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Clara Cell Protein CC16: A New Lung Epithelial Biomarker for Acute Lung Injury

Danny F. McAuley, MD; Michael A. Matthay, MD, FCCP
Author and Funding Information

Correspondence to: Michael A. Matthay, MD, FCCP, Cardiovascular Research Institute, University of California at San Francisco, 505 Parnassus Ave, M-917, San Francisco, CA 94143-0624; e-mail: michael.matthay@ucsf.edu

Dr. McAuley is Senior Lecturer and Consultant in Intensive Care Medicine, Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Microbiology Building, Queen's University of Belfast.

Dr. Matthay is Professor of Medicine and Anesthesia and is Senior Associate at the Cardiovascular Research Institute, University of California at San Francisco.


The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1408-1410. doi:10.1378/chest.09-0304
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Extract

There has been considerable interest in the contribution of lung epithelial injury to the pathogenesis of acute lung injury (ALI). Injury to the alveolar epithelium leads to alveolar edema, a decrease in surfactant activity, a reduction in alveolar fluid clearance, and more procoagulant and antifibrinolytic activity in the distal airspaces of the lung.13 One approach to estimating the degree of lung epithelial injury has been to measure plasma and airspace biomarkers of alveolar epithelial injury in patients with ALI. In addition to providing more insight into pathogenesis, biomarkers of lung epithelial injury may also have diagnostic value for differentiating cardiogenic edema from primary lung injury edema, particularly since the diagnostic criteria for ALI,4 bilateral chest radiographic infiltrates with arterial hypoxemia (PaO2/FiO2 ratio, < 300), are often present in patients with acute respiratory failure from cardiogenic edema as well as in patients with ALI.5 Also, elevated lung microvascular pressure often coexists in patients with ALI, as has been reported in the ARDS Network Fluid and Catheter Treatment Trial,6 in which 29% of patients in whom ALI had been diagnosed had a pulmonary artery wedge pressure of > 18 mm Hg. Thus, a biomarker that helps to make the diagnosis of ALI would be valuable to both guide clinical management as well as to define a more homogenous patient cohort for clinical trials of ALI.

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