title: Activated protein C in the treatment of acute lung injury and acute respiratory distress syndrome.
abstract: BACKGROUND
  Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) frequently necessitate mechanical ventilation in the intensive care unit. The syndromes have a high mortality rate and there is at present no treatment specifically directed at the underlying pathogenesis. Central in the pathophysiology of ALI/ARDS is alveolocapillary inflammation leading to permeability edema. As a result of the crosstalk between inflammation and coagulation, activation of proinflammatory and procoagulant/antifibrinolytic pathways contributes to disruption of the endothelial barrier. Protein C (PC) plays a central role in maintaining the equilibrium between coagulation and inflammation. Additionally, natural anticoagulants, such as PC, are depleted, both in blood as well as in the lung. Therefore, the PC system is of interest as a therapeutic target in patients with ALI/ARDS.
  
  
  METHODS
  This review is based on a Medline search of relevant basic and clinical studies.
  
  
  OBJECTIVE
  It discusses the potential role of activated PC in modulating the proinflammatory/procoagulant state for enhancing endothelial barrier function in animal models and human ALI/ARDS.
authors.affiliation: Department of Intensive Care, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands +31 20 4443933 ; +31 20 4442392 ; cornet@vumc.nl.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Cornet
authors.forename: Geerten P
authors.initials: GP
authors.lastname: van Nieuw Amerongen
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: Armand Rj
authors.initials: AR
authors.lastname: Girbes
authors.forename: Ab Johan
authors.initials: AJ
authors.lastname: Groeneveld