Mucosal surfaces are constantly exposed to a microbiome consisting of micro-organisms that heavily influence human immunity and health. In the lung these micro-organisms consist of bacteria, viruses and fungi and exist in a relatively low biomass state. Bacterial communities of the lung modulate local inflammation and correlate with changes in pulmonary physiology and clinical outcomes in patients with lung disease. Instrumental to this progress has been the study of these bacterial communities in the pathogenesis of pulmonary fibrosis, a fatal and progressive disease culminating in respiratory failure. Key pathophysiological mechanisms in pulmonary fibrosis include recurrent idiopathic alveolar epithelial injury, unchecked collagen deposition, mucociliary dysfunction due to muc5b overexpression, hypoxia, and altered host defense. These key mechanisms and their related consequences promote severe progressive architectural lung destruction and loss of local homeostasis. As such, pulmonary fibrosis is an appropriate target disease for the study of the lung microbiome. Herein, we discuss recent advances in our understanding of the role of the lung microbiome in the pathogenesis of pulmonary fibrosis. We highlight fundamental clinical observations, mechanistic insights and identify crucial areas for further discovery science. An improved understanding of how the lung microbiome acts to influence outcomes in patients with pulmonary fibrosis will lead to enhanced therapies for this devastating lung disease.

中文翻译：

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肺微生物组在肺纤维化中的演变作用。

粘膜表面经常暴露在由微生物组成的微生物组中，这些微生物严重影响人类免疫和健康。在肺中，这些微生物由细菌、病毒和真菌组成，并以相对较低的生物量状态存在。肺部细菌群落调节局部炎症，并与肺部疾病患者的肺部生理学和临床结果的变化相关。有助于这一进展的是对肺纤维化发病机制中这些细菌群落的研究，肺纤维化是一种致命的进行性疾病，最终导致呼吸衰竭。肺纤维化的关键病理生理机制包括复发性特发性肺泡上皮损伤、未受抑制的胶原沉积、由于 muc5b 过度表达、缺氧和宿主防御改变引起的黏膜纤毛功能障碍。这些关键机制及其相关后果促进了严重的进行性肺结构破坏和局部稳态的丧失。因此，肺纤维化是肺微生物组研究的合适目标疾病。在此，我们讨论了我们对肺微生物组在肺纤维化发病机制中作用的理解的最新进展。我们强调基本的临床观察、机制见解并确定进一步发现科学的关键领域。更好地了解肺微生物组如何影响肺纤维化患者的预后，将促进对这种破坏性肺病的治疗。肺纤维化是肺微生物组研究的合适目标疾病。在此，我们讨论了我们对肺微生物组在肺纤维化发病机制中作用的理解的最新进展。我们强调基本的临床观察、机制见解并确定进一步发现科学的关键领域。更好地了解肺微生物组如何影响肺纤维化患者的预后，将促进对这种破坏性肺病的治疗。肺纤维化是肺微生物组研究的合适目标疾病。在此，我们讨论了我们对肺微生物组在肺纤维化发病机制中作用的理解的最新进展。我们强调基本的临床观察、机制见解并确定进一步发现科学的关键领域。更好地了解肺微生物组如何影响肺纤维化患者的预后，将促进对这种破坏性肺病的治疗。