Skip to main content
Top
Published in: Respiratory Research 1/2022

Open Access 01-12-2022 | Community-Acquired Pneumonia | Research

Metabolomics profile in acute respiratory distress syndrome by nuclear magnetic resonance spectroscopy in patients with community-acquired pneumonia

Authors: Yongqin Yan, Jianuo Chen, Qian Liang, Hong Zheng, Yiru Ye, Wengang Nan, Xi Zhang, Hongchang Gao, Yuping Li

Published in: Respiratory Research | Issue 1/2022

Login to get access

Abstract

Background

Acute respiratory distress syndrome (ARDS) is a challenging clinical problem. Discovering the potential metabolic alterations underlying the ARDS is important to identify novel therapeutic target and improve the prognosis. Serum and urine metabolites can reflect systemic and local changes and could help understanding metabolic characterization of community-acquired pneumonia (CAP) with ARDS.

Methods

Clinical data of patients with suspected CAP at the First Affiliated Hospital of Wenzhou Medical University were collected from May 2020 to February 2021. Consecutive patients with CAP were enrolled and divided into two groups: CAP with and without ARDS groups. 1H nuclear magnetic resonance-based metabolomics analyses of serum and urine samples were performed before and after treatment in CAP with ARDS (n = 43) and CAP without ARDS (n = 45) groups. Differences metabolites were identifed in CAP with ARDS. Furthermore, the receiver operating characteristic (ROC) curve was utilized to identify panels of significant metabolites for evaluating therapeutic effects on CAP with ARDS. The correlation heatmap was analyzed to further display the relationship between metabolites and clinical characteristics.

Results

A total of 20 and 42 metabolites were identified in the serum and urine samples, respectively. Serum metabolic changes were mainly involved in energy, lipid, and amino acid metabolisms, while urine metabolic changes were mainly involved in energy metabolism. Elevated levels of serum 3-hydroxybutyrate, lactate, acetone, acetoacetate, and decreased levels of serum leucine, choline, and urine creatine and creatinine were detected in CAP with ARDS relative to CAP without ARDS. Serum metabolites 3-hydroxybutyrate, acetone, acetoacetate, citrate, choline and urine metabolite 1-methylnicotinamide were identified as a potential biomarkers for assessing therapeutic effects on CAP with ARDS, and with AUCs of 0.866 and 0.795, respectively. Moreover, the ROC curve analysis revealed that combined characteristic serum and urine metabolites exhibited a better classification system for assessing therapeutic effects on CAP with ARDS, with a AUC value of 0.952. In addition, differential metabolites strongly correlated with clinical parameters in patients with CAP with ARDS.

