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Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Research article

TIP peptide inhalation in experimental acute lung injury: effect of repetitive dosage and different synthetic variants

Authors: Erik K Hartmann, Rainer Thomas, Tanghua Liu, Joanna Stefaniak, Alexander Ziebart, Bastian Duenges, Daniel Eckle, Klaus Markstaller, Matthias David

Published in: BMC Anesthesiology | Issue 1/2014

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Abstract

Background

Inhalation of TIP peptides that mimic the lectin-like domain of TNF-α is a novel approach to attenuate pulmonary oedema on the threshold to clinical application. A placebo-controlled porcine model of acute respiratory distress syndrome (ARDS) demonstrated a reduced thermodilution-derived extravascular lung water index (EVLWI) and improved gas exchange through TIP peptide inhalation within three hours. Based on these findings, the present study compares a single versus a repetitive inhalation of a TIP peptide (TIP-A) and two alternate peptide versions (TIP-A, TIP-B).

Methods

Following animal care committee approval ARDS was induced by bronchoalveolar lavage followed by injurious ventilation in 21 anaesthetized pigs. A randomised-blinded three-group setting compared the single-dosed peptide variants TIP-A and TIP-B as well as single versus repetitive inhalation of TIP-A (n = 7 per group). Over two three-hour intervals parameters of gas exchange, transpulmonary thermodilution, calculated alveolar fluid clearance, and ventilation/perfusion-distribution were assessed. Post-mortem measurements included pulmonary wet/dry ratio and haemorrhage/congestion scoring.

Results

The repetitive TIP-A inhalation led to a significantly lower wet/dry ratio than a single dose and a small but significantly lower EVLWI. However, EVLWI changes over time and the derived alveolar fluid clearance did not differ significantly. The comparison of TIP-A and B showed no relevant differences. Gas exchange and ventilation/perfusion-distribution significantly improved in all groups without intergroup differences. No differences were found in haemorrhage/congestion scoring.

