Sydney Medical School, University of Sydney.
The Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia.
Curr Opin Organ Transplant. 2022 Jun 1;27(3):217-221. doi: 10.1097/MOT.0000000000000956.
Lung transplantation presents a rescue therapy for those with end-stage lung disease. Survival in lung transplant patients remains limited due to chronic lung allograft dysfunction (CLAD), a range of pathologic manifestations leading to graft loss. The mechanisms underlying CLAD remain poorly understood, and the lung microbiome has been suggested as a potential contributor to this condition. This review aims to explore how the pulmonary microbiome is impacted by lung transplantation, and how alterations in this microbiome may contribute to the pathogenesis of CLAD.
The pulmonary microbiome is made up of a range of microorganisms, and it varies considerably in lung transplant patients when compared with healthy controls. The lung microbiome changes over the early transplant period, and the composition of species appears to have an impact on inflammatory responses within the lungs. A number of studies have shown that an increase in bacterial biomass in the allograft, and enrichment with the genera Proteobacteria, or more specifically, Pseudomonas species, is associated with CLAD.
This area of research is still in its infancy; however, the suggestion that changes in the composition of the microbiome and enrichment with certain species may predispose to the pathologic changes that underlie CLAD indicate that modulation of the microbiome may be of use in potential future therapeutics.
肺移植为终末期肺病患者提供了一种挽救生命的治疗方法。肺移植患者的存活率仍然受到限制，原因是慢性肺移植物功能障碍（CLAD），一系列导致移植物丧失的病理表现。CLAD 的发病机制仍知之甚少，肺部微生物组被认为是这种疾病的潜在诱因。这篇综述旨在探讨肺移植如何影响肺部微生物组，以及这种微生物组的改变如何导致 CLAD 的发病机制。
肺部微生物组由多种微生物组成，与健康对照组相比，肺移植患者的肺部微生物组差异很大。肺微生物组在移植早期发生变化，物种组成似乎对肺部的炎症反应有影响。许多研究表明，同种异体移植物中细菌生物量的增加，以及变形菌门（Proteobacteria）或更具体地说，假单胞菌属（Pseudomonas）的富集与 CLAD 有关。
这一研究领域仍处于起步阶段；然而，微生物组组成的变化和某些物种的富集可能导致 CLAD 潜在病理变化的假设表明，微生物组的调节可能在未来的潜在治疗中有用。
