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Infection and the microbiome in bronchiectasis.

Micheál Mac Aogáin1,2, Alison J Dicker3, Pontus Mertsch4

  • 1Biochemical Genetics Laboratory, Department of Biochemistry, St. James's Hospital, Dublin, Ireland.

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Bronchiectasis involves complex interactions between microbes and immunity. Understanding the airway microbiome using next-generation sequencing (NGS) advances precision medicine for this lung disease.

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Area of Science:

  • Pulmonary Medicine
  • Microbiology
  • Immunology

Background:

  • Bronchiectasis is characterized by airway dilation, recurrent infections, and high morbidity.
  • Pathogenesis involves a complex interplay between microbial dysbiosis and immune dysregulation.
  • Distinct endophenotypes highlight heterogeneous disease mechanisms influencing treatment and prognosis.

Purpose of the Study:

  • To review the current understanding of infection and the microbiome in bronchiectasis.
  • To explore the role of next-generation sequencing (NGS) in characterizing airway microbiology.
  • To discuss future directions for precision medicine and therapeutic interventions.

Main Methods:

  • Review of current literature on bronchiectasis, microbiome, and host immunity.
  • Emphasis on insights gained from targeted amplicon sequencing and shotgun metagenomics.
  • Discussion of translational and clinical studies applying these advancements.

Main Results:

  • NGS has revolutionized the study of airway microbiology, revealing previously uncultured microbes.
  • Understanding the bronchiectasis microbiome provides key insights into host immune interactions.
  • The interplay of microbiome, inflammation, immunity, and metabolism is central to disease progression.

Conclusions:

  • A paradigm shift in understanding bronchiectasis is driven by integrating microbiome insights with clinical, inflammatory, immunological, and metabolic factors.
  • Precision medicine approaches are emerging, targeting microbial balance and immune modulation.
  • Further research integrating these factors will improve treatment efficacy and patient outcomes.