Conclusions

In comparison to a single application the repetitive inhalation of a TIP peptide in three-hour intervals may lead to a small additional reduction the lung water content. Two alternate TIP peptide versions showed interchangeable characteristics.
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Literature
1.
go back to reference Matthay MA, Zemans RL: The acute respiratory distress syndrome: pathogenesis and treatment. Annu Rev Pathol. 2011, 6: 147-163. 10.1146/annurev-pathol-011110-130158.CrossRefPubMedPubMedCentral Matthay MA, Zemans RL: The acute respiratory distress syndrome: pathogenesis and treatment. Annu Rev Pathol. 2011, 6: 147-163. 10.1146/annurev-pathol-011110-130158.CrossRefPubMedPubMedCentral
2.
go back to reference Matthay MA, Wiener-Kronish JP: Intact epithelial barrier function is critical for the resolution of alveolar edema in humans. Am Rev Respir Dis. 1990, 142 (6 Pt 1): 1250-1257.CrossRefPubMed Matthay MA, Wiener-Kronish JP: Intact epithelial barrier function is critical for the resolution of alveolar edema in humans. Am Rev Respir Dis. 1990, 142 (6 Pt 1): 1250-1257.CrossRefPubMed
3.
go back to reference Yang G, Hamacher J, Gorshkov B, White R, Sridhar S, Verin A, Chakraborty T, Lucas R: The dual role of TNF in Pulmonary Edema. J Cardiovasc Dis Res. 2011, 1 (1): 29-36.CrossRef Yang G, Hamacher J, Gorshkov B, White R, Sridhar S, Verin A, Chakraborty T, Lucas R: The dual role of TNF in Pulmonary Edema. J Cardiovasc Dis Res. 2011, 1 (1): 29-36.CrossRef
4.
go back to reference Ware LB, Matthay MA: Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001, 163 (6): 1376-1383. 10.1164/ajrccm.163.6.2004035.CrossRefPubMed Ware LB, Matthay MA: Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001, 163 (6): 1376-1383. 10.1164/ajrccm.163.6.2004035.CrossRefPubMed
5.
go back to reference Zemans RL, Matthay MA: Bench-to-bedside review: the role of the alveolar epithelium in the resolution of pulmonary edema in acute lung injury. Crit Care. 2004, 8 (6): 469-477. 10.1186/cc2906.CrossRefPubMedPubMedCentral Zemans RL, Matthay MA: Bench-to-bedside review: the role of the alveolar epithelium in the resolution of pulmonary edema in acute lung injury. Crit Care. 2004, 8 (6): 469-477. 10.1186/cc2906.CrossRefPubMedPubMedCentral
6.
go back to reference Bastarache JA, Ong T, Matthay MA, Ware LB: Alveolar fluid clearance is faster in women with acute lung injury compared to men. J Crit Care. 2011, 26 (3): 249-256. 10.1016/j.jcrc.2010.06.005.CrossRefPubMed Bastarache JA, Ong T, Matthay MA, Ware LB: Alveolar fluid clearance is faster in women with acute lung injury compared to men. J Crit Care. 2011, 26 (3): 249-256. 10.1016/j.jcrc.2010.06.005.CrossRefPubMed
7.
go back to reference Matthay MA: Alveolar fluid clearance in patients with ARDS: does it make a difference?. Chest. 2002, 122 (6 Suppl): 340S-343S.CrossRefPubMed Matthay MA: Alveolar fluid clearance in patients with ARDS: does it make a difference?. Chest. 2002, 122 (6 Suppl): 340S-343S.CrossRefPubMed
9.
go back to reference Dagenais A, Frechette R, Yamagata Y, Yamagata T, Carmel JF, Clermont ME, Brochiero E, Masse C, Berthiaume Y: Downregulation of ENaC activity and expression by TNF-alpha in alveolar epithelial cells. Am J Physiol Lung Cell Mol Physiol. 2004, 286 (2): L301-L311. 10.1152/ajplung.00326.2002.CrossRefPubMed Dagenais A, Frechette R, Yamagata Y, Yamagata T, Carmel JF, Clermont ME, Brochiero E, Masse C, Berthiaume Y: Downregulation of ENaC activity and expression by TNF-alpha in alveolar epithelial cells. Am J Physiol Lung Cell Mol Physiol. 2004, 286 (2): L301-L311. 10.1152/ajplung.00326.2002.CrossRefPubMed
10.