Conclusions

Serum- and urine-based metabolomics analyses identified characteristic metabolic alterations in CAP with ARDS and might provide promising circulatory markers for evaluating therapeutic effects on CAP with ARDS.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kaku S, Nguyen C, Htet N, Tutera D, Barr J, Paintal H, et al. Acute respiratory distress syndrome: etiology, pathogenesis, and summary on management. J Intensive Care Med. 2020;35(8):723–37.PubMedCrossRef Kaku S, Nguyen C, Htet N, Tutera D, Barr J, Paintal H, et al. Acute respiratory distress syndrome: etiology, pathogenesis, and summary on management. J Intensive Care Med. 2020;35(8):723–37.PubMedCrossRef
2.
go back to reference Ferrarini A, Righetti L, Martínez M, Fernández-López M, Mastrangelo A, Horcajada J, et al. Discriminant biomarkers of acute respiratory distress syndrome associated to H1N1 influenza identified by metabolomics HPLC-QTOF-MS/MS platform. Electrophoresis. 2017;38(18):2341–8.PubMedCrossRef Ferrarini A, Righetti L, Martínez M, Fernández-López M, Mastrangelo A, Horcajada J, et al. Discriminant biomarkers of acute respiratory distress syndrome associated to H1N1 influenza identified by metabolomics HPLC-QTOF-MS/MS platform. Electrophoresis. 2017;38(18):2341–8.PubMedCrossRef
3.
go back to reference Coppola S, Froio S, Marino A, Brioni M, Cesana B, Cressoni M, et al. Respiratory mechanics, lung recruitability, and gas exchange in pulmonary and extrapulmonary acute respiratory distress syndrome. Crit Care Med. 2019;47(6):792–9.PubMedCrossRef Coppola S, Froio S, Marino A, Brioni M, Cesana B, Cressoni M, et al. Respiratory mechanics, lung recruitability, and gas exchange in pulmonary and extrapulmonary acute respiratory distress syndrome. Crit Care Med. 2019;47(6):792–9.PubMedCrossRef
4.
go back to reference Gotts J, Bernard O, Chun L, Croze R, Ross J, Nesseler N, et al. Clinically relevant model of pneumococcal pneumonia, ARDS, and nonpulmonary organ dysfunction in mice. Am J Physiol Lung Cell Mol Physiol. 2019;317(5):L717–36.PubMedPubMedCentralCrossRef Gotts J, Bernard O, Chun L, Croze R, Ross J, Nesseler N, et al. Clinically relevant model of pneumococcal pneumonia, ARDS, and nonpulmonary organ dysfunction in mice. Am J Physiol Lung Cell Mol Physiol. 2019;317(5):L717–36.PubMedPubMedCentralCrossRef
5.
go back to reference Bernard G, Artigas A, Brigham K, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–24.PubMedCrossRef Bernard G, Artigas A, Brigham K, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–24.PubMedCrossRef
6.
go back to reference Chen C, Shi L, Li Y, Wang X, Yang S. Disease-specific dynamic biomarkers selected by integrating inflammatory mediators with clinical informatics in ARDS patients with severe pneumonia. Cell Biol Toxicol. 2016;32(3):169–84.PubMedPubMedCentralCrossRef Chen C, Shi L, Li Y, Wang X, Yang S. Disease-specific dynamic biomarkers selected by integrating inflammatory mediators with clinical informatics in ARDS patients with severe pneumonia. Cell Biol Toxicol. 2016;32(3):169–84.PubMedPubMedCentralCrossRef
8.
go back to reference Siddiqui M, Pandey S, Azim A, Sinha N, Siddiqui M. Metabolomics: an emerging potential approach to decipher critical illnesses. Biophys Chem. 2020;267: 106462.PubMedCrossRef Siddiqui M, Pandey S, Azim A, Sinha N, Siddiqui M. Metabolomics: an emerging potential approach to decipher critical illnesses. Biophys Chem. 2020;267: 106462.PubMedCrossRef
9.
go back to reference Izquierdo-Garcia J, Nin N, Jimenez-Clemente J, Horcajada J, Arenas-Miras M, Gea J, et al. Metabolomic profile of ARDS by nuclear magnetic resonance spectroscopy in patients With H1N1 influenza virus pneumonia. Shock. 2018;50(5):504–10.PubMedCrossRef Izquierdo-Garcia J, Nin N, Jimenez-Clemente J, Horcajada J, Arenas-Miras M, Gea J, et al. Metabolomic profile of ARDS by nuclear magnetic resonance spectroscopy in patients With H1N1 influenza virus pneumonia. Shock. 2018;50(5):504–10.PubMedCrossRef
