated images.</li>
	<li>Excise and image other organs, as done in step 6.9-6.10, where metastasis have been identified by luminescence, such as brain, liver, adrenal, bone, lymph nodes, kidney or spleen31.</li>
	<li>Perfuse the lung with 1 mL of 4% paraformaldehyde by inserting the needle into the trachea of the mouse. The lungs will inflate if well-perfused. 
	Caution: 4% paraformaldehyde is a toxic, a health hazard GHS07 and GHS08.</li>
	<li>Transfer the lungs into a 15 mL conical with 5 mL of 4% paraformaldehyde.</li>
	<li>Fix the lungs or other tissues by incubating the tissue with 4% paraformaldehyde overnight at 4 &#176;C in a shaking device at 30-50 rpm.</li>
	<li>Embed lungs (or other tissues) in paraffin or optimum cutting temperature compound depending on the application32. 
	NOTE: Paraffin is the preferred method to preserve the lung structure and for Masson Trichrome and Hematoxylin-Eosin staining.</li>
</ol>

<ol>
	<li>Siegel, R. L., Miller, K. D., Jemal, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cancer+statistics,+2015.">Cancer statistics, 2015.</a> CA-Cancer J Clin. 65, 5-29 (2015).</li><li>Gaspar, L. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+metastases+in+lung+cancer.">Brain metastases in lung cancer.</a> Expert Rev Anticanc. 4, 259-270 (2004).</li><li>Hess, K. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metastatic+patterns+in+adenocarcinoma.">Metastatic patterns in adenocarcinoma.</a> Cancer. 106, 1624-1633 (2006).</li><li>Hoffman, P. C., Mauer, A. M., Vokes, E. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+cancer.">Lung cancer.</a> Lancet. 355, 479-485 (2000).</li><li>Travis, W. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathology+of+lung+cancer.">Pathology of lung cancer.</a> Clin Chest Med. 23 (1), 65-81 (2002).</li><li>Chen, Z., Fillmore, C. M., Hammerman, P. S., Kim, C. F., Wong, K. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-small-cell+lung+cancers:+a+heterogeneous+set+of+diseases.">Non-small-cell lung cancers: a heterogeneous set of diseases.</a> Nat Rev Cancer. 14, 535-546 (2014).</li><li>Kim, C. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mouse+models+of+human+non-small-cell+lung+cancer:+raising+the+bar.">Mouse models of human non-small-cell lung cancer: raising the bar.</a> Cold Spring Harb Sym. 70, 241-250 (2005).</li><li>Meuwissen, R., Berns, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mouse+models+for+human+lung+cancer.">Mouse models for human lung cancer.</a> Gene Dev. 19, 643-664 (2005).</li><li>Junttila, M. R., de Sauvage, F. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+tumour+micro-environment+heterogeneity+on+therapeutic+response.">Influence of tumour micro-environment heterogeneity on therapeutic response.</a> Nature. 501, 346-354 (2013).</li><li>Nguyen, L. V., Vanner, R., Dirks, P., Eaves, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cancer+stem+cells:+an+evolving+concept.">Cancer stem cells: an evolving concept.</a> Nat Rev Cancer. 12, 133-143 (2012).</li><li>Minchinton, A. I., Tannock, I. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Drug+penetration+in+solid+tumours.">Drug penetration in solid tumours.</a> Nat Rev Cancer. 6, 583-592 (2006).</li><li>Leblond, A. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developing+cell+therapy+techniques+for+respiratory+disease:+intratracheal+delivery+of+genetically+engineered+stem+cells+in+a+murine+model+of+airway+injury.">Developing cell therapy techniques for respiratory disease: intratracheal delivery of genetically engineered stem cells in a murine model of airway injury.</a> Hum Gene Ther. 20, 1329-1343 (2009).</li><li>Vaughan, A. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lineage-negative+progenitors+mobilize+to+regenerate+lung+epithelium+after+major+injury.">Lineage-negative progenitors mobilize to regenerate lung epithelium after major injury.</a> Nature. 517, 621-625 (2015).</li><li>Zuo, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=p63(+)Krt5(+)+distal+airway+stem+cells+are+essential+for+lung+regeneration.">p63(+)Krt5(+) distal airway stem cells are essential for lung regeneration.</a> Nature. 517, 616-620 (2015).</li><li>Mahoney, J. E., Kim, C. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracing+the+potential+of+lung+progenitors.">Tracing the potential of lung progenitors.</a> Nat Biotechnol. 33, 152-154 (2015).</li><li>Wang, D., Morales, J. E., Calame, D. G., Alcorn, J. L., Wetsel, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transplantation+of+human+embryonic+stem+cell-derived+alveolar+epithelial+type+II+cells+abrogates+acute+lung+injury+in+mice.">Transplantation of human embryonic stem cell-derived alveolar epithelial type II cells abrogates acute lung injury in mice.