go back to reference Elia N, Tapponnier M, Matthay MA, Hamacher J, Pache JC, Brundler MA, Totsch M, De Baetselier P, Fransen L, Fukuda N, Morel DR, Lucas R: Functional identification of the alveolar edema reabsorption activity of murine tumor necrosis factor-alpha. Am J Respir Crit Care Med. 2003, 168 (9): 1043-1050. 10.1164/rccm.200206-618OC.CrossRefPubMed Elia N, Tapponnier M, Matthay MA, Hamacher J, Pache JC, Brundler MA, Totsch M, De Baetselier P, Fransen L, Fukuda N, Morel DR, Lucas R: Functional identification of the alveolar edema reabsorption activity of murine tumor necrosis factor-alpha. Am J Respir Crit Care Med. 2003, 168 (9): 1043-1050. 10.1164/rccm.200206-618OC.CrossRefPubMed
11.
go back to reference Hamacher J, Stammberger U, Roux J, Kumar S, Yang G, Xiong C, Schmid RA, Fakin RM, Chakraborty T, Hossain HM, Pittet JF, Wendel A, Black SM, Lucas R: The lectin-like domain of tumor necrosis factor improves lung function after rat lung transplantation–potential role for a reduction in reactive oxygen species generation. Crit Care Med. 2010, 38 (3): 871-878. 10.1097/CCM.0b013e3181cdf725.CrossRefPubMedPubMedCentral Hamacher J, Stammberger U, Roux J, Kumar S, Yang G, Xiong C, Schmid RA, Fakin RM, Chakraborty T, Hossain HM, Pittet JF, Wendel A, Black SM, Lucas R: The lectin-like domain of tumor necrosis factor improves lung function after rat lung transplantation–potential role for a reduction in reactive oxygen species generation. Crit Care Med. 2010, 38 (3): 871-878. 10.1097/CCM.0b013e3181cdf725.CrossRefPubMedPubMedCentral
12.
go back to reference Vadasz I, Schermuly RT, Ghofrani HA, Rummel S, Wehner S, Muhldorfer I, Schafer KP, Seeger W, Morty RE, Grimminger F, Weissmann N: The lectin-like domain of tumor necrosis factor-alpha improves alveolar fluid balance in injured isolated rabbit lungs. Crit Care Med. 2008, 36 (5): 1543-1550. 10.1097/CCM.0b013e31816f485e.CrossRefPubMed Vadasz I, Schermuly RT, Ghofrani HA, Rummel S, Wehner S, Muhldorfer I, Schafer KP, Seeger W, Morty RE, Grimminger F, Weissmann N: The lectin-like domain of tumor necrosis factor-alpha improves alveolar fluid balance in injured isolated rabbit lungs. Crit Care Med. 2008, 36 (5): 1543-1550. 10.1097/CCM.0b013e31816f485e.CrossRefPubMed
13.
go back to reference Xiong C, Yang G, Kumar S, Aggarwal S, Leustik M, Snead C, Hamacher J, Fischer B, Umapathy NS, Hossain H, Wendel A, Catravas JD, Verin AD, Fulton D, Black SM, Chakraborty T, Lucas R: The lectin-like domain of TNF protects from listeriolysin-induced hyperpermeability in human pulmonary microvascular endothelial cells - a crucial role for protein kinase C-alpha inhibition. Vascul Pharmacol. 2010, 52 (5–6): 207-213.CrossRefPubMedPubMedCentral Xiong C, Yang G, Kumar S, Aggarwal S, Leustik M, Snead C, Hamacher J, Fischer B, Umapathy NS, Hossain H, Wendel A, Catravas JD, Verin AD, Fulton D, Black SM, Chakraborty T, Lucas R: The lectin-like domain of TNF protects from listeriolysin-induced hyperpermeability in human pulmonary microvascular endothelial cells - a crucial role for protein kinase C-alpha inhibition. Vascul Pharmacol. 2010, 52 (5–6): 207-213.CrossRefPubMedPubMedCentral
14.
go back to reference Hartmann EK, Boehme S, Duenges B, Bentley A, Klein KU, Kwiecien R, Shi C, Szczyrba M, David M, Markstaller K: An inhaled tumor necrosis factor-alpha-derived TIP peptide improves the pulmonary function in experimental lung injury. Acta Anaesthesiol Scand. 2013, 57 (3): 334-341. 10.1111/aas.12034.CrossRefPubMed Hartmann EK, Boehme S, Duenges B, Bentley A, Klein KU, Kwiecien R, Shi C, Szczyrba M, David M, Markstaller K: An inhaled tumor necrosis factor-alpha-derived TIP peptide improves the pulmonary function in experimental lung injury. Acta Anaesthesiol Scand. 2013, 57 (3): 334-341. 10.1111/aas.12034.CrossRefPubMed
15.