10.
go back to reference Grassin-Delyle S, Roquencourt C, Moine P, Saffroy G, Carn S, Heming N, et al. Metabolomics of exhaled breath in critically ill COVID-19 patients: A pilot study. EBioMedicine. 2021;63: 103154.PubMedCrossRef Grassin-Delyle S, Roquencourt C, Moine P, Saffroy G, Carn S, Heming N, et al. Metabolomics of exhaled breath in critically ill COVID-19 patients: A pilot study. EBioMedicine. 2021;63: 103154.PubMedCrossRef
11.
go back to reference Cao B, Huang Y, She D, Cheng Q, Fan H, Tian X, et al. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. Clin Respir J. 2018;12(4):1320–60.PubMedCrossRef Cao B, Huang Y, She D, Cheng Q, Fan H, Tian X, et al. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. Clin Respir J. 2018;12(4):1320–60.PubMedCrossRef
12.
go back to reference Lin L, Yan H, Chen J, Xie H, Peng L, Xie T, et al. Application of metabolomics in viral pneumonia treatment with traditional Chinese medicine. Chin Med. 2019;14:8.PubMedPubMedCentralCrossRef Lin L, Yan H, Chen J, Xie H, Peng L, Xie T, et al. Application of metabolomics in viral pneumonia treatment with traditional Chinese medicine. Chin Med. 2019;14:8.PubMedPubMedCentralCrossRef
14.
go back to reference Hardy E, Fernandez-Patron C. Targeting MMP-regulation of inflammation to increase metabolic tolerance to COVID-19 pathologies: a hypothesis. Biomolecules. 2021;11(3):390.PubMedPubMedCentralCrossRef Hardy E, Fernandez-Patron C. Targeting MMP-regulation of inflammation to increase metabolic tolerance to COVID-19 pathologies: a hypothesis. Biomolecules. 2021;11(3):390.PubMedPubMedCentralCrossRef
15.
go back to reference Llibre A, Grudzinska F, O’Shea M, Duffy D, Thickett D, Mauro C, et al. Lactate cross-talk in host-pathogen interactions. Biochem J. 2021;478(17):3157–78.PubMedCrossRef Llibre A, Grudzinska F, O’Shea M, Duffy D, Thickett D, Mauro C, et al. Lactate cross-talk in host-pathogen interactions. Biochem J. 2021;478(17):3157–78.PubMedCrossRef
16.
go back to reference Hu J, Rommereim D, Minard K, Woodstock A, Harrer B, Wind R, et al. Metabolomics in lung inflammation:a high-resolution (1)h NMR study of mice exposedto silica dust. Toxicol Mech Methods. 2008;18(5):385–98.PubMedPubMedCentralCrossRef Hu J, Rommereim D, Minard K, Woodstock A, Harrer B, Wind R, et al. Metabolomics in lung inflammation:a high-resolution (1)h NMR study of mice exposedto silica dust. Toxicol Mech Methods. 2008;18(5):385–98.PubMedPubMedCentralCrossRef
18.
19.
go back to reference Clarke H, Kim D, Meza C, Ormsbee M, Hickner R. The evolving applications of creatine supplementation: could creatine improve vascular health? Nutrients. 2020;12(9):2893.CrossRef Clarke H, Kim D, Meza C, Ormsbee M, Hickner R. The evolving applications of creatine supplementation: could creatine improve vascular health? Nutrients. 2020;12(9):2893.CrossRef
20.
go back to reference Gualano B, Artioli G, Poortmans J, Lancha JA. Exploring the therapeutic role of creatine supplementation. Amino Acids. 2010;38(1):31–44.PubMedCrossRef Gualano B, Artioli G, Poortmans J, Lancha JA. Exploring the therapeutic role of creatine supplementation. Amino Acids. 2010;38(1):31–44.PubMedCrossRef
21.
go back to reference Sadowska-Krępa E, Bańkowski S, Kargul A, Iskra J. Changes in blood antioxidant status in American football players and soccer players over a training macrocycle. J Exerc Sci Fit. 2021;19(4):229–33.PubMedPubMedCentralCrossRef Sadowska-Krępa E, Bańkowski S, Kargul A, Iskra J. Changes in blood antioxidant status in American football players and soccer players over a training macrocycle. J Exerc Sci Fit. 2021;19(4):229–33.PubMedPubMedCentralCrossRef
22.
