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Am J Respir Crit Care Med. 2018 Jul 15;198(2):256-263. doi: 10.1164/rccm.201801-0139WS.

Future Research Directions in Pneumonia. NHLBI Working Group Report.

Author information

1
1 Pulmonary, Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
2
2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
3
3 Department of Environmental Health, Harvard T. H. Chan School of Public Health, and.
4
4 Pulmonary and Critical Care Division, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
5
5 Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana.
6
6 Department of Medicine, University of Washington, Seattle, Washington.
7
7 Marsico Lung Institute and.
8
8 Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
9
9 Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
10
10 Department of Internal Medicine.
11
11 Department of Microbiology and Immunology, and.
12
12 Institute of Gerontology, University of Michigan, Ann Arbor, Michigan.
13
13 Center for Biomedical Information Research, Stanford University, Stanford, California.
14
14 Center for Translational Research in Infection and Inflammation, Tulane School of Medicine, New Orleans, Louisiana.
15
15 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
16
16 Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.
17
17 Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York.
18
18 Department of Medicine, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey.
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19 Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama.
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20 Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky.
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21 Department of Pediatrics, Columbia University, New York, New York.
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22 Pulmonary, Critical Care and Sleep Medicine, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, New York.
23
23 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont.
24
24 Emergency Medicine Service, Durham Veterans Affairs Health Care System, Durham, North Carolina.
25
25 Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
26
26 Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.
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27 Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
28
28 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and.
29
29 Division of Lung Diseases, NHLBI, NIH, Bethesda, Maryland.

Abstract

Pneumonia is a complex pulmonary disease in need of new clinical approaches. Although triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as acute respiratory distress syndrome and to organ dysfunction beyond the lungs and over extended time frames after pathogen clearance, some of which increase the risk for subsequent pneumonia. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extrapulmonary complications of pneumonia. The NHLBI assembled a working group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decline caused by pneumonia. This report summarizes the working group's specific recommendations in the areas of pneumonia susceptibility, host response, and consequences. Overarching goals include the development of more host-focused clinical approaches for preventing and treating pneumonia, the generation of predictive tools (for pneumonia occurrence, severity, and outcome), and the elucidation of mechanisms mediating immune resistance and tissue resilience in the lung. Specific areas of research are highlighted as especially promising for making advances against pneumonia.

KEYWORDS:

bacterial infection; host response; host susceptibility; pneumonia; viral infection

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