go back to reference Hazemi P, Tzotzos SJ, Fischer B, Andavan GS, Fischer H, Pietschmann H, Lucas R, Lemmens-Gruber R: Essential structural features of TNF-alpha lectin-like domain derived peptides for activation of amiloride-sensitive sodium current in A549 cells. J Med Chem. 2010, 53 (22): 8021-8029. 10.1021/jm100767p.CrossRefPubMedPubMedCentral Hazemi P, Tzotzos SJ, Fischer B, Andavan GS, Fischer H, Pietschmann H, Lucas R, Lemmens-Gruber R: Essential structural features of TNF-alpha lectin-like domain derived peptides for activation of amiloride-sensitive sodium current in A549 cells. J Med Chem. 2010, 53 (22): 8021-8029. 10.1021/jm100767p.CrossRefPubMedPubMedCentral
16.
go back to reference Shabbir W, Scherbaum-Hazemi P, Tzotzos S, Fischer B, Fischer H, Pietschmann H, Lucas R, Lemmens-Gruber R: Mechanism of action of novel lung edema therapeutic AP301 by activation of the epithelial sodium channel. Mol Pharmacol. 2013, 84 (6): 899-910. 10.1124/mol.113.089409.CrossRefPubMedPubMedCentral Shabbir W, Scherbaum-Hazemi P, Tzotzos S, Fischer B, Fischer H, Pietschmann H, Lucas R, Lemmens-Gruber R: Mechanism of action of novel lung edema therapeutic AP301 by activation of the epithelial sodium channel. Mol Pharmacol. 2013, 84 (6): 899-910. 10.1124/mol.113.089409.CrossRefPubMedPubMedCentral
17.
go back to reference Hartmann EK, Boehme S, Bentley A, Duenges B, Klein KU, Elsaesser A, Baumgardner JE, David M, Markstaller K: Influence of respiratory rate and end-expiratory pressure variation on cyclic alveolar recruitment in an experimental lung injury model. Crit Care. 2012, 16 (1): R8-10.1186/cc11147.CrossRefPubMedPubMedCentral Hartmann EK, Boehme S, Bentley A, Duenges B, Klein KU, Elsaesser A, Baumgardner JE, David M, Markstaller K: Influence of respiratory rate and end-expiratory pressure variation on cyclic alveolar recruitment in an experimental lung injury model. Crit Care. 2012, 16 (1): R8-10.1186/cc11147.CrossRefPubMedPubMedCentral
18.
go back to reference Garcia-Delgado M, Touma-Fernandez A, Chamorro-Marin V, Ruiz-Aguilar A, Aguilar-Alonso E, Fernandez-Mondejar E: Alveolar fluid clearance in healthy pigs and influence of positive end-expiratory pressure. Crit Care. 2010, 14 (2): R36-10.1186/cc8914.CrossRefPubMedPubMedCentral Garcia-Delgado M, Touma-Fernandez A, Chamorro-Marin V, Ruiz-Aguilar A, Aguilar-Alonso E, Fernandez-Mondejar E: Alveolar fluid clearance in healthy pigs and influence of positive end-expiratory pressure. Crit Care. 2010, 14 (2): R36-10.1186/cc8914.CrossRefPubMedPubMedCentral
19.
go back to reference Lim CM, Hong SB, Koh Y, Lee SD, Kim WS, Kim DS, Kim WD: Hypothermia attenuates vascular manifestations of ventilator-induced lung injury in rats. Lung. 2003, 181 (1): 23-34. 10.1007/s00408-002-0111-x.CrossRefPubMed Lim CM, Hong SB, Koh Y, Lee SD, Kim WS, Kim DS, Kim WD: Hypothermia attenuates vascular manifestations of ventilator-induced lung injury in rats. Lung. 2003, 181 (1): 23-34. 10.1007/s00408-002-0111-x.CrossRefPubMed
20.
go back to reference Matute-Bello G, Frevert CW, Martin TR: Animal models of acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2008, 295 (3): L379-L399. 10.1152/ajplung.00010.2008.CrossRefPubMedPubMedCentral Matute-Bello G, Frevert CW, Martin TR: Animal models of acute lung injury. Am J Physiol Lung Cell Mol Physiol. 2008, 295 (3): L379-L399. 10.1152/ajplung.00010.2008.CrossRefPubMedPubMedCentral
21.
go back to reference Wang HM, Bodenstein M, Markstaller K: Overview of the pathology of three widely used animal models of acute lung injury. Eur Surg Res. 2008, 40 (4): 305-316. 10.1159/000121471.CrossRefPubMed Wang HM, Bodenstein M, Markstaller K: Overview of the pathology of three widely used animal models of acute lung injury. Eur Surg Res. 2008, 40 (4): 305-316. 10.1159/000121471.CrossRefPubMed
22.
go back to reference Wang HM, Bodenstein M, Duenges B, Ganatti S, Boehme S, Ning Y, Roehrig B, Markstaller K: Ventilator-associated lung injury superposed to Oleic Acid Infusion or Surfactant Depletion: Histopathological characteristics of two porcine models of acute lung injury. Eur Surg Res. 2010, 45 (3–4): 121-133.CrossRefPubMed Wang HM, Bodenstein M, Duenges B, Ganatti S, Boehme S, Ning Y, Roehrig B, Markstaller K: Ventilator-associated lung injury superposed to Oleic Acid Infusion or Surfactant Depletion: Histopathological characteristics of two porcine models of acute lung injury. Eur Surg Res. 2010, 45 (3–4): 121-133.CrossRefPubMed