go back to reference Kumar A, Cordes T, Thalacker-Mercer A, Pajor A, Murphy A, Metallo C. NaCT/SLC13A5 facilitates citrate import and metabolism under nutrient-limited conditions. Cell Rep. 2021;36(11): 109701.PubMedPubMedCentralCrossRef Kumar A, Cordes T, Thalacker-Mercer A, Pajor A, Murphy A, Metallo C. NaCT/SLC13A5 facilitates citrate import and metabolism under nutrient-limited conditions. Cell Rep. 2021;36(11): 109701.PubMedPubMedCentralCrossRef
23.
go back to reference Williams N, O’Neill L. A role for the krebs cycle intermediate citrate in metabolic reprogramming in innate immunity and inflammation. Front Immunol. 2018;9:141.PubMedPubMedCentralCrossRef Williams N, O’Neill L. A role for the krebs cycle intermediate citrate in metabolic reprogramming in innate immunity and inflammation. Front Immunol. 2018;9:141.PubMedPubMedCentralCrossRef
24.
go back to reference Huang L, Wang C, Xu H, Peng G. Targeting citrate as a novel therapeutic strategy in cancer treatment. Biochim Biophys Acta Rev Cancer. 2020;1873(1):188332.PubMedCrossRef Huang L, Wang C, Xu H, Peng G. Targeting citrate as a novel therapeutic strategy in cancer treatment. Biochim Biophys Acta Rev Cancer. 2020;1873(1):188332.PubMedCrossRef
25.
go back to reference Infantino V, Pierri C, Iacobazzi V. Metabolic routes in inflammation: the citrate pathway and its potential as therapeutic target. Curr Med Chem. 2019;26(40):7104–16.PubMedCrossRef Infantino V, Pierri C, Iacobazzi V. Metabolic routes in inflammation: the citrate pathway and its potential as therapeutic target. Curr Med Chem. 2019;26(40):7104–16.PubMedCrossRef
26.
go back to reference Micheli V, Simmonds H, Sestini S, Ricci C. Importance of nicotinamide as an NAD precursor in the human erythrocyte. Arch Biochem Biophys. 1990;283(1):40–5.PubMedCrossRef Micheli V, Simmonds H, Sestini S, Ricci C. Importance of nicotinamide as an NAD precursor in the human erythrocyte. Arch Biochem Biophys. 1990;283(1):40–5.PubMedCrossRef
27.
go back to reference Li F, Chong Z, Maiese K. Cell Life versus cell longevity: the mysteries surrounding the NAD+ precursor nicotinamide. Curr Med Chem. 2006;13(8):883–95.PubMedPubMedCentralCrossRef Li F, Chong Z, Maiese K. Cell Life versus cell longevity: the mysteries surrounding the NAD+ precursor nicotinamide. Curr Med Chem. 2006;13(8):883–95.PubMedPubMedCentralCrossRef
28.
go back to reference Su C, Liu D, Kao S, Chen H. Nicotinamide abrogates acute lung injury caused by ischaemia/reperfusion. Eur Respir J. 2007;30(2):199–204.PubMedCrossRef Su C, Liu D, Kao S, Chen H. Nicotinamide abrogates acute lung injury caused by ischaemia/reperfusion. Eur Respir J. 2007;30(2):199–204.PubMedCrossRef
29.
go back to reference Zhang Q, Li J, Zhong H, Xu Y. The mechanism of nicotinamide on reducing acute lung injury by inhibiting MAPK and NF-κB signal pathway. Molecular Med. 2021;27(1):115.CrossRef Zhang Q, Li J, Zhong H, Xu Y. The mechanism of nicotinamide on reducing acute lung injury by inhibiting MAPK and NF-κB signal pathway. Molecular Med. 2021;27(1):115.CrossRef
30.
go back to reference Moreno-Vinasco L, Quijada H, Sammani S, Siegler J, Letsiou E, Deaton R, et al. Nicotinamide phosphoribosyltransferase inhibitor is a novel therapeutic candidate in murine models of inflammatory lung injury. Am J Respir Cell Mol Biol. 2014;51(2):223–8.PubMedPubMedCentral Moreno-Vinasco L, Quijada H, Sammani S, Siegler J, Letsiou E, Deaton R, et al. Nicotinamide phosphoribosyltransferase inhibitor is a novel therapeutic candidate in murine models of inflammatory lung injury. Am J Respir Cell Mol Biol. 2014;51(2):223–8.PubMedPubMedCentral
31.
go back to reference Zhong O, Wang J, Tan Y, Lei X, Tang Z. Effects of NAD+ precursor supplementation on glucose and lipid metabolism in humans: a meta-analysis. Nutr Metab (Lond). 2022;19(1):20.CrossRef Zhong O, Wang J, Tan Y, Lei X, Tang Z. Effects of NAD+ precursor supplementation on glucose and lipid metabolism in humans: a meta-analysis. Nutr Metab (Lond). 2022;19(1):20.CrossRef
32.
