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Fungal-Associated Endotypes as a Treatable Trait in Bronchiectasis
Kai Xian Thng1,2, Micheál Mac Aogáin3,4, Sanjay H Chotirmall5,6
1Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore.
Pulmonary Therapy
|December 30, 2025
Summary
Fungi play a significant role in bronchiectasis, influencing disease severity and inflammation. Advanced molecular techniques are improving the diagnosis and understanding of fungal infections in this condition.
Area of Science:
- Pulmonology
- Mycology
- Microbiome Research
Background:
- Bronchiectasis is characterized by structural abnormalities and impaired mucociliary clearance, creating a predisposition to fungal colonization.
- Fungal colonization in bronchiectasis is increasingly linked to disease severity, exacerbation frequency, and airway inflammation.
- Host immunity significantly influences immunopathogenic responses to fungi in bronchiectasis.
Purpose of the Study:
- To review the clinical significance of fungi in bronchiectasis.
- To discuss current challenges in diagnosing and treating fungal infections in bronchiectasis.
- To explore emerging fungal-associated endotypes and the influence of environmental factors.
Main Methods:
- Review of emerging evidence on fungi in bronchiectasis pathophysiology.
- Analysis of diagnostic limitations and promise of culture-independent molecular techniques.
- Integration of next-generation sequencing and microbiomics data.
Main Results:
- Fungal-associated traits correlate with bronchiectasis severity, exacerbations, and inflammation.
- Next-generation sequencing identifies difficult-to-culture fungi, advancing microbiome understanding.
- Integrative microbiomics reveals fungal roles alongside bacteria (e.g., Pseudomonas aeruginosa) and in distant organs.
- Fungal-associated inflammatory endotypes represent potential treatable traits.
- Environmental factors like air pollution and climate change impact fungal-associated bronchiectasis endotypes.
Conclusions:
- Fungi are critical players in bronchiectasis, impacting disease progression and inflammation.
- Improved diagnostics, particularly molecular methods, are crucial for managing fungal involvement.
- Understanding fungal-associated endotypes, influenced by the exposome, is key for targeted therapies.
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