Changes in the respiratory microbiome during acute exacerbations of idiopathic pulmonary fibrosis

Abstract

Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) have been defined as events of clinically significant respiratory deterioration with an unidentifiable cause. They carry a significant mortality and morbidity and while their exact pathogenesis remains unclear, the possibility remains that hidden infection may play a role. The aim of this pilot study was to determine whether changes in the respiratory microbiota occur during an AE-IPF. Bacterial DNA was extracted from bronchoalveolar lavage from patients with stable IPF and those experiencing an AE-IPF. A hyper-variable region of the 16S ribosomal RNA gene (16S rRNA) was amplified, quantified and pyrosequenced. Culture independent techniques demonstrate AE-IPF is associated with an increased BAL bacterial burden compared to stable disease and highlight shifts in the composition of the respiratory microbiota during an AE-IPF.

Impaired diversity of the lung microbiome predicts progression of idiopathic pulmonary fibrosis

“…Based on our examination at diagnosis, the occurrence of an AE in the future was not related to an increased total bacterial burden and the loss of diversity (Additional File 1: Figure S1). However, because this study highlighted the possibility of the effect of microbiomes on AEs [21][22][23], we intend to elucidate these findings in our next larger prospective study. Furthermore, we believe that it is imperative to investigate the causative bacteria on fibrosis in a murine model in the future.…”

Personalised medicine in interstitial lung diseases

“…and Stenotrophomonas sp., coupled with a significant decrease in Veillonella sp. The apparent translocation of bacteria usually confined to the gastrointestinal tract suggests a potential role for aspiration in the development of acute exacerbations [136]. These data suggest that the lung microbiome may serve as a preventive or therapeutic target as well as prognostic biomarker in IPF and potentially other ILD.…”

Review of the British Thoracic Society Winter Meeting 2017, 6–8 December 2017, London, UK

“…In patients with IPF, bacterial load at the time of diagnosis correlates with survival 26 27. Interestingly, during acute exacerbations, there is a further increase in bacterial burden and significant change in the profile of the microbiome, which is not detected by routine culture 28. The results of two ongoing studies examining the effect of antibiotics on IPF outcome (TIPAC 2 and CleanUp IPF) are eagerly awaited.…”