Endoplasmic reticulum stress and maladaptive repair in fibrotic interstitial lung diseases: A human-evidence-based narrative review
4 affiliations
- 1Department of Lung Oncology, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, Chin
- 2Preventive Healthcare Center, The Third Clinical Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, Chin
- 3Department of Gynecology, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, Jilin, Chin
- 4College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, Chin
Abstract
Fibrotic interstitial lung diseases (ILDs) are characterized by progressive extracellular-matrix accumulation but arise from biologically diverse injuries. This narrative review examines endoplasmic reticulum (ER) stress as a context-dependent regulator of maladaptive repair, prioritizing evidence from human genetics, tissue, single-cell and spatial studies, patient-derived systems, biomarkers, and clinical trials. In selected familial surfactant disorders, pathogenic variants provide direct evidence that impaired proteostasis can cause fibrotic lung disease. In sporadic idiopathic pulmonary fibrosis (IPF), epithelial unfolded protein response (UPR) signatures and KRT8/KRT17-enriched transitional states are associated with arrested alveolar regeneration, but do not establish a single causal pathway. IRE1α, PERK–eIF2α, and ATF6 can support adaptive proteostasis during acute stress yet may contribute to inflammatory signaling, epithelial injury, or differentiation arrest when activation is persistent. Human spatial studies place stressed epithelium within SPP1-positive macrophage, activated-fibroblast, and endothelial niches, although ER-stress activity outside epithelium remains less certain. Evidence is strongest in IPF and familial surfactant disorders; extension to progressive pulmonary fibrosis, connective-tissue-disease-associated ILD, or fibrotic hypersensitivity pneumonitis remains inferential. Current antifibrotic and PDE4B-directed therapies slow functional decline but do not demonstrate correction of epithelial proteostasis. Direct ER, UPR, or integrated-stress-response strategies have not established human efficacy in fibrotic ILD. Future studies should define disease- and cell-specific repair states, measure target engagement longitudinally, and test interventions during potentially reversible windows of repair arrest.
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BibTeX
@article{xu2026endoplasmic,
title = {{Endoplasmic reticulum stress and maladaptive repair in fibrotic interstitial lung diseases: A human-evidence-based narrative review}},
author = {Jianan Xu and Xian Jin and Xuewei Li and Zhenyu Li and Bo Zhu and Lin Tian},
journal = {Therapeutic Advances in Respiratory Disease},
year = {2026},
month = sep,
doi = {10.1177/17534666261491576},
url = {https://doi.org/10.1177/17534666261491576},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Endoplasmic reticulum stress and maladaptive repair in fibrotic interstitial lung diseases: A human-evidence-based narrative review
AU - Jianan Xu
AU - Xian Jin
AU - Xuewei Li
AU - Zhenyu Li
AU - Bo Zhu
AU - Lin Tian
PY - 2026
DA - 2026/09/30
JO - Therapeutic Advances in Respiratory Disease
DO - 10.1177/17534666261491576
UR - https://doi.org/10.1177/17534666261491576
AB - Fibrotic interstitial lung diseases (ILDs) are characterized by progressive extracellular-matrix accumulation but arise from biologically diverse injuries. This narrative review examines endoplasmic reticulum (ER) stress as a context-dependent regulator of maladaptive repair, prioritizing evidence from human genetics, tissue, single-cell and spatial studies, patient-derived systems, biomarkers, and clinical trials. In selected familial surfactant disorders, pathogenic variants provide direct evidence that impaired proteostasis can cause fibrotic lung disease. In sporadic idiopathic pulmonary fibrosis (IPF), epithelial unfolded protein response (UPR) signatures and KRT8/KRT17-enriched transitional states are associated with arrested alveolar regeneration, but do not establish a single causal pathway. IRE1α, PERK–eIF2α, and ATF6 can support adaptive proteostasis during acute stress yet may contribute to inflammatory signaling, epithelial injury, or differentiation arrest when activation is persistent. Human spatial studies place stressed epithelium within SPP1-positive macrophage, activated-fibroblast, and endothelial niches, although ER-stress activity outside epithelium remains less certain. Evidence is strongest in IPF and familial surfactant disorders; extension to progressive pulmonary fibrosis, connective-tissue-disease-associated ILD, or fibrotic hypersensitivity pneumonitis remains inferential. Current antifibrotic and PDE4B-directed therapies slow functional decline but do not demonstrate correction of epithelial proteostasis. Direct ER, UPR, or integrated-stress-response strategies have not established human efficacy in fibrotic ILD. Future studies should define disease- and cell-specific repair states, measure target engagement longitudinally, and test interventions during potentially reversible windows of repair arrest.
SN - 1753-4658
SN - 1753-4666
ER -