Interleukin-10, age and acute lung injury genetics: the action is in the interaction

Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), are important public health issues, and both incidence and mortality increase with age 1. Given that only a moderate percentage of individuals with the same level of exposure develop ALI/ARDS, it is logical to investigate whether inherent interindividual variation will, in part, determine the risk of ALI/ARDS. Better understanding of the genetic factors influencing both risk of developing ALI/ARDS and outcomes following ALI/ARDS may aid in the identification of high-risk individuals, suggest areas for laboratory research and lead to the development of more specific, targeted pharmacogenomic strategies for treatment and prevention 2. Research on the genetic epidemiology of ALI/ARDS is in its early stages. Studies in this area have either used physiological hypotheses (including angiotensin-converting enzyme and surfactant proteins) 3, 4 or bioinformatics approaches based on animal experiments to select candidate genes 5. In this issue of the European Respiratory Journal , Gong et al . 6 provide an important contribution to understanding the genetic aetiology of ARDS and outcomes following ARDS. In a well-constructed cohort study, the authors report an association of an interleukin (IL)-10 promoter polymorphism with ALI/ARDS that differed by strata of age. Gong et al . 6 should be commended on several important strengths of their study. First, the large nested case–control design ensured that all non-ARDS subjects were drawn from the same at-risk cohort, minimising the bias due …