</a> Mol Ther. 18, 625-634 (2010).</li><li>Ortiz, L. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mesenchymal+stem+cell+engraftment+in+lung+is+enhanced+in+response+to+bleomycin+exposure+and+ameliorates+its+fibrotic+effects.">Mesenchymal stem cell engraftment in lung is enhanced in response to bleomycin exposure and ameliorates its fibrotic effects.</a> Proc Natl Acad Sci USA. 100, 8407-8411 (2003).</li><li>Suzuki, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prognostic+significance+of+the+size+of+central+fibrosis+in+peripheral+adenocarcinoma+of+the+lung.">Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung.</a> Ann Thorac Surg. 69, 893-897 (2000).</li><li>Cancer Genome Atlas Research, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comprehensive+molecular+profiling+of+lung+adenocarcinoma.">Comprehensive molecular profiling of lung adenocarcinoma.</a> Nature. 511, 543-550 (2014).</li><li>Scotton, C. J., Chambers, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bleomycin+revisited:+towards+a+more+representative+model+of+IPF?.">Bleomycin revisited: towards a more representative model of IPF?.</a> Am J Physiol-Lung C. 299, L439-L441 (2010).</li><li>Hay, J., Shahzeidi, S., Laurent, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanisms+of+bleomycin-induced+lung+damage.">Mechanisms of bleomycin-induced lung damage.</a> Arch Toxicol. 65, 81-94 (1991).</li><li>Vaccaro, C. A., Brody, J. S., Snider, G. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alveolar+wall+basement+membranes+in+bleomycin-induced+pulmonary+fibrosis.">Alveolar wall basement membranes in bleomycin-induced pulmonary fibrosis.</a> Am Rev Respir Dis. 132, 905-912 (1985).</li><li>Venkatesan, N., Ebihara, T., Roughley, P. J., Ludwig, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alterations+in+large+and+small+proteoglycans+in+bleomycin-induced+pulmonary+fibrosis+in+rats.">Alterations in large and small proteoglycans in bleomycin-induced pulmonary fibrosis in rats.</a> Am J Resp Crit Care. 161, 2066-2073 (2000).</li><li>Moore, B. B., Hogaboam, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Murine+models+of+pulmonary+fibrosis.">Murine models of pulmonary fibrosis.</a> Am J Physiol-Lung C. 294, L152-L160 (2008).</li><li>Izbicki, G., Segel, M. J., Christensen, T. G., Conner, M. W., Breuer, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Time+course+of+bleomycin-induced+lung+fibrosis.">Time course of bleomycin-induced lung fibrosis.</a> Int J Exp Pathol. 83, 111-119 (2002).</li><li>Schrier, D. J., Phan, S. H., McGarry, B. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+the+nude+(nu/nu)+mutation+on+bleomycin-induced+pulmonary+fibrosis.+A+biochemical+evaluation.">The effects of the nude (nu/nu) mutation on bleomycin-induced pulmonary fibrosis. A biochemical evaluation.</a> Am Rev Respir Dis. 127, 614-617 (1983).</li><li>Ponomarev, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+novel+triple-modality+reporter+gene+for+whole-body+fluorescent,+bioluminescent,+and+nuclear+noninvasive+imaging.">A novel triple-modality reporter gene for whole-body fluorescent, bioluminescent, and nuclear noninvasive imaging.</a> Eur J Nucl Med Mol I. 31, 740-751 (2004).</li><li>Morten, B. C., Scott, R. J., Avery-Kiejda, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+Three+Different+Methods+for+Determining+Cell+Proliferation+in+Breast+Cancer+Cell.">Comparison of Three Different Methods for Determining Cell Proliferation in Breast Cancer Cell.</a> J. Vis. Exp. , (2016).</li><li>Tseng, J. C., Kung, A. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+bioluminescence+imaging+of+mouse+tumor+models.">Quantitative bioluminescence imaging of mouse tumor models.</a> Cold Spring Harbor protocols. , (2015).</li><li>Byrne, F. L., McCarroll, J. A., Kavallaris, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analyses+of+Tumor+Burden+In+Vivo+and+Metastasis+Ex+Vivo+Using+Luciferase-Expressing+Cancer+Cells+in+an+Orthotopic+Mouse+Model+of+Neuroblastoma.">Analyses of Tumor Burden In Vivo and Metastasis Ex Vivo Using Luciferase-Expressing Cancer Cells in an Orthotopic Mouse Model of Neuroblastoma.</a> Methods Mol Biol. 1372, 61-77 (2016).</li><li>Parkinson, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+necropsy+and+selected+tissue+and+sample+collection+in+rats+and+mice.">Diagnostic necropsy and selected tissue and sample collection in rats and mice.</a> J. Vis. Exp. , (2011).</li><li>Tammela, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+Wnt-producing+niche+drives+proliferative+potential+and+progression+in+lung+adenocarcinoma.">A Wnt-producing niche drives proliferative potential and progression in lung adenocarcinoma.</a> Nature. 545, 355-359 (2017).