1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and.
2 Department of Biostatistics, School of Public Health, and.
Am J Respir Crit Care Med. 2019 May 1;199(9):1127-1138. doi: 10.1164/rccm.201809-1650OC.
Idiopathic pulmonary fibrosis (IPF) causes considerable global morbidity and mortality, and its mechanisms of disease progression are poorly understood. Recent observational studies have reported associations between lung dysbiosis, mortality, and altered host defense gene expression, supporting a role for lung microbiota in IPF. However, the causal significance of altered lung microbiota in disease progression is undetermined. To examine the effect of microbiota on local alveolar inflammation and disease progression using both animal models and human subjects with IPF. For human studies, we characterized lung microbiota in BAL fluid from 68 patients with IPF. For animal modeling, we used a murine model of pulmonary fibrosis in conventional and germ-free mice. Lung bacteria were characterized using 16S rRNA gene sequencing with novel techniques optimized for low-biomass sample load. Microbiota were correlated with alveolar inflammation, measures of pulmonary fibrosis, and disease progression. Disruption of the lung microbiome predicts disease progression, correlates with local host inflammation, and participates in disease progression. In patients with IPF, lung bacterial burden predicts fibrosis progression, and microbiota diversity and composition correlate with increased alveolar profibrotic cytokines. In murine models of fibrosis, lung dysbiosis precedes peak lung injury and is persistent. In germ-free animals, the absence of a microbiome protects against mortality. Our results demonstrate that lung microbiota contribute to the progression of IPF. We provide biological plausibility for the hypothesis that lung dysbiosis promotes alveolar inflammation and aberrant repair. Manipulation of lung microbiota may represent a novel target for the treatment of IPF.
特发性肺纤维化 (IPF) 导致相当大的全球发病率和死亡率,其疾病进展机制尚不清楚。最近的观察性研究报告称,肺菌群失调、死亡率和宿主防御基因表达改变之间存在关联,支持肺微生物群在 IPF 中的作用。然而,改变的肺微生物群在疾病进展中的因果意义尚不确定。
使用动物模型和 IPF 患者观察肺微生物群对局部肺泡炎症和疾病进展的影响。
对于人类研究,我们对 68 名 IPF 患者的 BAL 液中的肺微生物群进行了特征描述。对于动物建模,我们使用了常规和无菌小鼠的肺纤维化小鼠模型。使用针对低生物量样本负荷优化的新型技术对 16S rRNA 基因测序进行了细菌鉴定。将微生物组与肺泡炎症、肺纤维化测量值和疾病进展相关联。
肺微生物组的破坏预示着疾病进展,与局部宿主炎症相关,参与疾病进展。在 IPF 患者中,肺细菌负荷预测纤维化进展,微生物多样性和组成与肺泡促纤维化细胞因子增加相关。在纤维化的小鼠模型中,肺菌群失调先于肺损伤高峰并持续存在。在无菌动物中,缺乏微生物组可预防死亡。
我们的结果表明,肺微生物群有助于 IPF 的进展。我们为肺菌群失调促进肺泡炎症和异常修复的假设提供了生物学依据。对肺微生物群的操纵可能代表了治疗 IPF 的新靶点。