Vreeman Emma C A, Pillay Janesh, Burgess Janette K
University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Critical Care, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands.
Pharmacol Ther. 2025 Aug;272:108891. doi: 10.1016/j.pharmthera.2025.108891. Epub 2025 May 28.
After the severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) pandemic, the emergence of long-term sequelae post-infection poses a new healthcare challenge. Following initial infection with SARS-CoV-2, approximately 1 in 10 people experience post-acute sequelae of COVID-19 (PASC), also known as long COVID. PASC can affect the entire body, with the airways and lungs being a primary target of the initial viral infection. Many post-COVID symptoms have been associated with fibrotic lung lesions and diminished respiratory function. The reversibility, persistence, or progression of post-COVID-19 pulmonary fibrosis is still a topic of debate. We aimed to compare current findings and examined similar viral infections from the past, to increase understanding of prevalence, persistence and possible pharmacological targets of post-COVID-19 pulmonary fibrosis. Recent studies have documented PASC symptoms persisting up to 3 years post-recovery, and lung impairments present after 15 years after infection with the similar SARS-CoV virus in 2003. These findings suggest the potential for long-term pulmonary fibrosis following SARS-CoV-2 infection, highlighting the need for new anti-fibrotic treatments capable of reversing pulmonary fibrosis. Besides the approved anti-fibrotics, pirfenidone and nintedanib, other promising treatments include histone deacetylase inhibitors, angiotensin receptor blockers and mesenchymal stem cells. The pathophysiological mechanisms underlying post-COVID-19 pulmonary fibrosis are still incompletely understood, necessitating future research to clarify the development of persistent post-COVID-19 pulmonary fibrosis following SARS-CoV-2 infection. Given the widespread transmission of SARS-CoV-2, even a low prevalence of persistent post-COVID-19 pulmonary fibrosis would represent a significant public health concern for which therapeutic strategies are essential to identify.
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行之后，感染后长期后遗症的出现带来了新的医疗挑战。初次感染SARS-CoV-2后，约十分之一的人会出现新冠病毒感染后急性后遗症（PASC），也称为长期新冠。PASC可影响全身，呼吸道和肺部是初始病毒感染的主要靶点。许多新冠后症状与肺纤维化病变和呼吸功能下降有关。新冠后肺纤维化的可逆性、持续性或进展仍是一个有争议的话题。我们旨在比较当前的研究结果，并研究过去类似的病毒感染，以增进对新冠后肺纤维化的患病率、持续性及可能的药物靶点的了解。最近的研究记录了PASC症状在康复后持续长达3年，以及在2003年感染类似SARS-CoV病毒15年后出现的肺部损伤。这些发现表明SARS-CoV-2感染后可能出现长期肺纤维化，凸显了需要新的能够逆转肺纤维化的抗纤维化治疗方法。除了已获批的抗纤维化药物吡非尼酮和尼达尼布外，其他有前景的治疗方法还包括组蛋白去乙酰化酶抑制剂、血管紧张素受体阻滞剂和间充质干细胞。新冠后肺纤维化的病理生理机制仍未完全了解，需要未来的研究来阐明SARS-CoV-2感染后持续性新冠后肺纤维化的发展情况。鉴于SARS-CoV-2的广泛传播，即使新冠后肺纤维化持续性的患病率较低，也将是一个重大的公共卫生问题，因此必须确定治疗策略。
