1 Pulmonary, Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Am J Respir Crit Care Med. 2018 Jul 15;198(2):256-263. doi: 10.1164/rccm.201801-0139WS.
Pneumonia is a complex pulmonary disease in need of new clinical approaches. Although triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as acute respiratory distress syndrome and to organ dysfunction beyond the lungs and over extended time frames after pathogen clearance, some of which increase the risk for subsequent pneumonia. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extrapulmonary complications of pneumonia. The NHLBI assembled a working group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decline caused by pneumonia. This report summarizes the working group's specific recommendations in the areas of pneumonia susceptibility, host response, and consequences. Overarching goals include the development of more host-focused clinical approaches for preventing and treating pneumonia, the generation of predictive tools (for pneumonia occurrence, severity, and outcome), and the elucidation of mechanisms mediating immune resistance and tissue resilience in the lung. Specific areas of research are highlighted as especially promising for making advances against pneumonia.
肺炎是一种复杂的肺部疾病,需要新的临床方法。虽然肺炎是由病原体引发的,但通常是由于宿主防御失调引起的,而这种失调可能发生在感染之前。随后,免疫抵抗和组织弹性的协调活动决定了肺炎是否以及如何进展或消退。宿主反应不足或不适当会导致更严重的后果,如急性呼吸窘迫综合征,以及在病原体清除后肺部以外的器官功能障碍和更长时间的扩展,其中一些会增加随后发生肺炎的风险。对这种宿主反应的更好理解将指导预防和治疗肺炎以及减轻肺炎后续肺部和肺外并发症的新方法的开发。NHLBI 召集了一个外部研究人员工作组,优先考虑宿主导向性肺炎研究的途径,这些途径应该为中断由肺炎引起的不健康下降周期提供新的方法。本报告总结了工作组在肺炎易感性、宿主反应和后果领域的具体建议。总体目标包括开发更多以宿主为中心的预防和治疗肺炎的临床方法,生成预测工具(用于肺炎的发生、严重程度和结果),并阐明介导肺部免疫抵抗和组织弹性的机制。突出了一些特别有希望在对抗肺炎方面取得进展的研究领域。