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Macrolides show potential in treating interstitial lung diseases (ILDs) by reducing fibrosis, modulating immune responses, and influencing lung microbiota. Further large-scale research is needed to confirm their therapeutic efficacy in ILDs.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Microbiology

Background:

  • Diffuse interstitial lung diseases (ILDs) encompass a range of chronic lung conditions with significant morbidity.
  • Current therapeutic options for ILDs are limited, highlighting the need for novel treatment strategies.
  • Macrolides are a class of antibiotics with known antimicrobial and emerging non-antimicrobial properties.

Purpose of the Study:

  • To review the current evidence on the use of macrolides in the treatment of diffuse interstitial lung diseases (ILDs).
  • To explore the potential antifibrotic, immunomodulatory, and microbiota-modulating effects of macrolides in ILDs.

Main Methods:

  • Comprehensive literature review of studies investigating macrolide therapy in ILDs.
  • Analysis of preclinical data (cellular models) and clinical case reports.
  • Examination of research on macrolides' effects on autophagy, protein aggregate clearance, surfactant homeostasis, immune responses, and lung microbiota.

Main Results:

  • Macrolides demonstrate potential as antifibrotic agents by promoting cellular clearance mechanisms and regulating surfactant homeostasis.
  • Immunomodulatory effects of macrolides have been observed, with applications in organizing pneumonia, including steroid-sparing strategies.
  • Emerging research suggests macrolides may modulate lung microbiota and host-microbiota interactions, particularly relevant in idiopathic pulmonary fibrosis.

Conclusions:

  • Macrolide therapy presents promising avenues for ILD treatment, targeting fibrosis, inflammation, and microbial dysbiosis.
  • The evidence base, particularly from high-quality clinical trials, is currently limited.
  • Extensive, large-scale research is warranted to establish the safety and efficacy of macrolides in managing diffuse interstitial lung diseases.