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Oxidant-Antioxidant Balance in Acute Lung Injury^*

From the Departments of Anesthesiology (Drs. Lang, McArdle, and Matalon) and Medicine (Dr. O’Reilly), Division of Pulmonary and Critical Care Medicine School of Medicine, University of Alabama at Birmingham, Birmingham, AL.

Correspondence to: Sadis Matalon, PhD, Department of Anesthesiology, University of Alabama at Birmingham, 1530 Third Ave South, BMR2 224, Birmingham, AL 35294-2172; e-mail: Sadis.Matalon{at}ccc.uab.edu

ARDS is a disease process that is characterized by diffuse inflammation in the lung parenchyma. The involvement of inflammatory mediators in ARDS has been the subject of intense investigation,^{1 2} and oxidant-mediated tissue injury is likely to be important in the pathogenesis of ARDS.³ In response to various inflammatory stimuli, lung endothelial cells, alveolar cells, and airway epithelial cells, as well as activated alveolar macrophages, produce both nitric oxide and superoxide, which may react to form peroxynitrite, which can nitrate and oxidize key amino acids in various lung proteins, such as surfactant protein A, and inhibit their functions. The nitration and oxidation of a variety of crucial proteins present in the alveolar space have been shown to be associated with diminished function in vitro and also have been identified ex vivo in proteins sampled from patients with acute lung injury (ALI)/ARDS. Various enzymes and low-molecular-weight scavengers that are present in the lung tissue and alveolar lining fluid decreased the concentration of these toxic species. The purpose of this brief chapter is to review the results from various studies demonstrating increased levels of reactive oxygen-nitrogen intermediates in the alveolar spaces of patients with ALI/ARDS.

Key Words: acute lung injury • alveolar epithelium • antioxidants • nitric oxide • nitrotyrosine • superoxide • surfactant protein A

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