So, "The scientific rationale for targeting GM-CSF in patients with ARDS is gaining strength. The initial injury response or exudative phase of ARDS is characterised by release of potent proinflammatory mediators, including GM-CSF, monocyte chemoattractant protein 1 (CCL2), IL-1a, IL-8, and TNF secreted by resident alveolar macrophages, leading to recruitment of neutrophils and monocytes. Neutrophils have been strongly implicated in the development of ARDS40 by acting as primary effector cells of bystander tissue injury through release of proteinases, reactive oxygen species, and neutrophil extracellular traps; recent reports have also highlighted the role of neutrophil extracellular traps in COVID-19.41, 42 Moreover, the extent, duration, and priming status of neutrophils in alveolar airspaces are strong predictors of outcome in ARDS.25 Alveolar GM-CSF contributes to acute and persistent neutrophilic inflammation by affecting neutrophil function, including promoting upregulation of the IgA Fc receptor, formyl peptide receptor (FPR1), CD11b, and expression of the leukotriene B4 receptor; chemotaxis, phagocytosis, release of leukotriene B4 and arachidonic acid, NADPH oxidase 2 (CYBB)-mediated superoxide anion generation; and by exerting a pronounced prosurvival effect mediated by phosphoinositide 3-kinase (PI3K)-dependent inhibition of neutrophil apoptosis."
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