American journal of respiratory and critical care medicine最新文献

{"title":"Gut microbiota associate with disease severity and survival in idiopathic pulmonary fibrosis.","authors":"John S Kim, Abigail Loe, Shwu-Fan Ma, Piyush Ranjan, Jay H Lipinski, Sheridan G Mikhail, Stephen J Gurczynski, Xiaofeng Zhou, Gary B Huffnagle, John Erb Downward, Joseph D Metcalf, Nicole Falkowski, Kathleen A Stringer, Robert P Dickson, Yong Huang, Bethany B Moore, Fernando J Martinez, Susan Murray, Imre Noth, David N O'Dwyer","doi":"10.1093/ajrccm/aamag249","DOIUrl":"10.1093/ajrccm/aamag249","url":null,"abstract":"<p><strong>Rationale: </strong>Gut microbiota modify immunity. Dysregulated immunity plays a key role in the pathogenesis of idiopathic pulmonary fibrosis (IPF). However, the role of gut microbiota in IPF pathogenesis is unknown.</p><p><strong>Objectives: </strong>Determine associations between gut microbiota, disease severity, and lung transplant-free survival in IPF.</p><p><strong>Methods: </strong>Gut microbiota from patients enrolled in the CleanUP-IPF trial were characterized using fecal swab samples (n = 411). CleanUP-IPF investigated the clinical efficacy of long-term antimicrobials in IPF. 16S ribosomal RNA gene amplicon sequencing and shotgun metagenomic sequencing were performed to comprehensively profile gut microbial communities. Associations between baseline microbiota with disease severity, transplant-free survival, and treatment heterogeneity were analyzed using principal component analysis, multivariate generalized linear models, additive models, and Cox regression models.</p><p><strong>Measurements and main results: </strong>Gut microbiota composition varied significantly with sex, age, and proton pump inhibitor use. Gut microbial diversity and community composition were significantly associated with impaired gas exchange (percent predicted diffusing capacity of lung for carbon monoxide). Several genera including the Lachnospiraceae unclassified genus were associated with improved transplant-free survival (hazard ratio [HR] = 0.34; 95% CI, 0.14-0.87; P = .02) in patients not assigned to antimicrobial treatment. Patients with a higher abundance of the Lachnospiraceae unclassified genus exposed to long-term cotrimoxazole had worse survival (HR = 6.09; 95% CI, 1.36-27.27; P = .02). Survival in pirfenidone-treated patients was significantly associated with a higher abundance of the gut Lachnospiraceae unclassified genus.</p><p><strong>Conclusions: </strong>In exploratory post hoc analysis, gut microbiota correlated with disease severity, associated with treatment heterogeneity and transplant-free survival in patients with IPF.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"2455-2466"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A grading system of dynamic fibrinolysis resistance in sepsis associates with ICU outcomes.","authors":"Lucy A Coupland, Steven A Frost, Jessica Lin, Nguyen Pham, Matthew Self, Philip J Crispin, David J Rabbolini, Charithani B Keragala, Robert L Medcalf, Anders Aneman","doi":"10.1093/ajrccm/aamag281","DOIUrl":"10.1093/ajrccm/aamag281","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"2647-2650"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148175125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Health after Preterm Birth: Knowledge Gaps and Respiratory Care Across the Lifespan","authors":"Joseph M Collaco,Steven H Abman,Paul E Moore,Leif D Nelin,A Ioana Cristea,Lauren Ingledow,Annie Janvier,Michelle M Kelly,Stephen E Kirkby,Sailesh Kotecha,Enid R Neptune,Francesca Polverino,Sharon A McGrath-Morrow,BPD Collaborative Outpatient Committee,Amit Agarwal,Gangaram G Akangire,Stamatia Alexiou,Dustin Anderson-Bell,Brianna C Aoyama,Eric D Austin,Christopher D Baker,Anita Bhandari,Sara K Dawson,Katherine G Enzer,Julie L Fierro,Jonathan M Gaffin,Kara N Goss,Mehtap Haktanir Abul,Lystra P Hayden,Jelte Kelchtermans,Joanne M Lagatta,Khanh V Lai,Jonathan C Levin,Winston M Manimtim,Robin L McKinney,Antonia P Popova,Carolyn Press,Lawrence M Rhein,Jessica L Rice,Catherine A Sheils,Roopa Siddaiah,Nicole Stephenson,Demet Toprak,Michael C Tracy,Natalie Villafranco","doi":"10.1093/ajrccm/aamag538","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag538","url":null,"abstract":"Abstract Prematurity affects approximately 10% of live births worldwide and contributes to substantial short and long-term morbidity, particularly respiratory disease. Approximately 35% of infants born before 32 weeks gestation are diagnosed with bronchopulmonary dysplasia (BPD). Many preterm infants regardless of BPD diagnosis also develop respiratory problems in both childhood and adulthood, more recently termed as prematurity-associated lung disease (PLD). As survival of preterm infants continues to improve, the lifetime burden of PLD and related health conditions remains high. Optimizing lung growth, minimizing the impact of