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Periarterial Leukocyte Accumulation in Allergic Airway Inflammation

We very much appreciate Dr. Eisenhut's interest in our manuscript (1) and comments about the role of nuclear factor (NF)-B on proinflammatory cytokine expression and alveolar fluid clearance in acute lung injury. However, while abnormal epithelial function and the resultant development of pulmonary edema are clearly important pathogenic events in acute lung injury, other processes, such as those involving neutrophil accumulation in the lungs, alveolar macrophage activation, and endothelial dysfunction, are also likely to contribute to the severity of pulmonary dysfunction and clinical outcome in this setting. Correcting alterations in epithelial function is an appropriate target for interventional trials in acute lung injury, and will be addressed by the inhaled -agonist trial soon to be initiated by the NIH ARDS Network. Nevertheless, additional therapies not specifically directed to epithelial dysfunction may also be effective in improving outcome from acute lung injury. Modulating the increased activation of NF-B that is present among the lung cell populations that participate in inducing lung injury remains a potential approach to diminishing the pulmonary and extrapulmonary organ dysfunction associated with sepsis and other causes of acute lung injury.

Edward Abraham

University of Alabama at Birmingham Birmingham, Alabama

FOOTNOTES

Conflict of Interest Statement: E.A. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Arcaroli J, Silva E, Maloney JP, He Q, Svetkauskaite D, Murphy JR, Abraham E. Variant IRAK-1 haplotype is associated with increased nuclear factor-B activation and worse outcomes in sepsis. Am J Respir Crit Care Med 2006;173:1335–1341.[Abstract/Free Full Text]

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