Pathophysiology of The Acute Respiratory Distress Syndrome: Insights from Clinical Studies

Sinha, Pratik; Bos, Lieuwe D.

Acute respiratory distress syndrome (ARDS) is a heterogeneous clinical syndrome that manifests secondary to numerous aetiological insults and consequently it is associated with a multitude of pathophysiological abnormalities. Despite over 50 years of experimental studies, translation of these benchside discoveries into effective biological therapies has been elusive. Recent advances in high throughput biological sampling, imaging and advances in data analytics has allowed studying ARDS in human subjects based on pragmatic studies. In this review, we present some of the key advances made in our knowledge of the pathophysiology of ARDS, based on histopathology, imaging, protein and transcriptomic biomarkers. Finally, we review the role of such human studies in understanding the pathophysiology of COVID-19 related ARDS. As the pandemic evolves, it is becoming increasingly clear that our knowledge of the pathophysiological drivers in both COVID-19 and non-COVID-19 ARDS is incomplete. Systematic and large-scale data collection that is multi-dimensional and includes samples from several anatomical compartments and over several timepoints is key to unlocking the great systems biology puzzle that is ARDS.