Angiotensin II formation and endothelin clearance in ARDS patients in supine and prone positions

Wenz, Maieli; Hoffmann, B.; Bohlender, Jürgen; Kaczmarczyk, Gabriele

doi:10.1007/s001340051152

Cited by 26 publications

(12 citation statements)

References 15 publications

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“…Downregulation of ACE2 may result in the elevated plasma level of Ang II, which is a major substrate of ACE2. Additionally, Ang II is claimed considerably increased in ARDS patients [40]. Consistent with this report, the plasma levels of Ang II were also markedly upregulated in severe pneumonia patients (Figure 3h).…”

Section: Elevated Plasma Levels Of Mir-200c-3p In Severe Pneumonia Pasupporting

confidence: 89%

miRNA-200c-3p is crucial in acute respiratory distress syndrome

et al. 2017

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Influenza infection and pneumonia are known to cause much of their mortality by inducing acute respiratory distress syndrome (ARDS), which is the most severe form of acute lung injury (ALI). Angiotensin-converting enzyme 2 (ACE2), which is a negative regulator of angiotensin II in the renin–angiotensin system, has been reported to have a crucial role in ALI. Downregulation of ACE2 is always associated with the ALI or ARDS induced by avian influenza virus, severe acute respiratory syndrome-coronavirus, respiratory syncytial virus and sepsis. However, the molecular mechanism of the decreased expression of ACE2 in ALI is unclear. Here we show that avian influenza virus H5N1 induced the upregulation of miR-200c-3p, which was then demonstrated to target the 3′-untranslated region of ACE2. Then, we found that nonstructural protein 1 and viral RNA of H5N1 contributed to the induction of miR-200c-3p during viral infection. Additionally, the synthetic analog of viral double-stranded RNA (poly (I:C)), bacterial lipopolysaccharide and lipoteichoic acid can all markedly increase the expression of miR-200c-3p in a nuclear factor-κB-dependent manner. Furthermore, markedly elevated plasma levels of miR-200c-3p were observed in severe pneumonia patients. The inhibition of miR-200c-3p ameliorated the ALI induced by H5N1 virus infection in vivo, indicating a potential therapeutic target. Therefore, we identify a shared mechanism of viral and bacterial lung infection-induced ALI/ARDS via nuclear factor-κB-dependent upregulation of miR-200c-3p to reduce ACE2 levels, which leads increased angiotensin II levels and subsequently causes lung injury.

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Section: Elevated Plasma Levels Of Mir-200c-3p In Severe Pneumonia Pasupporting

confidence: 89%

miRNA-200c-3p is crucial in acute respiratory distress syndrome

et al. 2017

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“…The majority of the studies investigated patients with a predominance (w80% of the studies) of primary ARDS [22, 27, 39-41, 43, 57] while a minority investigated patients with a predominance of secondary ARDS (11%) [24,56,62,63]. Approximately 40% investigated a group of patients with equally distributed primary and secondary ARDS (between 20-80%) [4,5,18,23,26,28,42,50,60,61]. One-third of the studies (33%) did not describe the population studied [25, 51-55, 58, 59].…”

Section: An Overview Of the Literaturementioning

confidence: 99%

“…Except for two studies performed in pressurecontrolled ventilation [56,60], all were performed in volume-controlled ventilation. The majority of the studies (63%) did not describe the support used for pronation [26,27,39,40,42,43,[51][52][53][54][55][57][58][59][60][61].…”

Section: An Overview Of the Literaturementioning

confidence: 99%

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Prone position in acute respiratory distress syndrome

Pelosi¹,

Brazzi²,

Gattinoni³

2002

Eur Respir J

273

167

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In the last few years prone positioning has been used increasingly in the treatment of patients with acute respiratory distress syndrome (ARDS) and this manoeuvre is now considered a simple and safe method to improve oxygenation. However, the physiological mechanisms causing respiratory function improvement as well as the real clinical benefit are not yet fully understood. The aim of this review is to discuss the physiological and clinical effects of prone positioning in patients with ARDS.The main physiological aims of prone positioning are: 1) to improve oxygenation; 2) to improve respiratory mechanics; 3) to homogenise the pleural pressure gradient, the alveolar inflation and the ventilation distribution; 4) to increase lung volume and reduce the amount of atelectatic regions; 5) to facilitate the drainage of secretions; and 6) to reduce ventilator-associated lung injury.According to the available data, the authors conclude that: 1) oxygenation improves iny70-80% of patients with early acute respiratory distress syndrome; 2) the beneficial effects of oxygenation reduce after 1 week of mechanical ventilation; 3) the aetiology of acute respiratory distress syndrome may markedly affect the response to prone positioning; 4) extreme care is necessary when the manoeuvre is performed; 5) pressure sores are frequent and related to the number of pronations; 6) the supports used to prone and during positioning are different and nonstandardised among centres; and 7) intensive care unit and hospital stay and mortality still remain high despite prone positioning. Eur Respir J 2002; 20: 1017-1028. Acute respiratory distress syndrome (ARDS) is characterised by radiographical diffuse bilateral infiltrates, decreased respiratory compliance, small lung volumes and severe hypoxaemia. Correction of lifethreatening hypoxia and improvement of respiratory mechanics and lung volumes are the main treatment goals. To achieve these ends, it is important to select the most appropriate means of ventilatory support, thereby minimising the damaging effects of mechanical ventilation. Currently, ventilatory support using small tidal volumes and low plateau pressures and respiratory rate, to control arterial carbon dioxide tension (Pa,CO 2 ) and pH, are considered optimal [1]. Moreover, the application of relatively high levels of positive end-expiratory pressure (PEEP) seems to be beneficial in reducing ventilator-associated lung injury (VALI) and improving survival [2]. In 1974, BRYAN [3] suggested that anaesthetised and paralysed patients in the prone position should exhibit better expansion of the dorsal lung regions with a consequent improvement in oxygenation. In 1976, PIEHL and BROWN [4] showed, in a retrospective study, that the prone position improved oxygenation in five patients with ARDS without deleterious effects. One year later, DOUGLAS et al. [5] demonstrated, in a prospective study with a limited group of ARDS patients, that prone positioning could effectively improve oxygenation in ARDS. Starting from these repor...

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“…However, recent studies have suggested a role for the renin-angiotensin system (RAS) in ARDS and VILI [12,[16][17][18]. While the RAS is well known to have a primary role in the control of salt retention and blood pressure, its role in inflammation and injury suggest that is may be a novel therapeutic option for the treatment of ARDS and VILI.…”

Section: Introductionmentioning

confidence: 99%