Radiation-induced lung injury (RILI), including acute radiation pneumonitis and chronic radiation-induced lung fibrosis, is the most common side effect of radiation therapy. RILI is a complicated process that causes the accumulation, proliferation, and differentiation of fibroblasts and, finally, results in excessive extracellular matrix deposition. Currently, there are no approved treatment options for patients with radiation-induced pulmonary fibrosis (RIPF) partly due to the absence of effective targets. Current research advances include the development of small animal models reflecting modern radiotherapy, an understanding of the molecular basis of RIPF, and the identification of candidate drugs for prevention and treatment. Insights provided by this research have resulted in increased interest in disease progression and prognosis, the development of novel anti-fibrotic agents, and a more targeted approach to the treatment of RIPF.

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Pulmonary fibrosis is a chronic and irreversible lung disease with limited therapeutic regimens. Advances in elucidating the pathophysiological mechanism and discovering novel therapeutic interventions are still in urgent need. Here, the engineered lipid nanoparticles (LNPs) are developed for delivering RNA therapeutics to the lungs. Three different types of LNPs (native, cationic, and ligand incorporated) are optimized to facilitate the pulmonary delivery of RNAs. Among them, the mannose incorporated LNPs (Mannose LNPs) outperform the others and show efficient delivery of siRNAs down-regulating the epithelial-mesenchymal transition (EMT) associated protein, G2 and S phaseexpressed protein 1 (GTSE1). Treatment with the mannose LNPs confirms a significant decrease in collagen accumulation and EMT-related proteins in the fibrosis animal models and provides functional recovery from pulmonary fibrosis. This approach demonstrates that engineered LNPs can facilitate the delivery of RNA therapeutics to the lungs and potentially open a new regimen of treatment for pulmonary fibrosis.

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