</li><li>DuPage, M., Dooley, A. L., Jacks, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Conditional+mouse+lung+cancer+models+using+adenoviral+or+lentiviral+delivery+of+Cre+recombinase.">Conditional mouse lung cancer models using adenoviral or lentiviral delivery of Cre recombinase.</a> Nat Protoc. 4, 1064-1072 (2009).</li><li>Byrne, A. T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interrogating+open+issues+in+cancer+precision+medicine+with+patient-derived+xenografts.">Interrogating open issues in cancer precision medicine with patient-derived xenografts.</a> Nat Rev Cancer. 17, 254-268 (2017).</li><li>Nguyen, D. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=WNT/TCF+signaling+through+LEF1+and+HOXB9+mediates+lung+adenocarcinoma+metastasis.">WNT/TCF signaling through LEF1 and HOXB9 mediates lung adenocarcinoma metastasis.</a> Cell. 138, 51-62 (2009).</li><li>Raghu, G., Nyberg, F., Morgan, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+of+interstitial+lung+disease+and+its+association+with+lung+cancer.">The epidemiology of interstitial lung disease and its association with lung cancer.</a> Brit J Cancer. 91, S3-S10 (2004).</li><li>Hubbard, R., Venn, A., Lewis, S., Britton, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+cancer+and+cryptogenic+fibrosing+alveolitis.+A+population-based+cohort+study.">Lung cancer and cryptogenic fibrosing alveolitis. A population-based cohort study.</a> Am J Resp Crit Care. 161, 5-8 (2000).</li><li>Nagai, A., Chiyotani, A., Nakadate, T., Konno, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lung+cancer+in+patients+with+idiopathic+pulmonary+fibrosis.">Lung cancer in patients with idiopathic pulmonary fibrosis.</a> Tohoku J Exp Med. 167, 231-237 (1992).</li><li>Rock, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multiple+stromal+populations+contribute+to+pulmonary+fibrosis+without+evidence+for+epithelial+to+mesenchymal+transition.">Multiple stromal populations contribute to pulmonary fibrosis without evidence for epithelial to mesenchymal transition.</a> Proc Natl Acad Sci USA. 108, E1475-E1483 (2011).</li><li>Saito, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Survival+after+surgery+for+pathologic+stage+IA+non-small+cell+lung+cancer+associated+with+idiopathic+pulmonary+fibrosis.">Survival after surgery for pathologic stage IA non-small cell lung cancer associated with idiopathic pulmonary fibrosis.</a> Ann Thorac Surg. 92, 1812-1817 (2011).</li><li>Stevens, L. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extracellular+Matrix+Receptor+Expression+in+Subtypes+of+Lung+Adenocarcinoma+Potentiates+Outgrowth+of+Micrometastases.">Extracellular Matrix Receptor Expression in Subtypes of Lung Adenocarcinoma Potentiates Outgrowth of Micrometastases.</a> Cancer Res. 77, 1905-1917 (2017).</li><li>Harrison, J. H., Lazo, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=High+dose+continuous+infusion+of+bleomycin+in+mice:+a+new+model+for+drug-induced+pulmonary+fibrosis.">High dose continuous infusion of bleomycin in mice: a new model for drug-induced pulmonary fibrosis.</a> J Pharmacol Exp Ther. 243, 1185-1194 (1987).</li><li>Shcherbo, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bright+far-red+fluorescent+protein+for+whole-body+imaging.">Bright far-red fluorescent protein for whole-body imaging.</a> Nature Methods. 4, 741-746 (2007).</li><li>Aso, Y., Yoneda, K., Kikkawa, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morphologic+and+biochemical+study+of+pulmonary+changes+induced+by+bleomycin+in+mice.">Morphologic and biochemical study of pulmonary changes induced by bleomycin in mice.</a> Lab Invest. 35, 558-568 (1976).</li><li>Kim, C. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+bronchioalveolar+stem+cells+in+normal+lung+and+lung.">Identification of bronchioalveolar stem cells in normal lung and lung.</a> Cell. 121, 823-835 (2005).</li><li>Fichtner, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishment+of+patient-derived+non-small+cell+lung+cancer+xenografts+as+models+for+the+identification+of+predictive+biomarkers.">Establishment of patient-derived non-small cell lung cancer xenografts as models for the identification of predictive biomarkers.</a> Clin Cancer Res. 14, 6456-6468 (2008).</li><li>Zhang, X. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishment+of+patient-derived+non-small+cell+lung+cancer+xenograft+models+with+genetic+aberrations+within+EGFR,+KRAS+and+FGFR1:+useful+tools+for+preclinical+studies+of+targeted+therapies.">Establishment of patient-derived non-small cell lung cancer xenograft models with genetic aberrations within EGFR, KRAS and FGFR1: useful tools for preclinical studies of targeted therapies.</a> J Transl Med. 11, 168 (2013).</li></ol>

