Integrating Genomics Into Management of Fibrotic Interstitial Lung Disease

Chest. 2019 May;155(5):1026-1040. doi: 10.1016/j.chest.2018.12.011. Epub 2019 Jan 17.


Fibrotic interstitial lung diseases (ILDs) have a high mortality rate with an unpredictable disease course and clinical features that frequently overlap. Recent data indicate important roles for genomics in the mechanisms underlying susceptibility and progression of pulmonary fibrosis. The impact of these genomic markers on pharmacotherapy and their contribution to outcomes is increasingly recognized. Interstitial lung abnormalities, frequently considered representative of early ILD, have been consistently associated with the MUC5B promoter polymorphism, a common gene variant. Other rare gene variant mutations, including TERT, TERC, SFTPC, and DKC1, may be present in patients with familial interstitial pneumonia and are frequently associated with a usual interstitial pneumonia pattern of fibrosis. The minor allele of the MUC5B rs35705950 genotype is prevalent in several sporadic forms of ILD, including idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonitis. Gene mutations that characterize familial pulmonary fibrosis may be present in patients with connective tissue disease-related ILD, such as rheumatoid arthritis-ILD. Additionally, shorter telomere lengths and mutations in telomere biology-related genes have been demonstrated in both familial and sporadic ILD, with significant implications for disease progression, lung function, and survival. An improved understanding of the impact of genetic and genomic risk factors on disease progression would better guide personalized therapeutic choices in persons with fibrotic ILD.

Keywords: gene; genetics; idiopathic interstitial pneumonia; idiopathic pulmonary fibrosis; interstitial lung disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Cause of Death
  • Disease Progression
  • Female
  • Genetic Predisposition to Disease / epidemiology*
  • Genotype
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Lung Diseases, Interstitial / drug therapy*
  • Lung Diseases, Interstitial / epidemiology
  • Lung Diseases, Interstitial / genetics*
  • Male
  • Molecular Targeted Therapy / methods
  • Mucin-5B / drug effects
  • Mucin-5B / genetics*
  • Mutation / genetics
  • Polymorphism, Genetic*
  • Prognosis
  • Promoter Regions, Genetic / genetics
  • Pulmonary Fibrosis / drug therapy
  • Pulmonary Fibrosis / epidemiology
  • Pulmonary Fibrosis / genetics
  • Pulmonary Fibrosis / physiopathology
  • Risk Assessment
  • Survival Analysis
  • Treatment Outcome


  • Immunosuppressive Agents
  • Mucin-5B