U.O. Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCSS - Università Cattolica del Sacro Cuore, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2019 Jul;23(14):6379-6386. doi: 10.26355/eurrev_201907_18463.
Changes in the composition of the lung microbiome influence many lung diseases, including idiopathic pulmonary fibrosis (IPF), with a demonstrated association between the progression of IPF and the assessed pulmonary microbial community. A hypothesis to explain the pathogenesis of IPF is that an oxidant-antioxidant imbalance causes repeated epithelial cell injury and endogenous and exogenous antioxidants/redox modulators influence fibrogenesis, protect the lung against fibrosis, and prevent its progression.
The present article is focused on Lung Microbiome in Idiopathic Pulmonary Fibrosis and the role of Antioxidant/Antibiotic Combination Therapy.
N-Acetylcysteine (NAC) at concentrations possibly achievable by nebulization showed an in vitro synergy with colistin against S. maltophilia isolates (a common coloniser of the respiratory tract of patients with chronic lung disease). Combined NAC plus colistin seems to have a beneficial role in restoring oxidant injury which may be related to its antioxidant effect. Progress has been made in the identification of the lung microbiome and the possible causal role of bacteria in the IPF pathogenesis. Recent studies suggest that antibacterial therapy in combination with antioxidant therapy may be a promising avenue for the treatment of this untreatable disease. Novel routes of administration are also an important area of research and studies assessing the use of inhaled NAC in patients with IPF could be considered.
肺部微生物组的组成变化会影响许多肺部疾病，包括特发性肺纤维化（IPF），IPF 的进展与评估的肺部微生物群落之间存在明显关联。一种解释 IPF 发病机制的假设是，氧化还原失衡导致反复的上皮细胞损伤，内源性和外源性抗氧化剂/氧化还原调节剂影响纤维化形成、保护肺部免受纤维化、并阻止其进展。
本文重点介绍特发性肺纤维化中的肺部微生物组和抗氧化/抗生素联合治疗的作用。
雾化可能达到的浓度的 N-乙酰半胱氨酸（NAC）显示出与粘菌素对 S. maltophilia 分离株（慢性肺部疾病患者呼吸道的常见定植菌）的体外协同作用。联合 NAC 加粘菌素似乎在恢复氧化损伤方面具有有益作用，这可能与其抗氧化作用有关。在鉴定肺部微生物组和细菌在 IPF 发病机制中的可能因果作用方面已经取得了进展。最近的研究表明，抗菌治疗联合抗氧化治疗可能是治疗这种无法治愈疾病的有前途的途径。新的给药途径也是一个重要的研究领域，在评估吸入用 NAC 治疗 IPF 患者方面可以进行考虑。
