Anti-inflammatory therapies for acute respiratory distress syndrome

ABSTRACT

Introduction

Treatments for the acute respiratory distress syndrome (ARDS) are mainly supportive, and ventilatory management represents a key approach in these patients. Despite progress in pharmacotherapy, anti-inflammatory strategies for the treatment of ARDS have shown controversial results. Positive outcomes with pharmacologic and nonpharmacologic treatments have been found in two different biological subphenotypes of ARDS, suggesting that, with a personalized medicine approach, pharmacotherapy for ARDS can be effective.

Areas covered

This article reviews the literature concerning anti-inflammatory therapies for ARDS, focusing on pharmacological and stem-cell therapies, including extracellular vesicles.

Expert Opinion

Despite advances, ARDS treatments remain primarily supportive. Ventilatory and fluid management are important strategies in these patients that have demonstrated significant impacts on outcome. Anti-inflammatory drugs have shown some benefits, primarily in preclinical research and in specific clinical scenarios, but no recommendations are available from guidelines to support their use in patients with ARDS, except in particular settings such as different subphenotypes, specific etiologies, or clinical trials. Personalized medicine seems promising insofar as it may identify specific subgroups of patients with ARDS who may benefit from anti-inflammatory treatment. However, additional efforts are needed to move subphenotype characterization from bench to bedside.

KEYWORDS:

• Acute respiratory distress syndrome
• mechanical ventilation
• inflammation
• personalized pharmacological therapy
• corticosteroids
• ARDS

Article highlights

• Inflammation is one of the key processes of ARDS and is a current target of preclinical and clinical studies alike.

• All pharmacotherapies are still investigational, whereas supportive therapies are key for the management of patients with ARDS.

• Anti-inflammatory therapies have shown some benefit, primarily in preclinical settings or specific clinical scenarios.

• Personalized medicine focusing on subphenotypes may add important insights to ARDS pharmacotherapy in the near future.

Acknowledgments

The authors would like to express their gratitude to Moira Elizabeth Shottler and Filippe Vasconcellos for editing assistance.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

DB, IGI, and PRMR wrote the manuscript. CR, LB, PLS, FFC, PRMR edited the manuscript for intellectual content.

Additional information

Funding

This study was supported by the Brazilian Council for Scientific and Technological Development (CNPq) 443824/2018-5, 403485/2020-7, 408124/2021-0,, the Rio de Janeiro State Research Foundation (FAPERJ) E-26/010.001488/2019, and National Institute of Science and Technology for Regenerative Medicine 465656/2014-5.