{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:27Z","timestamp":1787028927490,"version":"build-2736575974"},"reference-count":274,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Acute respiratory distress syndrome (ARDS) remains a leading cause of morbidity and mortality in critically ill patients despite advances in supportive care and lung-protective ventilation. The syndrome is characterized by biological heterogeneity involving epithelial and endothelial injury, dysregulated inflammation, surfactant dysfunction, and impaired alveolar\u2013capillary barrier integrity. This review integrates experimental, translational, and clinical evidence to examine the biological and molecular basis underlying ARDS, with particular emphasis on alveolar\u2013capillary architecture, immune dysregulation, pulmonary mechanics, and the temporal evolution of diffuse alveolar damage. We further discuss emerging concepts in ARDS phenotyping and biomarker-based stratification as tools to address therapeutic heterogeneity and improve prognostic precision. Collectively, the evidence supports a shift from syndromic management toward biologically informed, precision-based approaches that may enable targeted interventions and improved clinical outcomes in ARDS.<\/jats:p>","DOI":"10.3390\/medsci14010134","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T12:59:44Z","timestamp":1773406784000},"page":"134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Current Insights into Clinical, Molecular, and Therapeutic Approaches to Acute Respiratory Distress Syndrome"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5477-3256","authenticated-orcid":false,"given":"Manuel","family":"Gonzalez-Plascencia","sequence":"first","affiliation":[{"name":"Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Universidad Aut\u00f3noma de Zacatecas, Carretera Zacatecas-Guadalajara Km.6, Ejido la Escondida, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1478-9068","authenticated-orcid":false,"given":"Margarita L.","family":"Martinez-Fierro","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Universidad Aut\u00f3noma de Zacatecas, Carretera Zacatecas-Guadalajara Km.6, Ejido la Escondida, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5821-9537","authenticated-orcid":false,"given":"Alfredo","family":"Salazar de Santiago","sequence":"additional","affiliation":[{"name":"Unidad Acad\u00e9mica de Odontolog\u00eda, Universidad Aut\u00f3noma de Zacatecas, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0138-6390","authenticated-orcid":false,"given":"Ana G.","family":"Casta\u00f1eda-Miranda","sequence":"additional","affiliation":[{"name":"Laboratorio de Magnetismo Ambiental, Posgrado en Ingenier\u00eda para la Innovaci\u00f3n Tecnol\u00f3gica, Unidad Acad\u00e9mica de Ingenier\u00eda El\u00e9ctrica, Universidad Aut\u00f3noma de Zacatecas, Zacatecas 98000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 I.","family":"Badillo-Almaraz","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Universidad Aut\u00f3noma de Zacatecas, Carretera Zacatecas-Guadalajara Km.6, Ejido la Escondida, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6307-1696","authenticated-orcid":false,"given":"Idalia","family":"Garza-Veloz","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Universidad Aut\u00f3noma de Zacatecas, Carretera Zacatecas-Guadalajara Km.6, Ejido la Escondida, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1038\/s41572-019-0069-0","article-title":"Acute respiratory distress syndrome","volume":"5","author":"Matthay","year":"2019","journal-title":"Nat. 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