The authors declare no competing financial interests.

Striking clinical parallels have been documented between lung cancer and other chronic diseases of the lung36. In particular, patients with idiopathic pulmonary fibrosis (IPF) have an increased predilection for developing lung cancer, and this association is independent of smoking history37,38. IPF is characterized by progressive destruction of lung architecture and impaired respiratory function through deposition of ECM3...

Lung cancer is the leading cause of cancer related deaths worldwide1. Patients with lung cancer eventually succumb from metastasis to distant organs, notably to the central nervous system, liver, adrenal glands, and bones2,3,4. Thoracic malignancies have been traditionally classified as small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC)5. NSCLC is the most frequently diagnosed malignancy and can be subdivided into different histological subtypes, including lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC)6. Genomic analysis of resected human primary lung cancers has revealed that tumors within a given histotype can also express diverse molecular perturbations, further contributing to their divergent clinical progression and confounding patient prognosis. The remarkable heterogeneity of lung cancers represents a significant challenge to the rational design, pre-clinical testing, and implementation of effective therapeutic strategies. Consequently, there is a need to expand the repertoire of tractable experimental lung cancer models to study the diverse cellular origins, molecular subtypes, and stages of this disease.
Various approaches using animal models have been employed to study lung cancer in vivo, each with their own advantages and disadvantages depending on the biological question(s) of interest. Genetically engineered mouse models (GEMMs) can target specific genetic alterations in a given progenitor cell type, resulting in tumors that progress within an immunocompetent host7. While extremely powerful and clinically relevant, the latency, variability, and/or lung tumor morbidity associated with GEMMs can be prohibitive to certain quantitative measurements and the detection of late stage metastasis in distant organs8. A complementary approach is the use of allograft models, whereby lung cancer cells, obtained either directly from a mouse tumor or derived first as established cell lines in culture, are re-introduced into syngeneic hosts. Analogously, lung cancer xenografts are established from human cell lines or patient derived tumor samples. Human cell line xenografts or patient derived xenografts (PDXs) are generally maintained in immunocompromised mice and therefore preclude complete immune-surveillance9. Despite this drawback, they provide an avenue to propagate limiting amounts of human biospecimens and study fundamental in vivo properties of human cancer cells, which encode for more complex genomic aberrations than GEMM tumors.
One useful property of allografts and xenografts is that they are amenable to traditional limiting cell dilution assays, employed to quantify the frequency of tumor initiating cells (TICs) within a malignant cell population10. In these experiments, a defined number of cells are injected subcutaneously into the flank of animals and the frequency of TICs can be estimated based on tumor take rate. Subcutaneous tumors however can be more hypoxic11 and may not model key physiological constraints of the lung tumor microenvironment. Intratracheal delivery of epithelial stem or progenitor cells into the lungs of mice is a method to study pulmonary regeneration and airway stem cell biology12. However, the engraftment rate from this technique can be relatively low, unless the lungs are first subjected to physiological forms of injury, such as viral infection13,14. Support from inflammatory stromal cells and/or the disruption of the lung basement membrane may improve retention of transplanted cells into relevant stem cell niches in the distal airways15. Fibrosis inducing agents can also pre-condition the lungs to enhance engraftment of induced pluripotent cells16 and mesenchymal stem cells17. Whether similar forms of airway injury can affect the engraftment rate, tumor initiating capacity, and outgrowth of lung cancer cells has yet to be systematically assessed.
In this study, we describe a method to increase the efficiency of orthotopic lung cancer cell engraftment, by pre-conditioning the lungs of mice with injury. LUAD arises in the distal airways with a significant subset of these cancers developing a fibrotic stroma18 that often correlates with poor prognosis19. Bleomycin, a natural nonribosomal hybrid peptide-polyketide, has been extensively utilized to induce pulmonary fibrosis in mice20. Airway instillation of bleomycin first promotes epithelial attrition in the alveoli and recruitment of inflammatory cells, including macrophages, neutrophils and monocytes21. This is followed by tissue remodeling in the distal airways, basement membrane reorganization22,23 and extracellular matrix (ECM) deposition24. The effects of a single bleomycin injection are transient, with fibrosis resolving after 30 days in most studies25. Using both allograft and xenograft models, we tested if pre-conditioning the airways of mice with bleomycin could significantly increase the take rate of LUAD cells in the lungs.

