Surfactant and Matrix Metalloproteinase 3 in the Pathogenesis of Acute Lung Injury

Acute lung injury (ALI) is a pulmonary inflammatory disorder resulting in respiratory failure that is initiated by a number of different insults to the lung. Despite very high mortality, there are still no effective treatments for this disease, and the main supportive therapy, mechanical ventilation, can further lung injury and contribute to ALI progression. The overall objective of this work was therefore to evaluate the role of two key players in the disease process, such as: i) lung surfactant, a material essential for minimizing the work of breathing and for pulmonary immunomodulation, and ii) matrix metalloproteinase 3 (MMP-3), protease involved in the inflammatory response associated with ALI. The experimental approach consisted of exposing mice to different models of ALI, in order to investigate: i) the effects of exogenous surfactant administration on injury progression, ii) the role of MMP-3 in the pulmonary inflammatory response and iii) MMP-3 role in the surfactant alterations associated with ALI. The findings from this work underline the importance of a functional surfactant system in supporting the mechanics of breathing following lung injury. The data also illustrate that MMP-3 is an important contributor to the pulmonary inflammation associated with ALI. This exciting evidence has broadened the knowledge of ALI pathophysiology and identified a potential new therapeutic target –MMP-3- that could help improve the outcome of patients with this condition

Nephro-oncology: a link in evolution

A multidisciplinary approach represents the best method to interact with patients. Neoplastic and renal diseases are closely related to each other because of an increased risk of cancer among individuals with end-stage renal disease and because of the high prevalence of renal failure in cancer patients. Physicians should be able to know how to prevent and treat the possible complications which may appear during the course of neoplastic disease that may lead to kidney damage such as the Acute Tumor Lysis Syndrome, disorders of hydroelectrolitic balance, metabolic alterations in the calcium-phosphorus, anemia, interstitial and glomerular impairment due to chemotherapy. It is very important to know patients' renal function and directly monitor it, before and during treatment, using formulas for estimating glomerular filtration rate (GFR) and above all, specific biomarkers are more early and sensitive than the increase of creatinine, like neutrophil gelatinase-associated lipocalin. Additionally, physician should consider that alteration of GFR or substitutive renal treatments severely influence dosage of tumor markers and it could lead to wrong diagnosis of cancer. The aim of this article is to provide a review of problems related to cancer relevant in the development of renal failure and try to define the best therapeutic strategies to cope with possible kidney imbalances induced by cancer or its treatment