Long-term macrolides in diffuse interstitial lung diseases

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.