<table><tbody><tr><td>Bleomycin</td><td>Sigma</td><td>B5507-15UN</td><td>CAUTION Health hazard GHS08</td></tr><tr><td>Exel Catheter 24G</td><td>Fisher</td><td>1484121</td><td>Remove needle. For intratracheal injection</td></tr><tr><td>Ketamine (Ketaset inl 100 mg/mL C3N 10 mL)</td><td>Butler Schein</td><td>56344</td><td>To anesthetize mice</td></tr><tr><td>Xylazine</td><td>Butler Schein</td><td>33198</td><td>To anesthetize mice</td></tr><tr><td>Ketoprofen, 5,000 mg</td><td>Cayman Chemical</td><td>10006661</td><td>Analgesic</td></tr><tr><td>Puralube Veterinary Ophthalmic Ointment</td><td>BUTLER ANIMAL HEALTH COMPANY LLC</td><td>8897</td><td>To prevent eye dryness while under anesthesia</td></tr><tr><td>D-Luciferin powder</td><td>Perkin Elmer Health Sciences Inc</td><td>122799</td><td>For luminescent imaging. Reconstitute powder with PBS for a working concentration of 15mg/mL. Protect from Light</td></tr><tr><td>Rodent Intubation stand</td><td>Braintree Scientific</td><td>RIS-100</td><td>Recommended stand for intratracheal injection</td></tr><tr><td>MI-150 ILLUMINATOR 150W MI-150</td><td>DOLAN-JENNER INDUSTRIES</td><td>MI-150 / EEG2823M</td><td>To illuminate and visualize trachea</td></tr><tr><td>Graefe Forceps, 2.75 (7 cm) long serrat</td><td>Roboz</td><td>RS-5111</td><td>For intratracheal injection</td></tr><tr><td>Syringe Luer-Lok Sterile 5ml</td><td>BD / Fisher</td><td>309646</td><td></td></tr><tr><td>Satiny Smooth by Conair Dual Foil Wet/Dry Rechargeable Shaver</td><td>Conair</td><td>-</td><td>To shave mice</td></tr><tr><td>Bonn Scissors, 3.5&quot; straight 15 mm sharp/sharp sure cut blades</td><td>Roboz</td><td>RS-5840SC</td><td></td></tr><tr><td>15 mL conical tube</td><td>BD / Fisher</td><td>352097</td><td></td></tr><tr><td>1.5 mL centrifuge tubes</td><td>USA SCIENTIFIC INC</td><td>1615-5500</td><td></td></tr><tr><td>Vial Scintillation 7 mL Borosilicate Glass GPI</td><td>Fisher</td><td>701350</td><td></td></tr><tr><td>Filter pipette tips (200 &amp;mu;L)</td><td>USA SCIENTIFIC INC</td><td>1120-8710</td><td></td></tr><tr><td>Phosphate Buffered Saline</td><td>Life Technologies</td><td>14190-144</td><td></td></tr><tr><td>0.25% Trypsin-EDTA</td><td>Life Technologies</td><td>25200-056</td><td></td></tr><tr><td>DMEM high glucose</td><td>Life Technologies</td><td>11965-092</td><td></td></tr><tr><td>RPMI Medium 1640</td><td>Life Technologies</td><td>11875-093</td><td></td></tr><tr><td>Fetal bovine serum USDA</td><td>Life Technologies</td><td>10437-028</td><td></td></tr><tr><td>Penicillin-Streptomycin</td><td>Life Technologies</td><td>15140-122</td><td></td></tr><tr><td>Amphotericin B</td><td>Sigma</td><td>A2942-20ML</td><td></td></tr><tr><td>Trypan Blue Stain 0.4%</td><td>Life Technologies</td><td>15250-061</td><td></td></tr><tr><td>Countess Automated Cell Counter</td><td>Life Technologies</td><td>AMQAX1000</td><td></td></tr><tr><td>Flask T/C 75cm sq canted neck, blue cap</td><td>Fisher / Corning</td><td>353135</td><td></td></tr><tr><td>IVIS Spectrum Xenogen Bioluminiscence</td><td>Perkin Elmer Health Sciences Inc</td><td>124262</td><td>For &lt;em&gt;in vivo&lt;/em&gt; bioluminescence imaging</td></tr><tr><td>Living image software</td><td>Perkin Elmer Health Sciences Inc</td><td>128113</td><td>For &lt;em&gt;in vivo&lt;/em&gt; bioluminescence analysis</td></tr><tr><td>XGI-8 Gas Anesthesia System</td><td>Perkin Elmer Health Sciences Inc</td><td>118918</td><td>For Isoflurane anesthesia</td></tr><tr><td>BD Ultra-Fine II Short Needle Insulin Syringe 1 cc. 31 G x 8 mm (5/16 in)</td><td>BD / Fisher</td><td>BD328418</td><td>For retro-orbital luciferin injection</td></tr><tr><td>Syringe 1ml</td><td>BD / Fisher</td><td>14-823-434</td><td>For intraperitoneal injections</td></tr><tr><td>26 G x 1/2 in. needle</td><td>BD / Fisher</td><td>305111</td><td>For intraperitoneal injections</td></tr><tr><td>4% Paraformaldehyde</td><td>VWR</td><td>43368-9M</td><td>CAUTION Health hazard GHS07, GHS08. For fixing tissue</td></tr><tr><td>Pipet-Lite Pipette, Unv. SL-200XLS+</td><td>METTLER-TOLEDO INTERNATIONAL</td><td>17014411</td><td></td></tr><tr><td>Mayer&#039;s Hematoxylin</td><td>ELECTRON MICROSCOPY SCIENCES</td><td>517-28-2</td><td></td></tr><tr><td>Eosin Y stain 0.25% (w/v) in 57%</td><td>Fisher</td><td>67-63-0</td><td></td></tr><tr><td>Masson Trichrome Stain Kit</td><td>IMEB Inc</td><td>K7228</td><td>For masson trichrome stain to visualize collagen</td></tr><tr><td>Superfrost plus glass slides</td><td>Fisher</td><td>1255015</td><td></td></tr><tr><td>6 well plate</td><td>Corning</td><td>C3516</td><td></td></tr><tr><td>Universal Mycoplasma Detection Kit</td><td>ATCC</td><td>30-1012K</td><td></td></tr><tr><td>OCT Embedding compound</td><td>ELECTRON MICROSCOPY SCIENCES</td><td>62550-12</td><td>For embedding tissue for frozen sections</td></tr><tr><td>Leica CM3050 S Research Cryostat</td><td>Leica</td><td>CM3050 S</td><td>To section tissue for staining analysis</td></tr><tr><td>Keyence All-in One Fluorescence Microscope</td><td>Keyence</td><td>BZ-X700</td><td></td></tr><tr><td>ImageJ</td><td>US National Institutes of Health</td><td>IJ1.46</td><td>http://rsbweb.nih.gov/ij/ download.html</td></tr><tr><td>Prism 7.0 for Mac OS X</td><td>GraphPad Software, Inc.</td><td>-</td><td></td></tr><tr><td>Athymic (Crl:NU(NCr)-Foxn1nu) mice</td><td>Charles River</td><td>NIH-553</td><td></td></tr><tr><td>NSG (NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ) mice</td><td>Jackson Laboratories</td><td>5557</td><td></td></tr><tr><td>B6129SF1/J mice</td><td>Jackson Laboratories</td><td>101043</td><td></td></tr><tr><td>NIH-H2030 cells</td><td>ATCC</td><td>CRL-5914</td><td></td></tr><tr><td>368T1</td><td>generously provided by Monte Winslow (Standford University)</td><td>-</td><td></td></tr><tr><td>PC9 cells</td><td>Nguyen DX et al. Cell. 2009;138:51&amp;ndash;62</td><td>-</td><td></td></tr><tr><td>H2030 BrM3 cells</td><td>Nguyen DX et al. Cell. 2009;138:51&amp;ndash;62</td><td>-</td><td></td></tr></tbody></table>

pre-conditioning the airways of mice with bleomycin increases the efficiency of orthotopic lung cancer cell engraftment