comorbidities, and improving quality of life are ongoing challenges. Individuals born preterm are also at higher risk for being diagnosed with early-onset chronic obstructive pulmonary disease in adulthood. Despite these public health implications, outpatient management is often variable, and PLD remains underrecognized and heterogeneous across clinical settings. In this expert consensus statement from the BPD Collaborative, we summarize key knowledge gaps and provide pragmatic recommendations to help standardize outpatient care for PLD across the lifespan. Recommendations address models of care delivery, approaches to disease monitoring and management, and the evaluation and treatment of common comorbidities. Given limited high-quality evidence in several domains, many recommendations are necessarily based on expert opinion. Our objectives are to highlight priorities for future research, promote continuity between pediatric and adult care, and support development of evidence-based strategies to reduce underdiagnosis and undertreatment and to improve long-term outcomes for individuals born preterm.","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"39 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripubertal changes in asthma.","authors":"Alexandra E Silva, Giuliana Ferrante, Patricia Silveyra, Adnan Custovic, Stefania La Grutta, Erick Forno","doi":"10.1093/ajrccm/aamag373","DOIUrl":"10.1093/ajrccm/aamag373","url":null,"abstract":"<p><p>Asthma is a heterogeneous disease affecting nearly 300 million people around the world. It is the most common chronic respiratory disease of childhood. There are significant sex differences in asthma incidence, severity, and morbidity around the time of puberty. The reasons for these peripubertal changes are still not fully understood, but they are likely multifactorial. In this review, we will discuss several proposed contributing mechanisms, including sex differences in anatomy and development, the effects of sex hormones on airway inflammation and reactivity, the immunomodulatory effects of sex hormones, differences in mucociliary function, and sex differences in genetic and epigenetic factors.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"2592-2606"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148443803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tool in lesion-but still off target: a call of concern for lung cancer screening.","authors":"Jacob Schwartz, Michael Murn, Isaac Laniado, Jamie L Studts, Brett C Bade","doi":"10.1093/ajrccm/aamag393","DOIUrl":"10.1093/ajrccm/aamag393","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"2673-2674"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An update to the classification, evaluation, and management of childhood interstitial lung disease in infancy: an official American Thoracic Society Clinical Practice Guideline.","authors":"Matthew D McGraw, Emily DeBoer, Jason P Weinman, Gail H Deutsch, Jennifer Pogoriler, Maureen B Parenti, Geoffrey Kurland, Joshua Blatter, Alicia M Casey, Robin R Deterding, Elizabeth K Fiorino, Lisa R Young, Hayley Barnes, Vivek Balasubramaniam, Steven K Brennan, Prangthip Charoenpong, Daniel Craven, Sharon Dell, Ralph Epaud, Martha P Fishman, Ann Gettys, Samuel Goldfarb, William A Gower, Duc M Ha, James S Hagood, Aaron Hamvas, Adam Jaffe, John C Kennedy, Katelyn Krivchenia, Deborah R Liptzin, Nadia Nathan, Rebekah J Nevel, Velda Ocasio-Ramirez, Gloria Pryhuber, Benjamin A Raby, Sara C Sadreameli, Alejandro Teper, Sara O Vargas, Timothy J Vece, Narayan P Iyer, Lawrence M Nogee, Jennifer A Wambach","doi":"10.1093/ajrccm/aamag375","DOIUrl":"10.1093/ajrccm/aamag375","url":null,"abstract":"<p><strong>Background: </strong>Childhood interstitial lung diseases (chILD) are a heterogeneous group of rare disorders. In 2013, the American Thoracic Society (ATS) developed a guideline regarding the classification, evaluation, and management of children <2 years old with chILD. The current guideline provides updated recommendations regarding genetic testing, chest imaging, lung biopsy, and lung transplant referral.</p><p><strong>Methods: </strong>The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to form clinical questions, summarize evidence, and develop recommendations, following ATS policies and procedures. A multidisciplinary panel with expertise in chILD formulated recommendations addressing diagnostic tools and referral for lung transplant evaluation.</p><p><strong>Results: </strong>Rapid and broad genetic testing is recommended for infants with chILD and respiratory failure (strong recommendation). Chest computed tomography (CT) remains an important part of the diagnostic evaluation (conditional recommendation). Surgical lung biopsy is recommended when there is urgency to identify a specific chILD disorder and genetic testing is not feasible, timely, or inconclusive; to identify histopathologic \"treatable traits\"; or to inform prognosis (strong recommendation). Referral for lung transplant evaluation is recommended for children with specific chILD disorders with predictable poor outcomes (strong recommendation). Repeat chest CT to aid decision-making, prognosis, and/or change therapies is suggested for children with chILD diagnosed before age 2 years (conditional recommendation).