The role of inflammation in idiopathic pulmonary fibrosis (IPF) is controversial. If inflammation were critical to the disease process, lung pathology would demonstrate an influx of inflammatory cells, and that the disease would respond to immunosuppression. Neither is true. The classic pathology does not display substantial inflammation, and no modulation of the immune system is effective as treatment. Recent data suggest that the pathophysiology of the disease is more a product of fibroblast dysfunction than of dysregulated inflammation. The role of inflammation in disease pathogenesis comes from pathology from atypical patients, biologic samples procured during exacerbations of the disease, and careful examination of biologic specimens from patients with stable disease. We suggest that inflammation is indeed a critical factor in IPF and propose five potential nontraditional mechanisms for the role of inflammation in the pathogenesis of IPF: the direct inflammatory hypothesis, the matrix hypothesis, the growth factor-receptor hypothesis, the plasticity hypothesis, and the vascular hypothesis. To address these, we review the literature exploring the differences in pathology, prognosis, and clinical course, as well as the role of cytokines, growth factors, and other mediators of inflammation, and last, the role of matrix and vascular supply in patients with IPF.

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The ability to target and accumulate monocytes and macrophages in areas of tissue inflammation plays an important role in innate and humoral immunity. However, when this process becomes uncontrolled, tissue injury and dysfunction may ensue. This paper will focus on understanding the role and action of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in regulating the molecular and biochemical pathways responsible for the regulation of the survival of human monocytes. We and others have found that ROS and RNS serve as important intracellular signaling molecules that influence cellular survival. Human monocytes are influenced by intracellular production of ROS and RNS, which affects both monocyte survival and death, depending on the form of nitric oxide presented to the cell. This review will address potential mechanisms by which ROS and RNS promote the survival of human monocytes and macrophages.

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