This study of the ROSE trial data explored two distinct molecular subtypes of ARDS (Acute Respiratory Distress Syndrome) to better understand the disease's complexity and potential for personalized treatment. Previous studies had identified different inflammatory profiles in ARDS patients, with this research addressing three key questions: <ol><li>Can these molecular subtypes be consistently identified in a more severe group of ARDS patients? </li><li>Do these subtypes respond differently to neuromuscular blockade treatment? </li><li>What specific biological processes differentiate these inflammatory profiles? </li></ol> Advanced transcriptomic and protein analyses examined blood samples from ARDS patients. Analysis of these data revealed two main molecular phenotypes: <ul><li>Hypoinflammatory phenotype (60.4% of patients) </li><li>Hyperinflammatory phenotype (39.6% of patients) </li></ul> Key findings demonstrated that the hyperinflammatory subtype was associated with:Significantly higher mortality rates relative to hypoinflammatory (61.6% vs. 30.3%)<ul><li>Significantly higher mortality rates relative to hypoinflammatory (61.6% vs. 30.3%)</li><li>Distinct gene expression patterns related to immune response</li><li>Unique changes in genes associated with tissue remodeling and cellular processes </li></ul> Notably, the neuromuscular blockade treatment showed no difference in effects across these subtypes. Complex relationships emerged between gene expression and protein levels, with some genes closely matching their protein counterparts and others displaying more variable connections. The study concludes that these molecular phenotypes possess distinct clinical, protein, and genetic characteristics, suggesting potential for more precise, personalized approaches to ARDS treatment in the future.

Re-Evaluation of Systemic Early Neuromuscular Blockade

Molecular Phenotypes of ARDS in the ROSE Trial have Differential Outcomes and Gene Expression Patterns That Differ at Baseline and Longitudinally Over Time.