Defining endotypes of bronchopulmonary dysplasia in preterm infants to improve precision-based therapies

TL;DR

This review discusses how identifying specific types of BPD in preterm infants can lead to more effective, personalized treatments.

Contribution

The paper introduces a framework for defining BPD endotypes using biomarkers and AI to guide precision therapies.

Findings

BPD endotypes include airway, parenchymal, and vascular subtypes with distinct prognoses.

Combining biomarkers and AI can improve the characterization of BPD endotypes.

Endotype-specific treatments are needed to optimize outcomes for preterm infants.

Abstract

Bronchopulmonary dysplasia (BPD) remains a debilitating disease in premature infants. The chronic pathogenesis of BPD with complex prenatal and postnatal programming challenges attempts at precisely defining or treating disease. While existing BPD definitions categorize disease severity, a lack of consideration of disease heterogeneity and endotypes has contributed to the failure of clinical trials to improve BPD outcomes. Recent studies have used advanced lung imaging techniques, echocardiography, and lung function tests to identify airway, parenchymal, and vascular BPD endotypes. These endotypes carry different prognoses and require endotype-specific treatment strategies to optimize infant outcomes. In this Review, we focus on the pathogenic mechanisms that specify individual BPD endotypes and discuss how combining biomarkers, functional studies, and artificial intelligence–based characterization of endotypes can inform precision therapies for BPD.

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