Defining endotypes of bronchopulmonary dysplasia in preterm infants to improve precision-based therapies

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Medical Imaging

Background:

• Bronchopulmonary dysplasia (BPD) is a significant cause of chronic lung disease in premature infants.
• Current BPD definitions lack specificity, failing to address disease heterogeneity and endotypes, which hinders clinical trial success.
• Understanding BPD pathogenesis is complex due to prenatal and postnatal factors.

Purpose of the Study:

• To review the pathogenic mechanisms underlying distinct BPD endotypes.
• To discuss how advanced techniques can identify these endotypes.
• To highlight the potential for endotype-specific therapies in BPD.

Main Methods:

• Review of recent studies utilizing advanced lung imaging, echocardiography, and pulmonary function tests.
• Analysis of pathogenic mechanisms contributing to BPD heterogeneity.
• Exploration of biomarker, functional studies, and AI for endotype characterization.

Main Results:

• Identification of distinct BPD endotypes, including airway, parenchymal, and vascular.
• Recognition that these endotypes have different prognoses.
• Evidence suggests endotype-specific treatments are necessary for optimal outcomes.

Conclusions:

• BPD is a heterogeneous disease with distinct endotypes requiring tailored treatment strategies.
• Advanced diagnostics are key to identifying BPD endotypes.
• Combining biomarkers, functional data, and AI can guide precision medicine for BPD.