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Blanchard F, James A, Assefi M, Kapandji N, Constantin JM. Personalized medicine targeting different ARDS phenotypes: The future of pharmacotherapy for ARDS? Expert Rev Respir Med 2023; 17:41-52. [PMID: 36724878 DOI: 10.1080/17476348.2023.2176302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Acute respiratory distress syndrome (ARDS) still represents a major challenge with high mortality rates and altered quality of life. Many well-designed studies have failed to improve ARDS outcomes. Heterogeneity of etiologies, mechanisms of lung damage, different lung mechanics, and different treatment approaches may explain these failures. At the era of personalized medicine, ARDS phenotyping is not only a field of research, but a bedside consideration when implementing therapy. ARDS has moved from being a simple syndrome to a more complex area of subgrouping. Intensivists must understand these phenotypes and therapies associated with a better outcome. AREAS COVERED After a brief sum-up of the different type of ARDS phenotypes, we will present some relevant therapy that may be impacted by phenotyping. A focus on pharmacotherapy will be realized before a section on non-pharmaceutical strategies. Eventually, we will highlight the limits of our knowledge of phenotyping and the pitfalls of personalized medicine. EXPERT OPINION Biological and morphological ARDS phenotypes are now well studied. The future of ARDS therapy will go through phenotyping that allows a personalized medication for each patient. However, a better assessment of these phenotypes is required, and clinical trials should be conducted with an ad-hoc phenotyping before randomization.
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Affiliation(s)
- Florian Blanchard
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France.,Antimicrobial Stewardship Team GH Paris Centre, Cochin Hospital, APHP, Paris, France
| | - Arthur James
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Mona Assefi
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Natacha Kapandji
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Michel Constantin
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
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Liang Y, Zhang Z, Tu J, Wang Z, Gao X, Deng K, El-Samahy MA, You P, Fan Y, Wang F. γ-Linolenic Acid Prevents Lipid Metabolism Disorder in Palmitic Acid-Treated Alpha Mouse Liver-12 Cells by Balancing Autophagy and Apoptosis via the LKB1-AMPK-mTOR Pathway. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:8257-8267. [PMID: 34281337 DOI: 10.1021/acs.jafc.1c02596] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Excessive fat deposition is the main character in nonalcoholic fatty liver disease (NAFLD), while γ-linolenic acid (GLA) is a polyunsaturated fatty acid that can reduce lipid deposition. This study investigated the effect and regulatory mechanism of GLA (100 μM) on lipid metabolism in alpha mouse liver 12 (AML-12) cells treated by 400 μM palmitic acid (PA). GLA reduced lipid content and increased fatty acid β oxidation, as indicated by decreasing triglyceride and cholesterol contents and increasing mRNA and protein expressions of CPT1α and PPARα. GLA relieved oxidative stress caused by PA, upregulated mRNA levels of superoxide dismutase and glutathione peroxidase, and decreased reactive oxygen species content. GLA reduced apoptosis, as indicated by decreases in the BAX/BCL2 expression level and apoptosis percentage. GLA activated autophagy, autophagosome-lysosome fusion, and LKB1-AMPK-mTOR signaling and upregulated mRNA and protein expressions of Beclin-1, autophagy-related 5, and liver kinase B1 (LKB1). These effects of GLA on lipid metabolism disorders of PA-treated hepatocytes were reversed by autophagy inhibitor 3MA and AMPK inhibitor compound C, confirming our conclusions. Overall, GLA can protect AML-12 cells from lipid metabolism disorder caused by PA via balancing autophagy and apoptosis mediated by the LKB1-AMPK-mTOR pathway. Consequently, GLA, as a dietary supplement, can help to prevent and treat NAFLD by regulating lipid metabolism and autophagy.