Lung cancer is a deadly treatment refractory disease that is biologically heterogeneous. To understand and effectively treat the full clinical spectrum of thoracic malignancies, additional animal models that can recapitulate diverse human lung cancer subtypes and stages are needed. Allograft or xenograft models are versatile and enable the quantification of tumorigenic capacity in vivo, using malignant cells of either murine or human origin. However, previously described methods of lung cancer cell engraftment have been performed in non-physiological sites, such as the flank of mice, due to the inefficiency of orthotopic transplantation of cells into the lungs. In this study, we describe a method to enhance orthotopic lung cancer cell engraftment by pre-conditioning the airways of mice with the fibrosis inducing agent bleomycin. As a proof-of-concept experiment, we applied this approach to engraft tumor cells of the lung adenocarcinoma subtype, obtained from either mouse or human sources, into various strains of mice. We demonstrate that injuring the airways with bleomycin prior to tumor cell injection increases the engraftment of tumor cells from 0-17% to 71-100%. Significantly, this method enhanced lung tumor incidence and subsequent outgrowth using different models and mouse strains. In addition, engrafted lung cancer cells disseminate from the lungs into relevant distant organs. Thus, we provide a protocol that can be used to establish and maintain new orthotopic models of lung cancer with limiting amounts of cells or biospecimen and to quantitatively assess the tumorigenic capacity of lung cancer cells in physiologically relevant settings.

To increase the efficiency of LUAD cancer cell engraftment into the lungs of mice, we developed a protocol that first pre-conditions the airways using bleomycin followed by orthotopic tumor cell injection (Figure 1). We confirmed that even when administered into immunocompromised athymic mice, bleomycin induced transient fibrosis by day 14 as evidenced by loss of airway architecture and increased collagen deposition (Figure 2). G...

Watch this Scientific Journal Video about Pre-Conditioning the Airways of Mice with Bleomycin Increases the Efficiency of Orthotopic Lung Cancer Cell Engraftment at JoVE.com

Pre-Conditioning the Airways of Mice with Bleomycin Increases the Efficiency of Orthotopic Lung Cancer Cell Engraftment

We describe a method to significantly enhance orthotopic engraftment of lung cancer cells into the murine lungs by pre-conditioning the airways with injury. This approach may also be applied to study stromal interactions within the lung microenvironment, metastatic dissemination, lung cancer co-morbidities, and to more efficiently generate patient derived xenografts.

Lung cancer is a deadly treatment refractory disease that is biologically heterogeneous. To understand and effectively treat the full clinical spectrum of ...

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13.6K Views.  Yale University School of Medicine. Beschrijven we een methode om engraftment van de orthotopic van longkanker kankercellen in de longen lymfkliertest aanzienlijk te verbeteren door preconditionering van de luchtwegen met blessure. Deze benadering kan ook worden toegepast om te studeren stromale interacties binnen de longen communicatie, gemetastaseerde verspreiding, long kanker co morbiditeit en efficiënter genereren patiënt afgeleid xenografts.

Video: Pre-Conditioning the Airways of Mice with Bleomycin Increases the Efficiency of Orthotopic Lung Cancer Cell Engraftment

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

Noninvasive Intratracheal Intubation to Study the Pathology and Physiology of Mouse Lung

The use of a model that mimics the condition of lung diseases in humans is critical for studying the pathophysiology and/or etiology of a particular disease and for developing therapeutic intervention. With the increasing availability of knockout and transgenic derivatives, together with a vast amount of genetic information, mice provide one of the best models to study the molecular mechanisms underlying the pathology and physiology of lung diseases. Inhalation, intranasal instillation, intratracheal instillation, and intratracheal intubation are the most widely used techniques by a number of investigators to administer materials of interest to mouse lungs. There are pros and cons for each technique depending on the goals of a study. Here a noninvasive intratracheal intubation method that can directly deliver exogenous materials to mouse lungs is presented. This technique was applied to administer bleomycin to mouse lungs as a model to study pulmonary fibrosis.

The use of a model that mimics the condition of lung diseases in humans is critical for studying the pathophysiology and/or etiology of a particular disease and for developing therapeutic intervention. Here a noninvasive intratracheal intubation method that can directly deliver exogenous materials to mouse lungs is presented.

The use of a model that mimics the condition of lung diseases in humans is critical for studying the pathophysiology and/or etiology of a particular ...

A Multimodal Imaging Approach Based on Micro-CT and Fluorescence Molecular Tomography for Longitudinal Assessment of Bleomycin-Induced Lung Fibrosis in Mice

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by the progressive and irreversible destruction of lung architecture, which causes significant deterioration in lung function and subsequent death from respiratory failure.
The pathogenesis of IPF in experimental animal models has been induced by bleomycin administration. In this study, we investigate an IPF-like mouse model induced by a double intratracheal bleomycin instillation. Standard histological assessments used for studying lung fibrosis are invasive terminal procedures. The goal of this work is to monitor lung fibrosis through noninvasive imaging techniques such as Fluorescent Molecular Tomography (FMT) and Micro-CT. These two technologies validated with histology findings could represent a revolutionary functional approach for real time non-invasive monitoring of IPF disease severity and progression. The fusion of different approaches represents a step further for understanding the IPF disease, where the molecular events occurring in a pathological condition can be observed with FMT and the subsequent anatomical changes can be monitored by Micro-CT.