</p><p><strong>Conclusions: </strong>This guideline provides evidence-based recommendations for genetic testing, chest imaging, lung biopsy, and referral for lung transplant evaluation to improve the diagnostic evaluation and management of children <2 years with chILD. Implementing this guideline will hopefully increase genetic testing for chILD, inform the diagnostic evaluation and disease monitoring of chILD, and identify future research priorities for chILD.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"2308-2337"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Withdrawn as duplicate: Reply to Liu et al.: Considerations on Stratified Analysis and Biomarker Use in CAD Detection in COPD.","authors":"Mairi A MacLeod, Kristopher D Knott, Edward D Nicol, Jadwiga A Wedzicha","doi":"10.1093/ajrccm/aamag106","DOIUrl":"10.1093/ajrccm/aamag106","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"e1-e5"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Withdrawn as duplicate: Considerations on Stratified Analysis and Biomarker Use in CAD Detection in COPD.","authors":"Zhican Liu, Lingling Zhang, Mingyan Jiang","doi":"10.1093/ajrccm/aamag105","DOIUrl":"10.1093/ajrccm/aamag105","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"e1-e6"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macrophage membrane-coated nanoparticles enhance survival in models of severe bacterial pneumonia","authors":"Katie Spencer,Michael A Matthay","doi":"10.1093/ajrccm/aamag539","DOIUrl":"https://doi.org/10.1093/ajrccm/aamag539","url":null,"abstract":"","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":"74 1","pages":""},"PeriodicalIF":24.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MMP12 induces fibrogenic macrophage differentiation to drive granuloma-associated cardiac fibrosis.","authors":"Mario Mazić, Clarice X Lim, Piyal Saha, Thomas El-Jammal, Roko Šango, Tayeba Ghazi, Armela Jahić, Paul Ettel, Joanna Jager, Angeliki Asimaki, Mary N Sheppard, Hannes Todt, Dagmar Kratky, Markus Hengstschläger, Wenjin Yang, Thomas Weichhart","doi":"10.1093/ajrccm/aamag354","DOIUrl":"10.1093/ajrccm/aamag354","url":null,"abstract":"<p><strong>Rationale: </strong>Cardiac sarcoidosis is a granulomatous inflammatory disease that frequently progresses to irreversible myocardial fibrosis and lethal conduction abnormalities. While mechanistic target of rapamycine complex 1 (mTORC1)-dependent macrophage activation has been implicated in this process, exactly how granulomatous inflammation is mechanistically converted into fibrotic remodeling at the level of macrophage effector function remains unknown.</p><p><strong>Methods: </strong>We employed a mouse model with myeloid-specific Tsc2 deletion that recapitulates key features of human cardiac sarcoidosis. Single-cell RNA sequencing, bioinformatic analyses, histopathology, in vitro functional studies in murine and human macrophages, and in vivo pharmacologic inhibition were integrated to define macrophage-intrinsic mechanisms driving granuloma-associated cardiac fibrosis.</p><p><strong>Measurements and main results: </strong>Constitutive mTORC1 activation induced a fibrogenic macrophage (FibMac) population in the heart characterized by expression of Cd63, Spp1, Gpnmb, and Fabp5 and arising through a TGF-β-dependent monocyte-to-FibMac differentiation process. We identified matrix metalloproteinase 12 (MMP12) as a macrophage-intrinsic inducer and dominant effector of this program. Recombinant MMP12 was sufficient to enforce fibrogenic macrophage differentiation and promote macrophage clustering and epithelioid features in both mouse and human macrophages. Conversely, selective MMP12 inhibition disrupted granuloma architecture, reduced fibroblast activation, and attenuated myocardial fibrosis in vivo, with concomitant improvement of cardiac conduction. In human cardiac sarcoidosis tissue, MMP12 colocalized with FibMac markers within granulomas, and reanalysis of published human fibrosis datasets revealed MMP12 expression within analogous fibrogenic macrophage populations.</p><p><strong>Conclusions: </strong>Our findings uncover MMP12 as a macrophage-intrinsic inducer and sustainer that links fibrogenic macrophage identity to granuloma architecture and cardiac fibrosis in sarcoidosis. Targeting this effector axis provides a therapeutic strategy distinct from upstream mTORC1 inhibition.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":"2409-2423"},"PeriodicalIF":21.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}