Review Article
Pathogenetic mechanisms in usual interstitial pneumonia/idiopathic pulmonary fibrosis
Eric S White MD,
Michael H Lazar,
Victor J Thannickal,
Corresponding Author
Eric S White MD
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
University of Michigan Medical Center, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 6301 MSRB III, 1150W Medical Center Drive, Ann Arbor, MI 48109-0642, USA.Search for more papers by this authorMichael H Lazar
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
Search for more papers by this authorVictor J Thannickal
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
Search for more papers by this authorEric S White MD,
Michael H Lazar,
Victor J Thannickal,
Corresponding Author
Eric S White MD
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
University of Michigan Medical Center, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, 6301 MSRB III, 1150W Medical Center Drive, Ann Arbor, MI 48109-0642, USA.Search for more papers by this authorMichael H Lazar
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
Search for more papers by this authorVictor J Thannickal
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
Search for more papers by this authorAbstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, usually fatal, form of interstitial lung disease characterized by failure of alveolar re-epithelialization, persistence of fibroblasts/myofibroblasts, deposition of extracellular matrix, and distortion of lung architecture which ultimately results in respiratory failure. Clinical IPF is associated with a histopathological pattern of usual interstitial pneumonia (UIP) on surgical lung biopsy. Therapy for this disease with glucocorticoids and other immunomodulatory agents is largely ineffective and recent trials of newer anti-fibrotic agents have been disappointing. While the inciting event(s) leading to the initiation of scar formation in UIP remain unknown, recent advances in our understanding of the mechanisms underlying both normal and aberrant wound healing have shed some light on pathogenetic mechanisms that may play significant roles in this disease. Unlike other fibrotic diseases of the lung, such as those associated with collagen vascular disease, occupational exposure, or chemotherapeutic agents, UIP is not associated with a significant inflammatory response; rather, dysregulated epithelial–mesenchymal interactions predominate. Identification of pathways crucial to fibrogenesis might offer potentially novel therapeutic targets to slow or halt the progression of IPF. This review focuses on evolving concepts of cellular and molecular mechanisms in the pathogenesis of UIP/IPF. Copyright © 2003 John Wiley & Sons, Ltd.
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