Journal
CHEST
Volume 155, Issue 3, Pages 587-594Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.chest.2018.10.022
Keywords
endothelial injury; mechanical ventilation; platelet-endothelial cell adhesion molecule; pulmonary fibrosis; ventilator-induced lung injury; wingless-related integration site
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Funding
- Instituto de Salud Carlos III, Spain [PI016/00049]
- Canadian Institutes of Health Research, Canada [FDN143285]
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ARDS is an acute inflammatory pulmonary process triggered by severe pulmonary and systemic insults to the alveolar-capillary membrane. This causes increased vascular permeability and the development of interstitial and alveolar protein-rich edema, leading to acute hypoxemic respiratory failure. Supportive treatment includes the use of lung-protective ventilatory strategies that decrease the work of breathing, can improve oxygenation, and minimize ventilator-induced lung injury. Despite substantial advances in supportive measures, there are no specific pharmacologic treatments for ARDS, and the overall hospital mortality rate remains about 40% in most series. The pathophysiology of ARDS involves interactions among multiple mechanisms, including immune cell infiltration, cytokine storm, alveolar-capillary barrier disruption, cell apoptosis, and the development of fibrosis. Here we review some new developments in the molecular basis of lung injury, with a focus on possible novel pharmacologic interventions aimed at improving the outcomes of patients with ARDS. Our focus is on platelet-endothelial cell adhesion molecule-1, which contributes to the maintenance and restoration of vascular integrity following barrier disruption. We also highlight the wingless-related integration site signaling pathway, which appears to be a central mechanism for lung healing as well as for fibrotic development.
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