Targeting respiratory microbiomes in COPD and bronchiectasis.

ABSTRACT

Introduction

This review summarizes our current understanding of the respiratory microbiome in COPD and Bronchiectasis. We explore the interplay between microbial communities, host immune responses, disease pathology and treatment outcomes.

Areas Covered

We detail the dynamics of the airway microbiome, its influence in chronic respiratory diseases, and analytical challenges. Relevant articles from PubMed and Medline searches between Jan 2010 and March 2024 were retrieved and summarized. The review examines clinical correlations of the microbiome in COPD and bronchiectasis, assessing how current therapies impact upon it. The potential of emerging immunotherapies, anti-inflammatories and antimicrobial strategies are discussed, with focus on the pivotal role of commensal taxa in maintaining respiratory health and the promising avenue of microbiome remodeling for disease management.

Expert Opinion

Given the heterogeneity in microbiome composition and its pivotal role in disease development and progression, a shift toward microbiome-directed therapeutics is appealing. This transition, from traditional ‘pathogen-centric’ diagnostic and treatment modalities to those acknowledging the microbiome, can be enabled by evolving cross-disciplinary platforms which have the potential to accelerate microbiome-based interventions into routine clinical practice. Bridging the gap between comprehensive microbiome analysis and clinical application, however, remains challenging, necessitating continued innovation in research, diagnostics, trials and therapeutic development pipelines.

KEYWORDS:

• Microbiome
• COPD
• Bronchiectasis
• Metagenomics
• Immunopathology

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Article Highlights

• The airway microbiome is increasingly acknowledged in COPD and bronchiectasis, influencing both disease pathology and treatment efficacy.

• Shifting focus to microbiome-centric strategies could significantly enhance treatment outcomes by leveraging the intricacies of microbial dynamics in the airways.

• Translating microbiome research into clinical practice entails significant analytical challenges and the need for advanced diagnostics and therapeutic pipelines.

• Environmental exposures and the host immune response shape the airway microbiome, emphasizing the need for their integration into comprehensive disease management and patient stratification models.

• The effects of novel treatments, including those targeting immune modulation and microbial populations, provides valuable perspectives on strategies to alter the airway microbiome for improved health outcomes in COPD and bronchiectasis.

Declarations of Interest

S.H. Chotirmall has served on advisory boards for CSL Behring, Pneumagen Ltd. and Boehringer-Ingelheim, on DSMBs for Inovio Pharmaceuticals and Imam Abdulrahman Bin Faisal University and has received personal fees from Astra-Zeneca and Chiesi Farmaceutici, all unrelated to this work.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank the Academic Respiratory Initiative for Pulmonary Health (TARIPH) and the Lee Kong Chian School of Medicine Centre for Microbiome Medicine for collaboration support.

Additional information

Funding

This work is supported by the Singapore Ministry of Health’s National Medical Research Council under the Clinician-Scientist Individual Research Grant MOH-001356 (S.H.C.) and a Clinician-Scientist Award MOH-000710 (S.H.C) and Transition Award MOH- 001275-00 (P.Y.T) and the Singapore Ministry of Education under its AcRF Tier 1 Grant (RT1/22) (S.H.C).