The Prognostic Value of Extracellular Matrix Component Concentrations in Serum During Treatment of Adult Respiratory Distress Syndrome with Extracorporeal CO2 Removal

Abstract

Summary:The time-dependent concentrations of hyaluronan, aminoterminal propeptide of type III procollagen, and laminin were determined in sera of 16 patients with severe adult respiratory distress syndrome during treatment with an extracorporeal CO 2 removal device. Patients were classified according to lung Parameters äs responders (n = 10) and non-responders (n = 6) to extracorporeal CO 2 removal. At the beginning of treatment strongly elevated serum concentrations of all studied extracellular matrix components were found. During the first 6-11 days of treatment the concentrations of aminoterminal propeptide of type III procollagen and hyaluronan increased further in non-responders but decreased in the majority of responders, while laminin decreased in both groups. No significant correlations were found between the serum concentrations of connective tissue components and the parameters of lung function. By non-parametric analysis of variance, significant differences between responders and non-responders according to treatment time could be established. By analysing the time course of the serum concentrations of hyaluronan and aminoterminal propeptide of type III procollagen, a total differentiation between responders and nonresponders was made pössible by the trends of these analytes äs early äs three days after the Start of treatment. The determination of aminoterminal propeptide of type III procollagen and hyaluronan in serum of patients with adult respiratory distress syndrome might therefore have prognostic significance in extracorporeal CO 2 removal. unfavourable rapid development of pulmonary fibroThe adult respiratory distress syndrome is a severe sis within about 2 weeks (5, 6), characterized by an condition of life-threatening organ failure, character-increase in fibroblast numbers and accelerated collaized by tachypnoea, hypoxaemia, diffuse interstitial gen metabolism (7,8). mfiltrates, alveolar oedema, and loss of lung compliance (l, 2). The syndrome develops in response to a Components of the extracellular matrix have been primary attack on lung cells like inhalation of toxins, determined in blood of patients with fibrotic lung aspiration of gastric contents (3) or äs a consequence diseases, but in contrast to e. g. liver fibrosis there of systemicdisorders like septicshock and multiorgan seems to be only a weak association between the trauma. Severe, progressive cases are associated with concentrations of such analytes in blood and the a mortality rate of up to 90% (4). One sequel of adult activity and/or grade of the fibrosing process in the respiratory distress syndrome is the prognostically lung (9).

The Role of Hyaluronan Synthase 3 in Ventilator-induced Lung Injury

“…A high BAL HA level in ARDS was also found by Modig and Hallgren (30). In patients with ARDS treated with an extracorporeal CO 2 removal device, Kropf and colleagues (31) found that there was a sustained increase of serum HA level in those who did not respond to therapy. However, the molecular weight of HA was not measured in these experiments, and the exact role of different-sized HA remains unknown.…”

The role of the host defence response in the progression and outcome of ARDS: pathophysiological correlations and response to glucocorticoid treatment

“…In nonsurvivors, the collagen content of the lung is increased two-to threefold after 2 weeks of ARDS and parallels the development of fibrosis [7]. Patients with ARDS dying after 7 days of respiratory failure have, in contrast to survivors, persistent elevation of extracellular matrix components (procollagen III) in the BAL and serum, indicating ongoing fibrogenesis [77,[128][129][130]. Patients with a procollagen III level greater than 1.75 U·mL -1 in BAL on day 7 had a 72% mortality rate compared with a 20% mortality rate in patients with a procollagen III level less than 1.75 U·mL -1 [131].…”

Higher urine desmosine levels are associated with mortality in patients with acute lung injury

“…Elevations of extracellular matrix proteins such as procollagen type I, procollagen type III, hyaluronan, and laminin have been reported in the bronchoalveolar lavage and pulmonary edema fluid of patients with ALI implicating damage to the extracellular matrix (4,15,18).…”