We describe a non-invasive multimodal imaging approach based on Micro-CT and fluorescence molecular tomography for longitudinal assessment of the mouse lung fibrosis model induced by double intratracheal instillation of bleomycin.

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease characterized by the progressive and irreversible destruction of lung architecture, which ...

Immunology and Infection

An Improved Method for Rapid Intubation of the Trachea in Mice

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity is a commonly used model to study both acute lung injury and fibrosis, and multiple methods have been developed for administering bleomycin (and other toxic agents) into the lungs. However, many of these approaches, such as transtracheal instillation, have inherent drawbacks, including the need for strong anesthetics and survival surgery. This paper reports a quick, reproducible method of intratracheal intubation that involves mild inhaled anesthesia, visualization of the trachea, and the use of a surrogate spirometer to confirm exposure. As a proof of concept, 8-12 week old C57BL/6 mice were administered either 2.0 U/kg of bleomycin or an equivalent volume of PBS, and both damage and fibrotic endpoints were measured post-exposure. This procedure allows researchers to treat a large cohort of mice in a relatively short period with little expense and minimal post-procedure care.

This article presents a rapid and simple method for administering bleomycin directly into the mouse trachea via intubation. Key advantages of this method are that it is highly reproducible, easy to master, and does not require specialized equipment or lengthy recovery times.

Despite some anatomical and physiological differences, mouse models continue to be an essential tool for studying human lung disease. Bleomycin toxicity ...

Induction of Mouse Lung Injury by Endotracheal Injection of Bleomycin

Pulmonary fibrosis is a hallmark of several human lung diseases with a different etiology. Since current therapies are rather limited, mouse models continue to be an essential tool for developing new antifibrotic strategies. Here we provide an effective method to investigate in vivo antifibrotic activity of human mesenchymal stromal cells obtained from whole umbilical cord (hUC-MSC) in attenuating bleomycin-induced lung injury. C57BL/6 mice receive a single endotracheal injection of bleomycin (1.5 U/kg body weight) followed by a double infusion of hUC-MSC (2.5 x 105) into the tail vein, 24 h and 7 days after the bleomycin administration. Upon sacrifice at days 8, 14, or 21, inflammatory and fibrotic changes, collagen content, and hUC-MSC presence in explanted lung tissue are analyzed. The injection of bleomycin into the mouse&#160;trachea allows the direct targeting of the lungs, leading to extensive pulmonary inflammation and fibrosis. The systemic administration of a double dose of hUC-MSC results in the early blunting of the bleomycin-induced lung injury. Intravenously infused hUC-MSC are transiently engrafted into the mouse lungs, where they exert their anti-inflammatory and antifibrotic activity. In conclusion, this protocol has been successfully applied for the preclinical testing of hUC-MSC in an experimental mouse model of human pulmonary fibrosis. However, this technique can be easily extended both to study the effect of different endotracheally administered substances on the pathophysiology of the lungs and to validate new anti-inflammatory and antifibrotic systemic therapies.

Here we present an effective method to investigate the antifibrotic activity of intravenously infused human mesenchymal stromal cells obtained from the whole umbilical cord following the induction of lung injury by an endotracheal injection of bleomycin in C57BL/6 mice. This protocol can be easily extended to the preclinical testing of other therapeutics.

Pulmonary fibrosis is a hallmark of several human lung diseases with a different etiology. Since current therapies are rather limited, mouse models ...

Direct Intrabronchial Administration to Improve the Selective Agent Deposition Within the Mouse Lung

Intratracheal (IT) administration of experimental agents is an essential technique in murine models of diffuse lung diseases, such as bleomycin-induced pulmonary fibrosis.&#160; However, distribution of intratracheally-administered agents to the distal mouse lung is often asymmetric, with lung parenchymal concentrations increased in the smaller (but equally accessible) left lung of the mouse.&#160; Described in this report is a novel intrabronchial (IB) approach to cannulate the left and/or right lungs of living mice non-operatively.&#160; It is also demonstrated how this approach can be used to selectively administer agents to one lung or adapted (via dose-adjusted IB delivery) to improve the left-right symmetry of lung delivery of experimental agents, thereby improving models of diffuse lung disease such as bleomycin-induced pulmonary fibrosis.

Intratracheal (IT) administration of experimental agents in mice often results in asymmetric delivery to the distal lungs.&#160; In this report, we describe a direct intrabronchial (IB) approach to cannulate each lung in living mice non-operatively.&#160; This approach can be used to selectively administer agents to one lung or may be adapted to improve the symmetric agent delivery to both lungs.

Intratracheal (IT) administration of experimental agents is an essential technique in murine models of diffuse lung diseases, such as bleomycin-induced ...

