Biochemical events associated with pulmonary failure in shock and trauma

Evidence obtained by biochemical analysis of BAL fluids from patients with ARDS indicates that at least 2 important pathogenic events take place in the pulmonary tissues. These are the release of neutrophil elastase and the generation of oxidants. Both events can lead to severe pulmonary injury as has been demonstrated in experimental animals. To better understand the mechanisms of oxidant damaged cells, H2O2 was added to cultured cells. H2O2 compromises a multitude of cellular functions, the combination of which leads to cell death. DNA is an important target for oxidant-induced injury. The formation of DNA strand breaks leads to activation of pADP-RP which in turn causes depletion of NAD and ATP, followed by Ca++ influx and eventually cell lysis. Inhibition of pADP-RP prevented cell lysis, but not DNA damage. A similar sequence of events has been described for cell injury following DNA damage induced by gamma-irradiation and alkylating agents and was proposed to be a suicide mechanism for cells with irreversibly damaged DNA. Sublethal doses of H2O2 will delay cell replication, but not necessarily prevent it.