Mikhail Sheridan G, O'Dwyer David N
Division of Pulmonary and Critical Care Medicine, Dept. of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Dept. of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA.
Breathe (Sheff). 2025 Apr 17;21(2):240167. doi: 10.1183/20734735.0167-2024. eCollection 2025 Apr.
Interstitial lung disease (ILD) is a heterogeneous chronic form of lung disease. The pathogenesis of ILD is poorly understood and a common form of ILD, idiopathic pulmonary fibrosis (IPF) is associated with poor prognosis. There is evidence for substantial dysregulated immune responses in ILD. The microbiome is a key regulator of the immune response, and the lung microbiome correlates with alveolar immunity and clinical outcomes in ILD. Most observational lung microbiome studies have been conducted in patients with IPF. A consistent observation in these studies is that the bacterial burden of the lung is elevated in patients with IPF and predicts mortality. However, our understanding of the mechanism is incomplete and our understanding of the role of the lung microbiome in other forms of ILD is limited. The microbiomes of the oropharynx and gut may have implications for the lung microbiome and pulmonary immunity in ILD but require substantial further research. Here, we discuss the studies supporting a role for the lung microbiome in the pathogenesis of IPF, and briefly describe the putative role of the oral-lung axis and the gut-lung axis in ILD.
间质性肺疾病（ILD）是一种异质性的慢性肺部疾病。ILD的发病机制尚不清楚，常见的ILD形式，特发性肺纤维化（IPF）预后较差。有证据表明ILD中存在大量免疫反应失调。微生物群是免疫反应的关键调节因子，肺部微生物群与ILD中的肺泡免疫和临床结果相关。大多数观察性肺部微生物群研究是在IPF患者中进行的。这些研究中一致的观察结果是，IPF患者的肺部细菌负荷升高，并可预测死亡率。然而，我们对其机制的理解并不完整，而且我们对肺部微生物群在其他形式ILD中的作用的了解有限。口咽部和肠道的微生物群可能对ILD中的肺部微生物群和肺部免疫有影响，但需要大量进一步的研究。在这里，我们讨论支持肺部微生物群在IPF发病机制中作用的研究，并简要描述口-肺轴和肠-肺轴在ILD中的假定作用。
