sirolimus and Pulmonary-Edema

Topics: Acute Lung Injury; Aged; Fatal Outcome; Fever; Humans; Immunosuppressive Agents; Male; Pulmonary Edema; Sirolimus

Hantaviruses in the Americas cause a highly lethal acute pulmonary edema termed hantavirus pulmonary syndrome (HPS). Hantaviruses nonlytically infect microvascular and lymphatic endothelial cells and cause dramatic changes in barrier functions without disrupting the endothelium. Hantaviruses cause changes in the function of infected endothelial cells that normally regulate fluid barrier functions. The endothelium of arteries, veins, and lymphatic vessels are unique and central to the function of vast pulmonary capillary beds that regulate pulmonary fluid accumulation.. We have found that HPS-causing hantaviruses alter vascular barrier functions of microvascular and lymphatic endothelial cells by altering receptor and signaling pathway responses that serve to permit fluid tissue influx and clear tissue edema. Infection of the endothelium provides several mechanisms for hantaviruses to cause acute pulmonary edema, as well as potential therapeutic targets for reducing the severity of HPS disease.. Here we discuss interactions of HPS-causing hantaviruses with the endothelium, roles for unique lymphatic endothelial responses in HPS, and therapeutic targeting of the endothelium as a means of reducing the severity of HPS disease.

Topics: Animals; Antibodies; Capillary Permeability; Cricetinae; Endothelial Cells; Fingolimod Hydrochloride; Hantavirus Pulmonary Syndrome; Host-Pathogen Interactions; Humans; Immunosuppressive Agents; Mesocricetus; Orthohantavirus; Propylene Glycols; Pulmonary Edema; Signal Transduction; Sirolimus; Sphingosine; Vascular Endothelial Growth Factor Receptor-2

In this study we describe 3 single lung transplant recipients who developed unilateral pulmonary edema in the setting of cardiac and renal dysfunction. All 3 patients responded to diuresis with clinical and radiographic improvement. Unilateral cardiogenic pulmonary edema should be considered in the differential diagnosis of dyspnea and unilateral radiographic infiltrates in single lung transplant recipients.

Topics: Angioplasty, Balloon, Coronary; Coronary Artery Disease; Echocardiography, Doppler; Female; Humans; Immunosuppressive Agents; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Pulmonary Edema; Radiography, Thoracic; Sirolimus; Tacrolimus; Treatment Outcome; Tuberous Sclerosis

Drug-eluting stents are widely used to prevent restenosis after coronary angioplasty. We here report a case of stent thrombosis within a sirolimus-eluting stent occurring two years after stent implantation, while the patient was on chronic aspirin therapy. The patient presented with acute ST-elevation myocardial infarction and pulmonary oedema; stent thrombosis was successfully treated with coronary angioplasty and deployment of a new coronary stent. This case suggests that long-term follow-up is needed in clinical studies on drug-eluting stents.

Topics: Aged; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Restenosis; Drug Delivery Systems; Female; Humans; Myocardial Infarction; Pulmonary Edema; Sirolimus; Stents; Thrombosis