23.
go back to reference Ballard-Croft C, Wang D, Sumpter LR, Zhou X, Zwischenberger JB: Large-animal models of acute respiratory distress syndrome. Ann Thorac Surg. 2012, 93 (4): 1331-1339. 10.1016/j.athoracsur.2011.06.107.CrossRefPubMed Ballard-Croft C, Wang D, Sumpter LR, Zhou X, Zwischenberger JB: Large-animal models of acute respiratory distress syndrome. Ann Thorac Surg. 2012, 93 (4): 1331-1339. 10.1016/j.athoracsur.2011.06.107.CrossRefPubMed
24.
go back to reference Hartmann EK, Bentley A, Duenges B, Klein KU, Boehme S, Markstaller K, David M: TIP peptide inhalation in oleic acid-induced experimental lung injury: a post-hoc comparison. BMC Res Notes. 2013, 6: 385-10.1186/1756-0500-6-385.CrossRefPubMedPubMedCentral Hartmann EK, Bentley A, Duenges B, Klein KU, Boehme S, Markstaller K, David M: TIP peptide inhalation in oleic acid-induced experimental lung injury: a post-hoc comparison. BMC Res Notes. 2013, 6: 385-10.1186/1756-0500-6-385.CrossRefPubMedPubMedCentral
25.
go back to reference Tzotzos S, Fischer B, Fischer H, Pietschmann H, Lucas R, Dupre G, Lemmens-Gruber R, Hazemi P, Prymaka V, Shabbir W: AP301, a synthetic peptide mimicking the lectin-like domain of TNF, enhances amiloride-sensitive Na(+) current in primary dog, pig and rat alveolar type II cells. Pulm Pharmacol Ther. 2013, 26 (3): 356-363. 10.1016/j.pupt.2012.12.011.CrossRefPubMedPubMedCentral Tzotzos S, Fischer B, Fischer H, Pietschmann H, Lucas R, Dupre G, Lemmens-Gruber R, Hazemi P, Prymaka V, Shabbir W: AP301, a synthetic peptide mimicking the lectin-like domain of TNF, enhances amiloride-sensitive Na(+) current in primary dog, pig and rat alveolar type II cells. Pulm Pharmacol Ther. 2013, 26 (3): 356-363. 10.1016/j.pupt.2012.12.011.CrossRefPubMedPubMedCentral
26.
go back to reference Graham MR, Gulati H, Kha L, Girling LG, Goertzen A, Mutch WA: Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury. Can J Anaesth. 2011, 58 (8): 740-750. 10.1007/s12630-011-9517-3.CrossRefPubMed Graham MR, Gulati H, Kha L, Girling LG, Goertzen A, Mutch WA: Resolution of pulmonary edema with variable mechanical ventilation in a porcine model of acute lung injury. Can J Anaesth. 2011, 58 (8): 740-750. 10.1007/s12630-011-9517-3.CrossRefPubMed
27.
28.
go back to reference Neumann P, Hedenstierna G: Ventilation-perfusion distributions in different porcine lung injury models. Acta Anaesthesiol Scand. 2001, 45 (1): 78-86. 10.1034/j.1399-6576.2001.450113.x.CrossRefPubMed Neumann P, Hedenstierna G: Ventilation-perfusion distributions in different porcine lung injury models. Acta Anaesthesiol Scand. 2001, 45 (1): 78-86. 10.1034/j.1399-6576.2001.450113.x.CrossRefPubMed
29.
go back to reference Luecke T, Roth H, Herrmann P, Joachim A, Weisser G, Pelosi P, Quintel M: PEEP decreases atelectasis and extravascular lung water but not lung tissue volume in surfactant-washout lung injury. Intensive Care Med. 2003, 29 (11): 2026-2033. 10.1007/s00134-003-1906-9.CrossRefPubMed Luecke T, Roth H, Herrmann P, Joachim A, Weisser G, Pelosi P, Quintel M: PEEP decreases atelectasis and extravascular lung water but not lung tissue volume in surfactant-washout lung injury. Intensive Care Med. 2003, 29 (11): 2026-2033. 10.1007/s00134-003-1906-9.CrossRefPubMed
30.
go back to reference Hartmann EK, Duenges B, Baumgardner JE, Markstaller K, David M: Correlation of thermodilution-derived extravascular lung water and ventilation/perfusion-compartments in a porcine model. Intensive Care Med. 2013, 39 (7): 1313-1317. 10.1007/s00134-013-2915-y.CrossRefPubMed Hartmann EK, Duenges B, Baumgardner JE, Markstaller K, David M: Correlation of thermodilution-derived extravascular lung water and ventilation/perfusion-compartments in a porcine model. Intensive Care Med. 2013, 39 (7): 1313-1317. 10.1007/s00134-013-2915-y.CrossRefPubMed
