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2015 ; 12 Suppl 2
(Suppl 2
): S186-92
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Viruses in Idiopathic Pulmonary Fibrosis Etiology and Exacerbation
#MMPMID26595738
Moore BB
; Moore TA
Ann Am Thorac Soc
2015[Nov]; 12 Suppl 2
(Suppl 2
): S186-92
PMID26595738
show ga
Viral infections are important contributors to exacerbation of asthma and chronic
obstructive pulmonary disease; however, the role of viruses in the pathogenesis
of idiopathic pulmonary fibrosis (IPF) is less clear. This likely reflects that
fact that IPF acute exacerbations are defined clinically as "noninfectious," and
little attention has been paid to the outcomes of patients with IPF with
diagnosed infections. However, accumulating evidence suggests that infections
(both bacterial and viral) may influence disease outcomes either as exacerbating
agents or initiators of disease. Support for a viral role in disease initiation
comes from studies demonstrating the presence of herpesviral DNA and epithelial
cell stress in the lungs of asymptomatic relatives at risk for developing
familial IPF. In addition, the number of studies that can associate viral
(especially herpesviral) signatures in the lung with the development of IPF is
steadily growing, and activated leukocyte signatures in patients with IPF provide
further support for infectious processes driving IPF progression. Animal modeling
has been used to better understand how a gamma herpesvirus infection can modulate
the pathogenesis of lung fibrosis and has demonstrated that preceding infections
appear to reprogram lung epithelial cells during latency to produce profibrotic
factors, making the lung more susceptible to subsequent fibrotic insult, whereas
exacerbations of existing fibrosis, or infections in susceptible hosts, involve
active viral replication and are influenced by antiviral therapy. In addition,
there is new evidence that bacterial burden in the lungs of patients with IPF may
predict a poor prognosis.