Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis.
Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis.
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DOI：
10.1016/s2213-2600(14)70028-1
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发表时间：
2014-03
影响因子：
76.2
通讯作者：
Huffnagle, Gary B.
中科院分区：
文献类型：
--
作者：
Dickson, Robert P.;Erb-Downward, John R.;Huffnagle, Gary B.
肺炎是发病率和死亡率的主要原因，自抗生素发现以来，没有新的治疗方法进入临床实践。非培养微生物鉴定技术的创新已经表明，以前在没有感染的情况下被认为是无菌的肺含有多样化和动态的微生物群落。在这篇个人观点中，我们认为这些观察结果表明了肺部微生物学和肺炎发病机制的传统概念模型的不足，阻碍了研究和实践的进展。我们提出了三个新的概念模型，以取代传统的肺部微生物学模型：一个适应性的岛屿模型的肺微生物学，环境梯度对肺部微生物群的影响，肺炎作为一种新兴的现象推动未开发的正反馈回路。我们认为，肺部微生物群的生态系统具有复杂适应系统的所有特征：不同的实体在一个共同的空间内相互作用，表现出相互依赖的行动，并具有适应条件变化的能力。复杂适应系统在行为上与肺炎发病机制的传统模型所代表的简单线性系统有着根本的不同，需要不同的分析方法。
Pneumonia is a major cause of morbidity and mortality for which no new methods of treatment have entered clinical practice since the discovery of antibiotics. Innovations in the techniques of culture-independent microbial identification have shown that the lungs, previously deemed sterile in the absence of infection, contain diverse and dynamic communities of microbes. In this Personal View, we argue that these observations have shown the inadequacy of traditional conceptual models of lung microbiology and the pathogenesis of pneumonia, hampering progress in research and practice. We propose three new conceptual models to replace the traditional models of lung microbiology: an adapted island model of lung biogeography, the effect of environmental gradients on lung microbiota, and pneumonia as an emergent phenomenon propelled by unexplored positive feedback loops. We argue that the ecosystem of lung microbiota has all of the features of a complex adaptive system: diverse entities interacting with each other within a common space, showing interdependent actions and possessing the capacity to adapt to changes in conditions. Complex adaptive systems are fundamentally different in behaviour from the simple, linear systems typified by the traditional model of pneumonia pathogenesis, and need distinct analytical approaches.