Mechanisms of lung crosstalk with end organs: scientific session V-ReSPIRE 2025.

Session V of the inaugural biennial Research Symposium on Pulmonary Injury and Repair of the Endothelium showcased cutting-edge research on pulmonary endothelial crosstalk with end organs and its role in vascular disease. Growing evidence suggests that communication between injured organs and distal vascular beds plays a critical role in the pathogenesis of complex conditions such as sepsis, acute respiratory distress syndrome, pulmonary arterial hypertension, and heart failure with preserved ejection fraction. Circulating mediators-including heparan sulfate fragments, proinflammatory cytokines, mitochondrial damage-associated molecular patterns, bone morphogenetic protein 9, bile acids, and nitric oxide-have emerged as key factors linking pulmonary endothelial dysfunction to neural impairment, acute kidney injury, subclinical liver injury, and left-sided heart disease. This review highlights recent advances in the field, identifies critical knowledge gaps, and outlines future research directions aimed at elucidating mechanisms of multiorgan dysfunction and identifying novel therapeutic targets.