INTEGRIS-IPF: A New Hope for Tomorrow

pp. 465-472) leverage a deep-learning CT algorithm to develop imaging biomarkers that predict IPF progression and mortality.The study demonstrates the feasibility of rapid automated segmentation of a diverse set of CT data to quantify imaging features that could complement clinical radiology reads.Berigei et al. (pp.473-483) use endobronchial optical coherence tomography to reveal a marked loss of small airways in patients with early IPF, even in areas minimally involved by fibrosis.Finally, Munchel and colleagues (pp.514-517) use fibrin-positron emission tomograpy scanning to show in vivo activation of the coagulation cascade in lungs of patients with IPF.These next-generation imaging tools expand the armamentarium available for ILD research, driving future progress in understanding and treating the disease. Novel Mechanistic InsightsFuture advancements in treatments require a deeper grasp of the mechanisms underlying fibrotic and inflammatory ILD.The contribution of immune cells to the pathogenesis of IPF has been particularly underestimated.Here, Unterman and colleagues (pp.484-496) use single-cell transcriptomics of peripheral blood mononuclear cells to identify immune aberrations in IPF.Calamita and colleagues (pp.521-523) identify a key role for natural killer T cells in promoting lung fibrosis.Also, in sarcoidosis, an inflammatory disease that has been gravely understudied, Crouser and colleagues (pp.497-507) perform elegant experiments to address the long-standing question of the role of angiotensinconverting enzyme.Using an ex vivo granuloma model, they demonstrate that the renin-angiotensin-aldosterone system promotes early sarcoidosis granuloma formation and that pretreatment with angiotensin-converting enzyme inhibitors significantly inhibited sarcoidosis granuloma formation.These key studies pave the way for novel therapeutic targeting of immune pathways in IPF and the renin-angiotensin-aldosterone system in sarcoidosis.We hope that the breadth of ILD research included in this issue highlights the significant progress that has been made and provides a glimpse into a future where patients living with ILD experience improved outcomes and quality of life.We thank the American Thoracic Society community for supporting the AJRCCM as we witness and contribute to this ransformation.