Cited by 372Pneumonia and Respiratory InfectionsGut microbiota and healthNosocomial Infections in ICU

Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis

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Dickson, Robert P, Erb-Downward, John R, Huffnagle, Gary B·2014·The Lancet Respiratory Medicine

Abstract

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.

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  • The microbiome and alveolar injury can propel each other in a dysregulated feedback loop that spans the host-microbiome divide.

    “The microbiome and alveolar injury can propel each other in a dysregulated feedback loop that spans the host–microbiome divide”

    From The microbiome and critical illness (2016) · cites this paper as [113]

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Research works printed but not linked: 3

  1. [8]Mason RJ Broaddus VC Martin T Murray and Nadel's textbook of respiratory medicine: 2-volume set 2010 Philadelphia Elsevier Health Sciences
  2. [41]Cohen J Cohen and Powderly: Infectious Diseases, 3/e 2010 St. Louis, MO, USA Mosby, Inc
  3. [56]Molyneaux PL Mallia P Cox MJ Outgrowth of the bacterial airway microbiome after rhinovirus exacerbation of chronic obstructive pulmonary disease Am J Respir Crit Care Med 2013 188 1224 1231 23992479 PMC3863728

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Authors
Dickson, R. P., Erb-Downward, J. R., & Huffnagle, G. B.
Affiliations
University of Michigan (US)
Corresponding author
Dickson, Robert P
Venue
The Lancet Respiratory Medicine
Publisher
Elsevier BV
Published
2014-03
Volume
2
Issue
3
Pages
238-246
ISSN
2213-2600 (ISSN-L)
OpenAlex
W2156749754
Cited by
371
References
84
Citations by year
2026: 35 · 2025: 43 · 2024: 39 · 2023: 24 · 2022: 25 · 2021: 44 · 2020: 30 · 2019: 30 · 2018: 26 · 2017: 26 · 2016: 22 · 2015: 19 · 2014: 8
FWCI
18.89
Type
journal article
Language
en
Open access
Locations
  • The Lancet Respiratory Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (U01HL098961, L30 HL120241, T32HL00774921, R01HL114447, T32HL007749)
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
lung microbiome, pneumonia pathogenesis, island model, environmental gradients, complex adaptive systems, positive feedback loop, emergence
MeSH terms
Humans, Lung, Models, Biological, Pneumonia

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