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Background  Despite advances in clinical management, there are currently no novel therapeutic targets for acute respiratory distress syndrome (ARDS). DNA methylation, as a reversible process involved in the development and progression of many diseases, would be used as potential therapeutic targets to improve the treatment strategies of ARDS. However, the meaningful DNA methylation sites associated with ARDS still remain largely unknown. We sought to determine the difference in DNA methylation between ARDS patients and healthy participants, and simultaneously, the feasible DNA methylation markers for potential therapeutic targets were also explored.    Methods  Microarray data of human blood samples for ARDS and healthy participants up to June 2019 was searched in GEO database. The difference analyses between ARDS and healthy population were performed through limma R package, and furthermore, interrelated analyses of DNA methylation and transcript were accomplished by VennDiagram R package. Perl and sva R package were used to merge microarray data and decrease heterogeneities among different studies. The biological function of screened methylation sites and their regulating genes were annotated according to UniProt database and Pubmed database. GO term and KEGG pathway enrichment analyses were conducted using DAVID 6.8 and KOBAS 3.0. The meaningful DNA methylation markers to distinguish ARDS from healthy controls were explored through ROC (receiver operating characteristic curves) analyses.    Results  Five datasets in GEO databases (one DNA methylation dataset, three mRNA datasets, and one mRNA dataset of healthy people) were enrolled in present analyses finally, and the series were GSE32707, GSE66890, GSE10474, GSE61672, and GSE67530. These databases included 99 patients with ARDS (within 48 h of onset) and 136 healthy participants. Difference analyses indicated 44,439 DNA methylation alterations and 29 difference mRNAs between ARDS and healthy controls. 40 methylation variations regulated transcription of 16 genes was explored via interrelated analysis. According to the functional annotations, 30 DNA methylation sites were related to the imbalance of inflammation or immunity, endothelial function, epithelial function and/or coagulation function. cg03341377, cg24310395, cg07830557 and cg08418670, with AUC up to 0.99, might be the meaningful characteristics with the highest performance to distinguish ARDS from healthy controls.    Conclusions  44,439 DNA methylation alterations and 29 difference mRNAs exist between ARDS and healthy controls. 30 DNA methylation sites may regulate transcription of 10 genes, which take part in pathogenesis of ARDS. These findings could be intervention targets, with validation experiments to be warranted to assess these further.

DNA methylation exploration for ARDS: a multi-omics and multi-microarray interrelated analysis