Thursday, June 15, 2017

Molecular and Immune Biomarkers in Acute Respiratory Distress Syndrome: A Perspective From Members of the Pulmonary Pathology Society

Vera Luiza CapelozziMD, PhDTimothy Craig AllenMD, JDMary Beth BeasleyMDPhilip T. CagleMDDon GuineeMDLida P. HaririMD, PhDAliya N. HusainMDDeepali JainMD, DNB, FIACSylvie LantuejoulMD, PhDBrandon T. LarsenMD, PhDRoss MillerMDMari Mino-KenudsonMDMehrad MitraMDKirtee RapariaMDAnja RodenMDFrank SchneiderMDLynette M. ShollMDMaxwell Lawrence SmithMD

From the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of Pathology, the University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Cagle and Miller); the Department of Pathology, Virginia Mason Medical Center, Seattle, Washington (Dr Guinee); the Department of Pathology, Massachusetts General Hospital, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, University of Chicago, Chicago, Illinois (Dr Husain); the Department of Pathology, All India Institute of Medical Sciences, New Delhi, India (Dr Jain); the Department of Pathology, INSERM Unit, Centre Léon Bérard, Lyon, France (Dr Lantuejoul) and the Université Joseph Fourier INSERM Unit, Grenoble, France (Dr Lantuejoul); the Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona (Drs Larsen and Smith); the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Mitra); Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota (Dr Roden); the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr Schneider); and the Department of Pathology, Brigham and Women's Hospital, Boston (Dr Sholl).
Reprints: Timothy Craig Allen, MD, JD, University of Texas Medical Branch, Department of Pathology, 301 University Blvd, Galveston, TX (email: ).
Acute respiratory distress syndrome (ARDS) is a multifactorial syndrome with high morbidity and mortality rates, characterized by deficiency in gas exchange and lung mechanics that lead to hypoxemia, dyspnea, and respiratory failure. Histologically, ARDS is characterized by an acute, exudative phase, combining diffuse alveolar damage and noncardiogenic edema, followed by a later fibroproliferative phase. Despite an enhanced understanding of ARDS pathogenesis, the capacity to predict the development of ARDS and to risk-stratify patients with the disease remains limited. Biomarkers may help to identify patients at the greatest risk of developing ARDS, to evaluate response to therapy, to predict outcome, and to improve clinical trials. The ARDS pathogenesis is presented in this article, as well as concepts and information on biomarkers that are currently used clinically or are available for laboratory use by academic and practicing pathologists and the developing and validating of new assays, focusing on the assays' major biologic roles in lung injury and/or repair and to ultimately suggest innovative, therapeutic approaches.

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