go back to reference MacKay D, Hathcock J, Guarneri E. Niacin: chemical forms, bioavailability, and health effects. Nutr Rev. 2012;70(6):357–66.PubMedCrossRef MacKay D, Hathcock J, Guarneri E. Niacin: chemical forms, bioavailability, and health effects. Nutr Rev. 2012;70(6):357–66.PubMedCrossRef
33.
go back to reference Bizkarguenaga M, Bruzzone C, Gil-Redondo R, SanJuan I, Martin-Ruiz I, Barriales D, et al. Uneven metabolic and lipidomic profiles in recovered COVID-19 patients as investigated by plasma NMR metabolomics. NMR Biomed. 2022;35(2): e4637.PubMedCrossRef Bizkarguenaga M, Bruzzone C, Gil-Redondo R, SanJuan I, Martin-Ruiz I, Barriales D, et al. Uneven metabolic and lipidomic profiles in recovered COVID-19 patients as investigated by plasma NMR metabolomics. NMR Biomed. 2022;35(2): e4637.PubMedCrossRef
34.
go back to reference Fabisiak J, Medvedovic M, Alexander D, McDunn J, Concel V, Bein K, et al. Integrative metabolome and transcriptome profiling reveals discordant energetic stress between mouse strains with differential sensitivity to acrolein-induced acute lung injury. Mol Nutr Food Res. 2011;55(9):1423–34.PubMedPubMedCentralCrossRef Fabisiak J, Medvedovic M, Alexander D, McDunn J, Concel V, Bein K, et al. Integrative metabolome and transcriptome profiling reveals discordant energetic stress between mouse strains with differential sensitivity to acrolein-induced acute lung injury. Mol Nutr Food Res. 2011;55(9):1423–34.PubMedPubMedCentralCrossRef
35.
go back to reference Meidert A, Choukèr A, Praun S, Schelling G, Dolch M. Exhaled breath and oxygenator sweep gas propionaldehyde in acute respiratory distress syndrome. Molecules (Basel, Switzerland). 2020;26(1):145.PubMedCentralCrossRef Meidert A, Choukèr A, Praun S, Schelling G, Dolch M. Exhaled breath and oxygenator sweep gas propionaldehyde in acute respiratory distress syndrome. Molecules (Basel, Switzerland). 2020;26(1):145.PubMedCentralCrossRef
36.
go back to reference Bruzzone C, Bizkarguenaga M, Gil-Redondo R, Diercks T, Arana E, de Vicuña AG, et al. SARS-CoV-2 infection dysregulates the metabolomic and lipidomic profiles of serum. iScience. 2020;23(10):101645.PubMedPubMedCentralCrossRef Bruzzone C, Bizkarguenaga M, Gil-Redondo R, Diercks T, Arana E, de Vicuña AG, et al. SARS-CoV-2 infection dysregulates the metabolomic and lipidomic profiles of serum. iScience. 2020;23(10):101645.PubMedPubMedCentralCrossRef
37.
go back to reference Chiu CY, Lin G, Cheng ML, Chiang MH, Tsai MH, Lai SH, et al. Metabolomic profiling of infectious parapneumonic effusions reveals biomarkers for guiding management of children with streptococcus pneumoniae pneumonia. Sci Rep. 2016;6:24930.PubMedPubMedCentralCrossRef Chiu CY, Lin G, Cheng ML, Chiang MH, Tsai MH, Lai SH, et al. Metabolomic profiling of infectious parapneumonic effusions reveals biomarkers for guiding management of children with streptococcus pneumoniae pneumonia. Sci Rep. 2016;6:24930.PubMedPubMedCentralCrossRef
38.
go back to reference Meoni G, Ghini V, Maggi L, Vignoli A, Mazzoni A, Salvati L, et al. Metabolomic/lipidomic profiling of COVID-19 and individual response to tocilizumab. PLoS Pathog. 2021;17(2): e1009243.PubMedPubMedCentralCrossRef Meoni G, Ghini V, Maggi L, Vignoli A, Mazzoni A, Salvati L, et al. Metabolomic/lipidomic profiling of COVID-19 and individual response to tocilizumab. PLoS Pathog. 2021;17(2): e1009243.PubMedPubMedCentralCrossRef
39.
go back to reference Wang D, Kong J, Wu J, Wang X, Lai M. GC-MS-based metabolomics identifies an amino acid signature of acute ischemic stroke. Neurosci Lett. 2017;642:7–13.PubMedCrossRef Wang D, Kong J, Wu J, Wang X, Lai M. GC-MS-based metabolomics identifies an amino acid signature of acute ischemic stroke. Neurosci Lett. 2017;642:7–13.PubMedCrossRef
40.
