Rizzo Alicia N, Aggarwal Neil R, Thompson B Taylor, Schmidt Eric P
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02144, USA.
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
J Clin Med. 2023 Feb 16;12(4):1563. doi: 10.3390/jcm12041563.
Acute respiratory distress syndrome (ARDS) is a common and life-threatening cause of respiratory failure. Despite decades of research, there are no effective pharmacologic therapies to treat this disease process and mortality remains high. The shortcomings of prior translational research efforts have been increasingly attributed to the heterogeneity of this complex syndrome, which has led to an increased focus on elucidating the mechanisms underlying the interpersonal heterogeneity of ARDS. This shift in focus aims to move the field towards personalized medicine by defining subgroups of ARDS patients with distinct biology, termed endotypes, to quickly identify patients that are most likely to benefit from mechanism targeted treatments. In this review, we first provide a historical perspective and review the key clinical trials that have advanced ARDS treatment. We then review the key challenges that exist with regards to the identification of treatable traits and the implementation of personalized medicine approaches in ARDS. Lastly, we discuss potential strategies and recommendations for future research that we believe will aid in both understanding the molecular pathogenesis of ARDS and the development of personalized treatment approaches.
急性呼吸窘迫综合征（ARDS）是导致呼吸衰竭的常见且危及生命的病因。尽管经过数十年研究，但仍没有有效的药物疗法来治疗这一疾病过程，死亡率依然很高。先前转化研究工作的不足越来越多地归因于这种复杂综合征的异质性，这导致人们越来越关注阐明ARDS个体间异质性背后的机制。这种关注点的转变旨在通过定义具有不同生物学特征的ARDS患者亚组（称为内型），推动该领域向个性化医学发展，以便快速识别最有可能从针对机制的治疗中获益的患者。在本综述中，我们首先提供历史视角并回顾推动ARDS治疗发展的关键临床试验。然后，我们回顾在ARDS中识别可治疗特征和实施个性化医学方法方面存在的关键挑战。最后，我们讨论未来研究的潜在策略和建议，我们认为这些将有助于理解ARDS的分子发病机制以及个性化治疗方法的开发。