Adoptive Transfer of IL-33-Stimulated Macrophages into Bleomycin-Induced Mouse Models to Study Their Effect on Idiopathic Pulmonary Fibrosis In Vivo

The inflammatory response caused by early lung injury is one of the important causes of the development of idiopathic pulmonary fibrosis (IPF), which is accompanied by the activation of inflammatory cells such as macrophages and neutrophils, as well as the release of inflammatory factors including TNF-&#945;, IL-1&#946;, and IL-6. Early inflammation caused by activated pulmonary interstitial macrophages (IMs) in response to IL-33 stimulation is known to play a vital role in the pathological process of IPF. This protocol describes the adoptive transfer of IMs stimulated by IL-33 into the lungs of mice to study IPF development. It involves the isolation and culture of primary IMs from host mouse lungs, followed by the adoptive transfer of stimulated IMs into the alveoli of bleomycin (BLM)-induced IPF recipient mice (which have been previously depleted of alveolar macrophages by treatment with clodronate liposomes), and the pathological evaluation of those mice. The representative results show that the adoptive transfer of IL-33-stimulated macrophages aggravates pulmonary fibrosis in mice, suggesting that the establishment of the macrophage adoptive transfer experiment is a good technical means to study IPF pathology.

Adoptive Transfer of IL-33-Stimulated Macrophages into Bleomycin-Induced Mouse Models to Study Their Effect on Idiopathic Pulmonary Fibrosis In Vivo

This protocol describes the isolation of pulmonary interstitial macrophages (IMs) and their adoptive transfer after IL-33 stimulation of the lung alveoli in a mouse model, which can facilitate the in vivo study of idiopathic pulmonary fibrosis (IPF).

The inflammatory response caused by early lung injury is one of the important causes of the development of idiopathic pulmonary fibrosis (IPF), which is ...

A Mouse Model of Pulmonary Fibrosis Induced by Nasal Bleomycin Nebulization

Pulmonary fibrosis is characteristic of several human lung diseases that arise from various causes. Given that treatment options are fairly limited, mouse models continue to be an important tool for developing new anti-fibrotic strategies. In this study, intrapulmonary administration of bleomycin (BLM) is carried out by nasal nebulization to create a mouse model of pulmonary fibrosis that closely mimics clinical disease characteristics. C57BL/6 mice received BLM (7 U/mL, 30 min/day) by nasal nebulization for 3 consecutive days and were sacrificed on day 9, 16, or 23 to observe inflammatory and fibrotic changes in lung tissue. Nasal aerosolized BLM directly targeted the lungs, resulting in widespread and uniform lung inflammation and fibrosis. Thus, we successfully generated an experimental mouse model of typical human pulmonary fibrosis. This method could easily be used to study the effects of the administration of various nasal aerosols on lung pathophysiology and validate new anti-inflammatory and anti-fibrotic treatments.

Various animal models of pulmonary fibrosis have been established using bleomycin to clarify the pathogenesis of pulmonary fibrosis and find new drug targets. However, most pulmonary fibrosis models targeting lung tissue have uneven drug administration. Here, we propose a model of uniform pulmonary fibrosis induced by nasal bleomycin nebulization.

Pulmonary fibrosis is characteristic of several human lung diseases that arise from various causes. Given that treatment options are fairly limited, mouse ...

Biology

Oropharyngeal Administration of Bleomycin in the Murine Model of Pulmonary Fibrosis

Interstitial lung disease (ILD) represents a broad spectrum of disorders characterized by the progressive and often irreversible scarring of the lung parenchyma, the most common being idiopathic pulmonary fibrosis (IPF). Several animal models of IPF have been developed, with the bleomycin murine model being the most widely used. Bleomycin is a chemotherapeutic known to induce DNA damage in the alveolar epithelium, resulting in acute lung injury and pulmonary fibrosis in humans. Rodent models of IPF use bleomycin administration via various methods, the most common being intratracheal (IT). Recently, the oropharyngeal aspiration (OA) technique has been shown to be equally efficacious as IT for multiple fibrosing agents, with considerably fewer side effects and an easier route of delivery. This protocol details the OA method of bleomycin delivery into the murine lung and highlights examples of potential downstream applications for data quantification. This methodology offers a simple, quick, and safe way to utilize this widely used animal model for studying the molecular mechanisms underlying IPF.

This protocol demonstrates the oropharyngeal aspiration technique for use in the bleomycin murine model of pulmonary fibrosis.

Interstitial lung disease (ILD) represents a broad spectrum of disorders characterized by the progressive and often irreversible scarring of the lung ...

Adenocarcinoma Engraftment: A Method to Implant Cancer Cells into the Murine Lungs

Source: Stevens, L.E. et al, <a href="https://www.jove.com/v/56650/pre-conditioning-airways-mice-with-bleomycin-increases-efficiency">Pre-Conditioning the Airways of Mice with Bleomycin Increases the Efficiency of Orthotopic Lung Cancer Cell Engraftment.</a> J. Vis. Exp. (2018).
This video describes a method to engraft lung adenocarcinoma cells in murine lungs by preconditioning the airways with fibrosis-inducing agent&#8211;bleomycin. This method significantly enhances orthotopic engraftment of lung cancer cells into murine lungs

Source: Stevens, L.E. et al, Pre-Conditioning the Airways of Mice with Bleomycin Increases the Efficiency of Orthotopic Lung Cancer Cell Engraftment. J. ...

Pre-Conditioning the Airways of Mice with Bleomycin Increases the Efficiency of Orthotopic Lung Cancer Cell Engraftment

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