Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)
are the clinical manifestations of severe lung damage and respiratory failure.
Characterized by severe inflammation and compromised lung function, ALI/ARDS
result in very high mortality of affected individuals. Currently, there are no
effective treatments for ALI/ARDS, and ironically, therapies intended to aid
patients (specifically mechanical ventilation, MV) may aggravate the symptoms.
Key events contributing to the development of ALI/ARDS are: increased oxidative
and proteotoxic stresses, unresolved inflammation, and compromised
alveolar-capillary barrier function. Since the airways and lung tissues are
constantly exposed to gaseous oxygen and airborne toxicants, the bronchial and
alveolar epithelial cells are under higher oxidative stress than other tissues.
Cellular protection against oxidative stress and xenobiotics is mainly conferred
by Nrf2, a transcription factor that promotes the expression of genes that
regulate oxidative stress, xenobiotic metabolism and excretion, inflammation,
apoptosis, autophagy, and cellular bioenergetics. Numerous studies have
demonstrated the importance of Nrf2 activation in the protection against
ALI/ARDS, as pharmacological activation of Nrf2 prevents the occurrence or
mitigates the severity of ALI/ARDS. Another promising new therapeutic strategy
in the prevention and treatment of ALI/ARDS is the activation of autophagy, a
bulk protein and organelle degradation pathway. In this review, we will discuss
the strategy of concerted activation of Nrf2 and autophagy as a preventive and
therapeutic intervention to ameliorate ALI/ARDS.