Evidence mapPaperPMID 41928265Full record

ArticleRespiratory research2026

KL-6 assisted subtyping of ARDS: from subtype-specific metabolomics to LPCAT1 as a pathogenic target.

Xiaowen Wang, Mingshan Xue, Lijun Su, Xian Luo, Youxia Li, Shaohui Fan, Qiurong Hu, Huizhao Liao, Chuci Jiang, Jiahong Chen and 3 more

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Article in Respiratory research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

13 authors.

Xiaowen Wang *Department of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuomolangma Avenue, Doumen District, Zhuhai, Guangdong, 519110, China.
Mingshan Xue *Department of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China.
Lijun SuDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China.
Xian LuoThe First Ward of Neurosurgery Department, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
Youxia LiDepartment of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuomolangma Avenue, Doumen District, Zhuhai, Guangdong, 519110, China.
Shaohui FanDepartment of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuomolangma Avenue, Doumen District, Zhuhai, Guangdong, 519110, China.
Qiurong HuDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China.
Huizhao LiaoDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China.
Chuci JiangDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China.
Jiahong ChenDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China.
Baoqing SunDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China. sunbaoqing@vip.163.com.
Shaoqiang LiDepartment of Clinical Laboratory, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, No. 28, Qiaozhong Middle Road, Liwan District, Guangzhou, Guangdong, 510000, China. lishaoqiang86@163.com.
Hongman WangDepartment of Respiratory and Critical Care Medicine, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuomolangma Avenue, Doumen District, Zhuhai, Guangdong, 519110, China. 2496453591@qq.com.

Funding

Graduate Research Fund of Zunyi Medical University ZYK256Guangzhou Medical University Research Capacity Enhancement Project 2025SRP013Guizhou Provincial Graduate Research Fund 2024YJSKYJJ309National Natural Science Foundation of China 82560024Science and Technology Fund of Guizhou Provincial Health Commission gzwkj2025-241
6 · The paper itself

Abstract

backgroundAcute lung injury (ALI) and the resulting acute respiratory distress syndrome (ARDS) exhibit marked clinical and biological heterogeneity, hindering subtype identification, biomarker discovery, and targeted therapy development. We used untargeted metabolomics to identify serum and bronchoalveolar lavage fluid (BALF) biomarkers across ARDS subtypes and potential therapeutic targets. We introduce a KL-6–assisted refinement of the Berlin Definition to separate patients with similar PaO₂/FiO₂ ratios but differing degrees of alveolar epithelial damage.

methodsWe enrolled 166 participants (137 ARDS, 29 controls). Using the Berlin Definition with KL-6–assisted classification, patients were stratified into common and severe subtypes. Serum metabolomes were compared between ARDS and controls and between subtypes; paired serum–BALF profiles characterized systemic vs. pulmonary features. Overlapping metabolites from four comparisons informed target prediction (SwissTargetPrediction, GeneCards), followed by in vitro and in vivo validation in LPS models.

resultsSerum profiles and pathway enrichment differed between ARDS and controls and between subtypes. The severe subtype was enriched in fatty-acid oxidation, dicarboxylic acids, and phospholipid remodeling. Three serum metabolites discriminated severe from other less severe ARDS subtypes (AUC > 0.8). This 3-metabolite panel achieved AUC 0.917 in 10-fold cross-validation. Paired analyses showed predominant systemic alterations with subtype-specific BALF signatures; five BALF metabolites were specific to the severe subtype and correlated with KL-6, oxygenation, inflammation, and CT scores. Five shared LysoPCs highlighted LPCAT1 as the top target. LPS upregulated LPCAT1, and this effect was partially reversed by TAK-242, a TLR4 inhibitor. Knockdown of LPCAT1 reduced inflammatory cytokine and MUC1 (KL-6) release in cell culture supernatants.

conclusionKL-6–assisted subtyping reveals distinct systemic and pulmonary metabolic signatures. Three serum metabolites provide evidence that justifies KL-6 as a marker of epithelial-injury–informed ARDS classification, and our results suggest that LPCAT1 is a promising therapeutic target for ARDS.

Indexed as

1-Acylglycerophosphocholine O-AcyltransferaseMetabolomicsMucin-1Respiratory Distress SyndromeAdultAgedAnimalsBiomarkersBronchoalveolar Lavage FluidFemaleHumansMaleMiddle Aged1-Acylglycerophosphocholine O-AcyltransferaseBiomarkersMUC1 protein, humanMucin-1ARDSKL-6LPCAT1MetabolomicsSubtype classification

Identifiers

PMID41928265
PMCPMC13169525

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.