Acute lung injury in the context of aging: Pathogenetic mechanisms and therapeutic strategies.

Acute lung injury (ALI) and its severe form, acute respiratory distress syndrome (ARDS), remain major challenges in critical care medicine, characterized by alveolar-capillary barrier disruption, excessive inflammation, and impaired gas exchange. With the growing aging population, aging has emerged as an important determinant of ALI/ARDS susceptibility, progression, and prognosis. Aging promotes pulmonary vulnerability through multiple interconnected mechanisms, including immune dysregulation, chronic inflammation, cellular senescence, mitochondrial dysfunction, and impaired tissue repair capacity, thereby facilitating inflammatory imbalance and defective lung regeneration. This review summarizes the key mechanisms underlying aging-associated susceptibility to ALI and discusses emerging therapeutic strategies targeting aging-related alterations, with emphasis on their translational challenges and clinical implications. These insights may provide new perspectives for the development of precision prevention and treatment approaches for elderly patients with ALI/ARDS.