Leukocyte telomere length: the dawn of a new era of personalised medicine in fibrotic interstitial lung diseases?

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal fibrotic lung disease of unknown cause [1]. Other types of pulmonary fibrosis may exhibit a phenotype of progressive pulmonary fibrosis (PPF), characterised by worsening respiratory symptoms, decline in lung function and early mortality, comparable to that of IPF [2, 3]. In both IPF and PPF, there is a dire need for biomarkers able to predict disease course and rate of progression, in order to inform management decisions with regard to antifibrotics, transplant referral and planning of end-of-life care, and to stratify trial populations with patients according to more specific endotypes. Despite many studies on biomarkers, and a large variety of biomarker candidates [4], none is yet validated, and there are many challenges still to be overcome. Ongoing research on peripheral blood biomarkers, especially multi-omics, and artificial intelligence applied to computed tomography (CT) imaging, may make precision medicine in interstitial lung disease (ILD) a reality, hopefully in the near future [4]. Leukocyte telomere length will be a biomarker applied to precision medicine. When <10th percentile, it is associated with increased risk of mortality in patients with fibrotic hypersensitivity pneumonitis or unclassifiable ILD exposed to immunosuppression. https://bit.ly/46TwAtv