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Affiliation(s)
- Yaxu Liang
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Zhen Zhang
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Jiayu Tu
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Zhibo Wang
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Xiaoxiao Gao
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Kaiping Deng
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - M A El-Samahy
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Peihua You
- Portal Agri-Industries Co., Ltd., Xingdian Street, Pikou District, Nanjing 210095, PR China
| | - Yixuan Fan
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
| | - Feng Wang
- Institute of Goats and Sheep Science, Nanjing Agricultural University, No. 1 Weigang, Nanjing, Jiangsu 210095, PR China
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Tasaka S, Tatsumi K. Clinical practice of acute respiratory distress syndrome in Japan: A nationwide survey and scientific evidences. Respir Investig 2017; 55:257-263. [PMID: 28705304 DOI: 10.1016/j.resinv.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 02/14/2017] [Accepted: 04/23/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been limited information about epidemiology and clinical practice of acute respiratory distress syndrome (ARDS) in Japan. METHODS An invitation letter to the web-based survey was mailed to all 871 board certified hospitals of the Japanese Respiratory Society. The questionnaires were designed to collect data on epidemiology and clinical practice of ARDS, including diagnostic measures and therapeutics. RESULTS Within 4 months of the survey period, valid responses were obtained from 296 (34%) hospitals. The incidence of ARDS was estimated to be 3.13 cases/100 hospital beds or 1.91 cases/ICU bed per year. The most frequent underlying disease was pneumonia (34%), followed by sepsis (29%). In hospitals with fewer ICU beds, pulmonologists tended to be in charge of management of ARDS patients. Routine diagnostic measures included computed tomography of the chest (69.6% of the hospitals) and Swan-Ganz catheterization was rarely performed for diagnosis. In 87.4% of the hospitals, non-invasive ventilation was applied to management of ARDS patients, especially those with mild disease. Prone positioning and extracorporeal membrane oxygenation (ECMO) for ARDS patients was more widely adopted in hospitals with larger numbers of ICU beds and intensivists. In 58.2% of the responding hospitals, corticosteroid was considered as a treatment option for ARDS, among which pulse therapy was routinely introduced to ARDS patients in 35.4%. CONCLUSIONS The incidence of ARDS in Japan was estimated to be lower than that in the recent international study. The scale and equipment of hospitals and the number of intensivists might influence clinical practice of ARDS.
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Affiliation(s)
- Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
| | - Koichiro Tatsumi
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan
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Ishibe Y, Shibata S, Takahashi G, Suzuki Y, Inoue Y, Endo S. Association of type II secretory phospholipase A 2 and surfactant protein D with the pulmonary oxygenation potential in patients with septic shock during polymyxin-B immobilized fiber-direct hemoperfusion. J Clin Apher 2016; 32:302-310. [PMID: 27623356 DOI: 10.1002/jca.21507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/08/2016] [Accepted: 08/22/2016] [Indexed: 01/31/2023]
Abstract
This study was undertaken to analyze the association of type II secretory phospholipase A2 (sPLA2 -II) and surfactant protein D (SP-D) with the pulmonary oxygenation potential in patients with septic shock during polymyxin-B immobilized fiber-direct hemoperfusion (PMX-DHP). The study was conducted in 25 patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). PMX-DHP lowered the blood endotoxin level in all patients. Following PMX-DHP, there were decreases from day 0 → day 1 → day 2 in both the mean plasma sPLA2 -II level (340 → 260 → 189 ng/mL) and plasma SP-D level (483 → 363 → 252 ng/mL). The PaO2/FiO2 ratio (P/F ratio) rose (210 → 237 → 262) in all patients. Upon the onset of ALI or ARDS, there was a significant negative correlation between the sPLA2 -II level and the P/F ratio. Furthermore, there was a significant positive correlation between the sPLA2 -II and TNF-α levels. The results suggest that as the blood endotoxin levels were lowered by the PMX-DHP, the inflammatory reactions were suppressed, with suppressed formation of sPLA2 -II and improved pulmonary oxygenation potential. The results also suggested possible involvement of TNF-α in the production of sPLA2 -II.
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Affiliation(s)
- Yoriko Ishibe
- Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.,Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan
| | - Shigehiro Shibata
- Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.,Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan
| | - Gaku Takahashi
- Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.,Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan
| | - Yasushi Suzuki
- Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.,Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan
| | - Yoshihiro Inoue
- Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.,Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan
| | - Shigeatsu Endo
- Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.,Iwate Prefectural Advanced Critical Care and Emergency Center, Morioka, Japan
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Visconti L, Santoro D, Cernaro V, Buemi M, Lacquaniti A. Kidney-lung connections in acute and chronic diseases: current perspectives. J Nephrol 2016; 29:341-348. [PMID: 26940339 DOI: 10.1007/s40620-016-0276-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/30/2016] [Indexed: 02/06/2023]
Abstract
Lung and kidney functions are intimately related in both health and disease. The regulation of acid-base equilibrium, modification of partial pressure of carbon dioxide and bicarbonate concentration, and the control of blood pressure and fluid homeostasis all closely depend on renal and pulmonary activities. These interactions begin in fetal age and are often responsible for the genesis and progression of diseases. In gestational age, urine is a fundamental component of the amniotic fluid, acting on pulmonary maturation and growth. Moreover, in the first trimester of pregnancy, kidney is the main source of proline, contributing to collagen synthesis and lung parenchyma maturation. Pathologically speaking, the kidneys could become damaged by mediators of inflammation or immuno-mediated factors related to a primary lung pathology or, on the contrary, it could be the renal disease that determines a consecutive pulmonary damage. Furthermore, non immunological mechanisms are frequently involved in renal and pulmonary diseases, as observed in chronic pathologies such as sleep apnea syndrome, pulmonary hypertension, progressive renal disease and hemodialysis. Kidney damage has also been related to mechanical ventilation. The aim of this review is to describe pulmonary-renal interactions and their related pathologies, underscoring the need for a close collaboration between intensivists, pneumologists and nephrologists.
