Response of the lower respiratory tract to injury. Mechanisms of repair of the parenchymal cells of the alveolar wall

S. I. Rennard, P. B. Bitterman, Ronald Crystal

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Although the lower respiratory tract is frequently exposed to injurious agents, the lung does possess some ability to effect repair and thus restore the damaged alveolar wall to normal; however, in some circumstances, normal repair is not possible. The result is often a markedly deranged alveolus, with improper proportions of epithelial cells (eg, relatively more cuboidal type-2-like cells), a loss of endothelial cells or a migration of endothelial cells into improper locations, and a proliferation of interstitial fibroblasts with an accompanying deposition of a collagenous extracellular matrix (ie, fibrosis). Although the development of 'fibrosis' is frequently thought to be a form of attempted 'repair' of an injured alveolar wall, this concept is not clearly established; it is possible that the expansion of fibroblastic numbers in the alveolar wall is part of the disease process itself, resulting from alveolar macrophagic activation, rather than an attempt by the macrophage to 'repair' an injured alveolar wall. Thus, it is not known if the development of fibrosis represents 'healing' and thus is beneficial (as a localized scar 'heals' a localized incision in the skin) or whether it represents part of the disease process itself. The distinction is important, as it is unclear whether therapy should be directed against the development of fibrosis per se. If fibroblastic expansion and deposition of the connective tissue products of these fibroblasts are a useful form of repair, prevention of this process may cause future loss of pulmonary function. Alternatively, if 'fibrosis' compromises pulmonary function (particularly decreased compliance), prevention of fibrosis might be beneficial. It is apparent, therefore, that what is needed is an understanding of the processes that lead to alveolar parenchymal cellular repair and how such processes might be manipulated for the benefit of the patient.

Original languageEnglish
Pages (from-to)735-739
Number of pages5
JournalChest
Volume84
Issue number6
Publication statusPublished - 1 Jan 1983
Externally publishedYes

Fingerprint

Respiratory System
Cell Wall
Fibrosis
Wounds and Injuries
Endothelial Cells
Fibroblasts
Lung
Pulmonary Fibrosis
Connective Tissue
Compliance
Cicatrix
Extracellular Matrix
Epithelial Cells
Macrophages
Skin
Therapeutics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Response of the lower respiratory tract to injury. Mechanisms of repair of the parenchymal cells of the alveolar wall. / Rennard, S. I.; Bitterman, P. B.; Crystal, Ronald.

In: Chest, Vol. 84, No. 6, 01.01.1983, p. 735-739.

Research output: Contribution to journalReview article

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