Although a demonstrated role for hypoxia in hantavirus-induced permeability has yet to be conclusively defined, the ability of extracorporeal membrane oxygenation (ECMO) to reduce HPS patient mortality [4, 6] strongly suggests a role for hypoxia and VEGF in the acute pulmonary edema of HPS patients. This evidence concerns the gene VEGFA and Hermansky-Pudlak syndrome.