ATP12A expression was increased in IPF small airways in vitro. (A and B) Human large (A) and small (B) airway epithelial cultures. Scale bars, 25 μm. Red indicates small airway epithelial cell marker SCGB3A2, green indicates acetylated α-tubulin, and blue indicates F-actin. (C) ATP12 expression was detected by immunoblotting in culture large and small airway cells from normal (NL) and IPF lungs. (D) Semiquantification of band intensity showed that ATP12A expression in IPF small airway culture was increased ∼100-fold, compared with NL. n = 8. *P < 0.05. (E) Airway surface liquid (ASL) pH is lower in IPF small airways, compared with normal lung small airways. n = 9. *P < 0.05. (F) Ouabain increased ASL pH in IPF small airways. n = 4. **P < 0.05 versus CTL. (G) Vonoprazan (VON) increased ASL pH in IPF small airways. n = 7. *P < 0.05 versus CTL. (H) IPF small airway apical surface activated more latent TGF-β1. n = 3. *P < 0.05. (I) VON decreased 30% of TGF-β1 activation in IPF small airways. n = 6. **P < 0.01.