Age-dependent differences in pulmonary host responses in ARDS: a prospective observational cohort study
Schouten, Laura R.; van Kaam, Anton H.; Kohse, Franziska; Veltkamp, Floor; Bos, Lieuwe D.; de Beer, Friso M.; van Hooijdonk, Roosmarijn T.; Horn, Janneke; Straat, Marleen; Witteveen, Esther; Glas, Gerie J.; Wieske, Luuk; van Vught, Lonneke A.; Wiewel, Maryse A.; Ingelse, Sarah A.; Cortjens, Bart; van Woensel, Job B.; Bos, Albert P.; Walther, Thomas; Schultz, Marcus J.; Wösten-van Asperen, Roelie M.; de Beer, Friso M.; Bos, Lieuwe D.; Glas, Gerie J.; Horn, Janneke; Hoogendijk, Arie J.; van Hooijdonk, Roosmarijn T.; Huson, Mischa A.; van der Poll, Tom; Scicluna, Brendon; Schouten, Laura R.; Schultz, Marcus J.; Straat, Marleen; van Vught, Lonneke A.; Wieske, Luuk; Wiewel, Maryse A.; Witteveen, Esther; Bonten, Marc J.; Cremer, Olaf L.; Frencken, Jos F.; van de Groep, Kirsten; Klein Klouwenberg, Peter M.; Koster-Brouwer, Maria E.; Ong, David S.; Verboom, Diana M.; for the MARS consortium
(2019) Annals of Intensive Care, volume 9, issue 1, pp.
(Article)
Abstract
Background: Results from preclinical studies suggest that age-dependent differences in host defense and the pulmonary renin–angiotensin system (RAS) are responsible for observed differences in epidemiology of acute respiratory distress syndrome (ARDS) between children and adults. The present study compares biomarkers of host defense and RAS in bronchoalveolar lavage (BAL) fluid
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from neonates, children, adults, and older adults with ARDS. Methods: In this prospective observational study, we enrolled mechanical ventilated ARDS patients categorized into four age groups: 20 neonates (< 28 days corrected postnatal age), 29 children (28 days–18 years), 26 adults (18–65 years), and 17 older adults (> 65 years of age). All patients underwent a nondirected BAL within 72 h after intubation. Activities of the two main enzymes of RAS, angiotensin converting enzyme (ACE) and ACE2, and levels of biomarkers of inflammation, endothelial activation, and epithelial damage were determined in BAL fluid. Results: Levels of myeloperoxidase, interleukin (IL)-6, IL-10, and p-selectin were higher with increasing age, whereas intercellular adhesion molecule-1 was higher in neonates. No differences in activity of ACE and ACE2 were seen between the four age groups. Conclusions: Age-dependent differences in the levels of biomarkers in lungs of ARDS patients are present. Especially, higher levels of markers involved in the neutrophil response were found with increasing age. In contrast to preclinical studies, age is not associated with changes in the pulmonary RAS.
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Keywords: ARDS, Angiotensin converting enzyme, Pathophysiology, Aging, Host response, Biomarkers, Critical Care and Intensive Care Medicine, Journal Article
ISSN: 2110-5820
Publisher: Springer-Verlag GmbH and Co. KG
Note: Funding Information: LRAS is supported by a research grant (PhD Scholarship) of the Academic Medical Center, Amsterdam, The Netherlands. FK and TW were supported by a grant of the Deutsche Forschungsgemeinschaft (WA1441/22‑2). This work was supported by grant 041‑201 from Center for Translational Molecular Medicine (CTMM) (http://www.ctmm.nl) for the Molecular Diagnosis and Risk stratifica‑ tion of Sepsis (MARS) project. Funding Information: MARS consortium members: Amsterdam University Medican Centers, Amsterdam, The Netherlands: Friso M. de Beer, Lieuwe D. Bos, Gerie J. Glas, Janneke Horn, Arie J. Hoogendijk, Roosmarijn T. van Hooijdonk, Mischa A. Huson, Tom van der Poll, Brendon Scicluna, Laura R. Schouten, Marcus J. Schultz, Marleen Straat, Lonneke A. van Vught, Luuk Wieske, Maryse A. Wiewel, and Esther Witteveen. University Medical Center Utrecht, Utrecht, The Netherlands: Marc J. Bonten, Olaf L. Cremer, Jos F. Frencken, Kirsten van de Groep, Peter M. Klein Klouwenberg, Maria E. Koster-Brouwer, David S. Ong, and Diana M. Verboom. Publisher Copyright: © 2019, The Author(s).
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