Systemically, alpha-2 agonists normalise sympathetic hyperactivity leading to an indirect anti-inflammatory effect: lowered proinflammatory cytokines and procalcitonin, increased anti-inflammatory cytokines.119–127 Alpha-2 agonists improve obstructive disease,128 of relevance as intrinsic PEEP is common in ARDS.129. The gene discussed is PSMA2; the disease is acute respiratory distress syndrome.