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Affiliation(s)
- Luca Visconti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Valeria Cernaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Buemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Lacquaniti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Markers of poor outcome in patients with acute hypoxemic respiratory failure. J Crit Care 2014; 29:797-802. [PMID: 24997724 DOI: 10.1016/j.jcrc.2014.05.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/06/2014] [Accepted: 05/10/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE This study described the acute hypoxemic respiratory failure (AHRF) population and identified potential modifiable markers of outcome. METHODS A prospective, multicenter study was performed in 22 intensive care units (ICUs). The clinical outcomes of patients with acute respiratory distress syndrome (ARDS) were compared to the outcomes in patients with non-ARDS AHRF, and a propensity score matched analysis was performed. RESULTS A total 837 patients with an arterial oxygen tension/fraction of inspired oxygen ratio (Pao2/Fio2) less than 300 mm Hg on ICU admission were included. Of these, 163 patients met the criteria defining ARDS, whereas the remaining 674 patients who had unilateral or no pulmonary opacities were classified as non-ARDS AHRF. Baseline Pao2/Fio2 ratio, thrombocytopenia, increased positive end-expiratory pressure (PEEP) were significantly associated with the 60-day mortality in hypoxemic respiratory failure after multivariate analysis. However, ARDS was not associated with increased 60-day mortality when independent predictors for the 60-day mortality and propensity score were controlled. In the case-control study, the 60-day mortality rate was 38.6% in the ARDS group and 32.3% in the non-ARDS AHRF group. In both patients with ARDS and non-ARDS AHRF, the mortality rate increased proportionally to a lower baseline Pao2/Fio2. CONCLUSION Lower baseline oxygenation (Pao2/Fio2) is a poor prognostic marker in acute hypoxemic respiratory failure.
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Chiumello D, Froio S, Bouhemad B, Camporota L, Coppola S. Clinical review: Lung imaging in acute respiratory distress syndrome patients--an update. Crit Care 2013; 17:243. [PMID: 24238477 PMCID: PMC4056355 DOI: 10.1186/cc13114] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective.
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Affiliation(s)
- Davide Chiumello
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Sara Froio
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Belaïd Bouhemad
- Multidisciplinary Critical Care Unit, La Pitié-Salpêtrière Hospital, University Pierre and Marie Curie Paris, Paris, France
| | - Luigi Camporota
- Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Silvia Coppola
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
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Osaka D, Shibata Y, Kanouchi K, Nishiwaki M, Kimura T, Kishi H, Abe S, Inoue S, Tokairin Y, Igarashi A, Yamauchi K, Aida Y, Nemoto T, Nunomiya K, Fukuzaki K, Kubota I. Soluble endothelial selectin in acute lung injury complicated by severe pneumonia. Int J Med Sci 2011; 8:302-8. [PMID: 21611111 PMCID: PMC3100737 DOI: 10.7150/ijms.8.302] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/02/2011] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pneumonia is still one of the most frequent causes of death in the elderly. Complication of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) by pneumonia makes patients very ill due to severe respiratory failure. Biomarkers that can discriminate the presence of complicating ALI/ARDS are required for early detection. The aim of this research was to investigate whether soluble endothelial selectin (sES) could be a biomarker for ALI. METHODS Serum sES levels were measured in 27 pneumonia patients, who were enrolled between April 2006 and September 2007. Among these patients, six had ALI or a condition that was clinically comparable to ALI (cALI). All patients who were enrolled were successfully treated and survived. RESULTS Circulating sES levels were elevated in pneumonia patients with ALI/cALI, and sES levels decreased following treatment of their pneumonia. Univariate and multivariate logistic regression analyses showed that sES was the only significant factor for identifying complicating ALI/cALI, independently of C-reactive protein (CRP) and lactate dehydrogenase (LDH). By receiver operating characteristic (ROC) curve analysis, the cut-off value for sES was 40.1 ng/mL, with a sensitivity of 0.8 and a specificity of 0.8. CONCLUSION sES may be a useful biomarker for discriminating complicating ALI/cALI in patients with severe pneumonia.
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Affiliation(s)
- Daisuke Osaka
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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