We request support for investigations aimed at understanding the pathogenesis and pathophysiology of pulmonary edema and lung injury and developing diagnostic tools and therapies which will improve the care of patients with ARDS. Proposed studies will address the cell biology, immunology, biochemistry, morphology and physiology of lung injury in several laboratory models and in patients. We will study the pathogenesis of lung injury produced by endotoxin, hyperoxia and irradiation. We propose that endothelial injury is an initial event common to these forms of lung injury and that the resulting alterations in endothelial structure or function trigger an inflammatory response which compounds the injury. The direct endothelial injury is postulated to involve toxic oxygen metabolites, proteinase/antiproteinase imbalance and alterations in endothelial cyclic nucleotide metabolism. We suggest that neutrophols, lymphocytes and macrophages participate in the response by directly affecting lung cells and by altering cell-cell interactions through humoral mediators, including eicosanoids and platelet activating factor (PAF). Production of mediators by endothelial cells may also alter their communications with inflammatory cells. These hypotheses will be investigated in sheep and in in vitro preparations in which the same insults are studied and the two kinds of information integrated. In isolated lungs and animals, we will study physical factors affecting normal and abnormal lung fluid balance and vascular function. We will develop methods for on-line measurements of pulmonary vascular functions, including permeability and free radical generation and test those methods in animals with the goal of applying them to humans. In humans undergoing hemodialysis and humans with ARDS, we will further investigate single pass indicator methods as tools for understanding lung dysfunction and predicting outcome; and we will conduct clinical trials of novel pharmacologic therapies. In patients with ARDS, we will determine the role of reversible bronchoconstriction in gas exchange and investigate the mechanics of interactions of patients with mechanical ventilators in order to develop improved ventilator therapy. This program will provide information spanning a spectrum from basic investigations to clinical studies which will provide new insights into mechanisms of lung failure and new approaches to prevention and therapy in patients with diffuse lung injury.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Specialized Center (P50)
Project #
5P50HL019153-13
Application #
3106545
Study Section
(SRC)
Project Start
1976-12-01
Project End
1991-11-30
Budget Start
1988-12-01
Budget End
1989-11-30
Support Year
13
Fiscal Year
1989
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Type
Schools of Medicine
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37203
Brigham, K L; Lane, K B; Meyrick, B et al. (2000) Transfection of nasal mucosa with a normal alpha1-antitrypsin gene in alpha1-antitrypsin-deficient subjects: comparison with protein therapy. Hum Gene Ther 11:1023-32
Conner, B D; Bernard, G R (2000) Acute respiratory distress syndrome. Potential pharmacologic interventions. Clin Chest Med 21:563-87
Mangialardi, R J; Martin, G S; Bernard, G R et al. (2000) Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med 28:3137-45
Brigham, K L; Stecenko, A A (2000) Gene therapy for acute lung injury. Intensive Care Med 26 Suppl 1:S119-23
Arons, M M; Wheeler, A P; Bernard, G R et al. (1999) Effects of ibuprofen on the physiology and survival of hypothermic sepsis. Ibuprofen in Sepsis Study Group. Crit Care Med 27:699-707
Peters, M T; Brigham, K L; King, G A et al. (1999) Optimization of cationic liposome-mediated gene transfer to human bronchial epithelial cells expressing wild-type or abnormal cystic fibrosis transmembrane conductance regulator (CFTR). Exp Lung Res 25:183-97
Wheeler, A P; Bernard, G R (1999) Treating patients with severe sepsis. N Engl J Med 340:207-14
Snapper, J R; Trochtenberg, D S; Hwang, Y S et al. (1999) Effect of pulmonary edema on tracheal diameter. Respiration 66:522-7
Dupont, W D; Plummer Jr, W D (1998) Power and sample size calculations for studies involving linear regression. Control Clin Trials 19:589-601
Clark, M P; Chow, C W; Rinaldo, J E et al. (1998) Multiple domains for initiator binding proteins TFII-I and YY-1 are present in the initiator and upstream regions of the rat XDH/XO TATA-less promoter. Nucleic Acids Res 26:2813-20

Showing the most recent 10 out of 202 publications