go back to reference Ke C, Pan C, Zhang Y, Zhu X, Zhang Y. Metabolomics facilitates the discovery of metabolic biomarkers and pathways for ischemic stroke: a systematic review. Metabolomics. 2019;15(12):152.PubMedCrossRef Ke C, Pan C, Zhang Y, Zhu X, Zhang Y. Metabolomics facilitates the discovery of metabolic biomarkers and pathways for ischemic stroke: a systematic review. Metabolomics. 2019;15(12):152.PubMedCrossRef
41.
go back to reference Zhang S, Zeng X, Ren M, Mao X, Qiao S. Novel metabolic and physiological functions of branched chain amino acids: a review. J Anim Sci Biotechnol. 2017;8:10.PubMedPubMedCentralCrossRef Zhang S, Zeng X, Ren M, Mao X, Qiao S. Novel metabolic and physiological functions of branched chain amino acids: a review. J Anim Sci Biotechnol. 2017;8:10.PubMedPubMedCentralCrossRef
42.
go back to reference Nakamura I. Impairment of innate immune responses in cirrhotic patients and treatment by branched-chain amino acids. World J Gastroenterol. 2014;20(23):7298–305.PubMedPubMedCentralCrossRef Nakamura I. Impairment of innate immune responses in cirrhotic patients and treatment by branched-chain amino acids. World J Gastroenterol. 2014;20(23):7298–305.PubMedPubMedCentralCrossRef
43.
go back to reference Sanchez-Lopez E, Zhong Z, Stubelius A, Sweeney S, Booshehri L, Antonucci L, et al. Choline uptake and metabolism modulate macrophage IL-1β and IL-18 production. Cell Metab. 2019;29(6):1350-62.e7.PubMedPubMedCentralCrossRef Sanchez-Lopez E, Zhong Z, Stubelius A, Sweeney S, Booshehri L, Antonucci L, et al. Choline uptake and metabolism modulate macrophage IL-1β and IL-18 production. Cell Metab. 2019;29(6):1350-62.e7.PubMedPubMedCentralCrossRef
44.
go back to reference Dushianthan A, Cusack R, Koster G, Grocott M, Postle A. Insight into erythrocyte phospholipid molecular flux in healthy humans and in patients with acute respiratory distress syndrome. PLoS ONE. 2019;14(8): e0221595.PubMedPubMedCentralCrossRef Dushianthan A, Cusack R, Koster G, Grocott M, Postle A. Insight into erythrocyte phospholipid molecular flux in healthy humans and in patients with acute respiratory distress syndrome. PLoS ONE. 2019;14(8): e0221595.PubMedPubMedCentralCrossRef
45.
go back to reference Sirniö P, Väyrynen J, Klintrup K, Mäkelä J, Karhu T, Herzig K, et al. Alterations in serum amino-acid profile in the progression of colorectal cancer: associations with systemic inflammation, tumour stage and patient survival. Br J Cancer. 2019;120(2):238–46.PubMedCrossRef Sirniö P, Väyrynen J, Klintrup K, Mäkelä J, Karhu T, Herzig K, et al. Alterations in serum amino-acid profile in the progression of colorectal cancer: associations with systemic inflammation, tumour stage and patient survival. Br J Cancer. 2019;120(2):238–46.PubMedCrossRef
46.
go back to reference Mehta A, Singh B, Arora N, Gaur S. Choline attenuates immune inflammation and suppresses oxidative stress in patients with asthma. Immunobiology. 2010;215(7):527–34.PubMedCrossRef Mehta A, Singh B, Arora N, Gaur S. Choline attenuates immune inflammation and suppresses oxidative stress in patients with asthma. Immunobiology. 2010;215(7):527–34.PubMedCrossRef
49.
go back to reference Malin S, Shavva V, Tarnawski L, Olofsson P. Functions of acetylcholine-producing lymphocytes in immunobiology. Curr Opin Neurobiol. 2020;62:115–21.PubMedCrossRef Malin S, Shavva V, Tarnawski L, Olofsson P. Functions of acetylcholine-producing lymphocytes in immunobiology. Curr Opin Neurobiol. 2020;62:115–21.PubMedCrossRef
Metadata
Title
Metabolomics profile in acute respiratory distress syndrome by nuclear magnetic resonance spectroscopy in patients with community-acquired pneumonia
Authors
Yongqin Yan
Jianuo Chen
Qian Liang
Hong Zheng
Yiru Ye
Wengang Nan
Xi Zhang
Hongchang Gao
Yuping Li
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Respiratory Research / Issue 1/2022
Electronic ISSN: 1465-993X
DOI
https://doi.org/10.1186/s12931-022-02075-w

Other articles of this Issue 1/2022

Respiratory Research 1/2022 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine