Renin-angiotensin-system, a potential pharmacological candidate, in acute respiratory distress syndrome during mechanical ventilation

Di Wang; Xiao-Qing Chai; Costan G Magnussen; Graeme R Zosky; Shu-Hua Shu; Xin Wei; Shan-Shan Hu

doi:10.1016/j.pupt.2019.101833

Renin-angiotensin-system, a potential pharmacological candidate, in acute respiratory distress syndrome during mechanical ventilation

Pulm Pharmacol Ther. 2019 Oct:58:101833. doi: 10.1016/j.pupt.2019.101833. Epub 2019 Aug 1.

Authors

Di Wang¹, Xiao-Qing Chai², Costan G Magnussen³, Graeme R Zosky⁴, Shu-Hua Shu¹, Xin Wei¹, Shan-Shan Hu⁵

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Anhui Provincial Hospital, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, 230001, Anhui, China.
² Department of Anesthesiology and Pain Medicine, Anhui Provincial Hospital, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, 230001, Anhui, China. Electronic address: [email protected].
³ Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, 7001, Tasmania, Australia; Research Centre of Applied and Preventive Cardiovascular Research, University of Turku, Turku, 20520, Finland.
⁴ Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, 7001, Tasmania, Australia; School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, 7001, Tasmania, Australia.
⁵ Institute of Clinical Pharmacology, Anhui Medical University, Hefei, 230032, Anhui, China.

Abstract

While effective treatments for acute respiratory distress syndrome (ARDS) are lacking, mechanical lung ventilation can sustain adequate gas exchange in critically ill patients with respiratory failure due to ARDS. However, as a result of the phenomenon of ventilator-induced lung injury (VILI), there is an increasing need to seek beneficial pharmacological therapies for ARDS. Recent studies have suggested the renin-angiotensin system (RAS), which consists of the ACE/Ang-II/AT1R axis and ACE2/Ang-(1-7)/MasR axis, plays a dual role in the pathogenesis of ARDS and VILI. This review highlights the deleterious action of ACE/Ang-II/AT1R axis and the beneficial role of ACE2/Ang-(1-7)/MasR axis, as well as AT2R, in VILI and ARDS, and also discusses the possibility of targeting RAS components with pharmacological interventions to improve outcomes in ARDS.

Keywords: Acute respiratory distress syndrome (ARDS); Mechanical ventilation; Renin-angiotensin system (RAS); Ventilator-induced lung injury (VILI).

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Animals
Humans
Proto-Oncogene Mas
Renin-Angiotensin System / drug effects*
Respiration, Artificial / adverse effects*
Respiratory Distress Syndrome / pathology
Respiratory Distress Syndrome / prevention & control
Respiratory Distress Syndrome / therapy*
Ventilator-Induced Lung Injury / drug therapy*
Ventilator-Induced Lung Injury / pathology
Ventilator-Induced Lung Injury / prevention & control