We compared therapeutic properties of natural and engineered chemokine (C-X-C motif) receptor 4 (CXCR4) agonists in a rat acute respiratory distress syndrome (ARDS) model utilizing the PaO 2 /fio 2ratio as a clinically relevant primary outcome criterion. Ventilated rats underwent unilateral lung ischemia from t = 0-70 min plus hemorrhage to a mean arterial blood pressure (MAP) of 30 mmHg from t = 40-70 min, followed by reperfusion/fluid resuscitation until t = 300 min. Natural CXCR4 agonists (CXCL12, ubiquitin) and engineered CXCL12 variants (CXCL12 1 , CXCL2 2 , CXCL12K27A/R41A/R47A, CXCL12 (3-68)) were administered within 5 min of fluid resuscitation. Animals treated with vehicle or CXCL12 (3-68) reached criteria for mild and moderate ARDS between t = 90-120 min and t = 120-180 min, respectively, and remained in moderate ARDS until t = 300 min. Ubiquitin, CXCL12, CXCL12 1 and CXCL12 2 prevented ARDS development. Potencies of CXCL12/CXCL12 1 /CXCL12 2 were higher than the potency of ubiquitin. CXCL12K27A/R41A/R47A was inefficacious. CXCL12 1 > CXCL12 stabilized MAP and reduced fluid requirements. CXCR4 agonists at doses that preserved lung function reduced histological injury of the post-ischemic lung and reduced mortality from 55 to 9%. Our findings suggest that CXCR4 protein agonists prevent development of ARDS and reduce mortality in a rat model, and that development of new engineered protein therapeutics with improved pharmacological properties for ARDS is possible. Acute respiratory distress syndrome (ARDS) remains a major contributor to morbidity and mortality in trauma patients. Although the incidence of ARDS in trauma patients has decreased in the last decade, mortality from ARDS has increased 1. The treatment of ARDS is currently limited to supportive therapy and lung-protective ventilation strategies. Drugs that attenuate development and progression of ARDS are not available, but highly desirable for their potential to improve outcomes. Several lines of evidence suggest that natural and synthetic agonists of chemokine (C-X-C motif) receptor 4 (CXCR4) protect lung endothelial barrier function and have lung protective properties in animal models 2-11. We showed previously that treatment with the non-cognate CXCR4 agonist ubiquitin protects lung endothelial barrier function during resuscitation from hemorrhagic shock and prevents development of ARDS in pre-clinical lung ischemia-reperfusion injury, endotoxemia and polytrauma models 2,5,6,10. The therapeutic potential of the