Disease-modifying treatment of chemical threat agent-induced acute lung injury

Ann N Y Acad Sci. 2020 Nov;1480(1):14-29. doi: 10.1111/nyas.14438. Epub 2020 Jul 29.


Acute respiratory distress syndrome (ARDS) is a highly morbid lung pathology induced by exposure to chemical warfare agents, including vesicants, phosgene, chlorine, and ricin. In this review, we describe the pathology associated with the development of ARDS in humans and experimental models of acute lung injury following animal exposure to these high-priority threat agents. Potential future approaches to disease-modifying treatment used in preclinical animal studies, including antioxidants, anti-inflammatories, biologics, and mesenchymal stem cells, are also described. As respiratory pathologies, including ARDS, are the major cause of morbidity and mortality following exposure to chemical threat agents, understanding mechanisms of disease pathogenesis is key to the development of efficacious therapeutics beyond the primary intervention principle, which remains mechanical ventilation.

Keywords: acute respiratory distress syndrome; chemical warfare agents; inflammation; mustards; oxidative stress.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Anti-Inflammatory Agents / therapeutic use*
  • Antioxidants / therapeutic use*
  • Chemical Warfare Agents / poisoning*
  • Humans
  • Respiration, Artificial*
  • Respiratory Distress Syndrome / chemically induced
  • Respiratory Distress Syndrome / metabolism
  • Respiratory Distress Syndrome / pathology
  • Respiratory Distress Syndrome / therapy*


  • Anti-Inflammatory Agents
  • Antioxidants
  • Chemical Warfare Agents