31.
go back to reference Schwameis R, Eder S, Pietschmann H, Fischer B, Mascher H, Tzotzos S, Fischer H, Lucas R, Zeitlinger M, Hermann R: A FIM study to assess safety and exposure of inhaled single doses of AP301-A specific ENaC channel activator for the treatment of acute lung injury. J Clin Pharmacol. 2014, 54 (3): 341-350. 10.1002/jcph.203.CrossRefPubMedPubMedCentral Schwameis R, Eder S, Pietschmann H, Fischer B, Mascher H, Tzotzos S, Fischer H, Lucas R, Zeitlinger M, Hermann R: A FIM study to assess safety and exposure of inhaled single doses of AP301-A specific ENaC channel activator for the treatment of acute lung injury. J Clin Pharmacol. 2014, 54 (3): 341-350. 10.1002/jcph.203.CrossRefPubMedPubMedCentral
32.
go back to reference Easley RB, Mulreany DG, Lancaster CT, Custer JW, Fernandez-Bustamante A, Colantuoni E, Simon BA: Redistribution of pulmonary blood flow impacts thermodilution-based extravascular lung water measurements in a model of acute lung injury. Anesthesiology. 2009, 111 (5): 1065-1074. 10.1097/ALN.0b013e3181bc99cf.CrossRefPubMedPubMedCentral Easley RB, Mulreany DG, Lancaster CT, Custer JW, Fernandez-Bustamante A, Colantuoni E, Simon BA: Redistribution of pulmonary blood flow impacts thermodilution-based extravascular lung water measurements in a model of acute lung injury. Anesthesiology. 2009, 111 (5): 1065-1074. 10.1097/ALN.0b013e3181bc99cf.CrossRefPubMedPubMedCentral
34.
go back to reference Grasso S, Stripoli T, Sacchi M, Trerotoli P, Staffieri F, Franchini D, De Monte V, Valentini V, Pugliese P, Crovace A, Driessen B, Fiore T: Inhomogeneity of lung parenchyma during the open lung strategy: a computed tomography scan study. Am J Respir Crit Care Med. 2009, 180 (5): 415-423. 10.1164/rccm.200901-0156OC.CrossRefPubMed Grasso S, Stripoli T, Sacchi M, Trerotoli P, Staffieri F, Franchini D, De Monte V, Valentini V, Pugliese P, Crovace A, Driessen B, Fiore T: Inhomogeneity of lung parenchyma during the open lung strategy: a computed tomography scan study. Am J Respir Crit Care Med. 2009, 180 (5): 415-423. 10.1164/rccm.200901-0156OC.CrossRefPubMed
35.
go back to reference Retamal J, Libuy J, Jimenez M, Delgado M, Besa C, Bugedo G, Bruhn A: Preliminary study of ventilation with 4 ml/kg tidal volume in acute respiratory distress syndrome: feasibility and effects on cyclic recruitment - derecruitment and hyperinflation. Crit Care. 2013, 17 (1): R16-10.1186/cc12487.CrossRefPubMedPubMedCentral Retamal J, Libuy J, Jimenez M, Delgado M, Besa C, Bugedo G, Bruhn A: Preliminary study of ventilation with 4 ml/kg tidal volume in acute respiratory distress syndrome: feasibility and effects on cyclic recruitment - derecruitment and hyperinflation. Crit Care. 2013, 17 (1): R16-10.1186/cc12487.CrossRefPubMedPubMedCentral
36.
go back to reference Fehrenbach A, Fehrenbach H, Wittwer T, Ochs M, Wahlers T, Richter J: Evaluation of pulmonary edema: stereological versus gravimetrical analysis. Eur Surg Res. 2001, 33 (4): 270-278. 10.1159/000049717.CrossRefPubMed Fehrenbach A, Fehrenbach H, Wittwer T, Ochs M, Wahlers T, Richter J: Evaluation of pulmonary edema: stereological versus gravimetrical analysis. Eur Surg Res. 2001, 33 (4): 270-278. 10.1159/000049717.CrossRefPubMed
Metadata
Title
TIP peptide inhalation in experimental acute lung injury: effect of repetitive dosage and different synthetic variants
Authors
Erik K Hartmann
Rainer Thomas
Tanghua Liu
Joanna Stefaniak
Alexander Ziebart
Bastian Duenges
Daniel Eckle
Klaus Markstaller
Matthias David
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-42

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