TOPIC IMPORTANCE Interstitial lung diseases (ILDs) represent a broad group of heterogeneous parenchymal lung diseases. Some ILDs progress, causing architectural distortion and pulmonary fibrosis, thus are called fibrotic ILDs. Recent studies have shown a beneficial effect of antifibrotic therapy in fibrotic ILDs other than Idiopathic Pulmonary Fibrosis (IPF) that manifest progressive pulmonary fibrosis (PPF). However, it is still challenging to predict which patients with fibrotic ILDs will manifest PPF. Precision medicine approaches could identify patients at risk for progression and guide treatment in patients with IPF or PPF. REVIEW FINDINGS Multiple biomarkers able to highlight disease susceptibility risk, provide an accurate diagnosis, prognosticate or assess treatment response have been identified. Advances in precision medicine led to the identification of endotypes that could discriminate patients with different fibrotic ILDs or patients with different disease course. Importantly, recent studies have shown that particular compounds were efficacious only in particular endotypes. The aforementioned findings are promising. However, implementation in clinical practice is still an unmet need. SUMMARY Substantial progress has been observed in the context of precision medicine approaches in fibrotic ILDs during the last years. Nonetheless, there are still infrastructure, financial, regulatory and ethical challenges to overcome for the implementation of precision medicine in the clinical practice. Overcoming such barriers and moving from ''one-size fits all'' approach to a patient-centered care could substantially improve patient's quality of life and survival.

中文翻译：

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纤维化间质性肺病精准医学的曙光。


主题 重要性 间质性肺疾病 （ILD） 代表了一大类异质性肺实质疾病。一些 ILD 进展，导致结构扭曲和肺纤维化，因此称为纤维化 ILD。最近的研究表明，抗纤维化治疗对表现为进行性肺纤维化 （PPF） 的特发性肺纤维化 （IPF） 以外的纤维化 ILD 有益。然而，预测哪些纤维化 ILD 患者会出现 PPF 仍然具有挑战性。精准医学方法可以识别有进展风险的患者，并指导 IPF 或 PPF 患者的治疗。综述结果 已经确定了多种能够突出疾病易感风险、提供准确诊断、预后或评估治疗反应的生物标志物。精准医学的进步导致确定了可以区分具有不同纤维化 ILD 的患者或不同病程患者的内型。重要的是，最近的研究表明，特定化合物仅对特定内型有效。上述发现是有希望的。然而，在临床实践中实施仍然是一个未满足的需求。摘要 在过去几年中，在纤维化 ILD 的精准医学方法的背景下观察到了实质性进展。尽管如此，在临床实践中实施精准医疗仍存在基础设施、财务、监管和道德挑战需要克服。克服这些障碍并从“一刀切”的方法转变为以患者为中心的护理，可以大大提高患者的生活质量和生存率。