Cited by 371Pneumonia and Respiratory InfectionsGut microbiota and healthNosocomial Infections in ICU

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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

DOI 10.1016/s2213-2600(14)70028-1PMC PMC4004084

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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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Authors: Dickson, R. P., Erb-Downward, J. R., & Huffnagle, G. B.
Affiliations: University of Michigan (US)
Corresponding author: Dickson, Robert P
ORCID: Dickson, Robert P
Huffnagle, Gary B
Venue: The Lancet Respiratory Medicine
Publisher: Elsevier BV
Published: 2014-03
Volume: 2
Issue: 3
Pages: 238-246
ISSN: 2213-2600 (ISSN-L)
DOI: 10.1016/s2213-2600(14)70028-1
PMC: PMC4004084
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: green
www.ncbi.nlm.nih.gov
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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Towards an ecology of the lung: new conceptual models of pulmonary microbiology and pneumonia pathogenesis

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