Microbial Bioactives
Microbial Bioactives | Online ISSN 2209-2161
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Volume 5 Number 1 2022
REVIEWS (Open Access)
Perinatal Tobacco Exposure, Microbiome Dysbiosis, and Progressive Fibrosing Interstitial Lung Diseases: A Systematic Review and Meta-Analysis
Zainab Nur-Eldeen Aziz 1*, Basil O. Saleh 1
Microbial Bioactives 5 (1) 1-8 https://doi.org/10.25163/microbbioacts.5110704
Submitted: 11 June 2022 Revised: 03 August 2022 Accepted: 12 August 2022 Published: 14 August 2022
Abstract
Perinatal exposure to tobacco smoke represents a critical yet underappreciated determinant of lifelong respiratory health, with emerging evidence implicating early microbial disruption as a central mechanistic pathway. The developing lung is no longer considered sterile; instead, it hosts a dynamic microbial ecosystem that interacts closely with immune maturation, epithelial integrity, and metabolic signaling. Disruption of this finely balanced system during prenatal and early postnatal life may predispose individuals to chronic pulmonary pathologies later in adulthood. This systematic review and meta-analysis synthesizes evidence published prior to 2022 to examine the relationship between perinatal tobacco exposure, alterations in the lung and airway microbiome, and the subsequent risk of progressive fibrotic interstitial lung diseases (PF-ILDs). Using PRISMA-guided methodology, observational and experimental studies were evaluated to identify consistent microbial, immunological, and structural lung changes associated with early tobacco smoke exposure. The findings suggest that nicotine, particulate matter, and tobacco-derived toxins induce persistent shifts in microbial composition, favoring dysbiosis characterized by reduced microbial diversity and enrichment of pro-inflammatory taxa. These microbial changes appear to amplify aberrant immune signaling, impair alveolar repair, and promote fibrotic remodeling across the lifespan. Meta-analytic synthesis indicates a significant association between early-life tobacco exposure and markers of impaired lung development, immune dysregulation, and increased susceptibility to fibrotic lung progression. By integrating microbiome science with developmental and environmental pulmonology, this review advances a life-course framework linking perinatal tobacco exposure to adult-onset PF-ILD. Understanding these early biological imprints highlights critical windows for prevention, risk stratification, and microbiome-targeted interventions aimed at reducing the global burden of progressive fibrotic lung disease.
Keywords: Perinatal tobacco exposure; lung microbiome; developmental origins of disease; pulmonary fibrosis; PF-ILD; immune dysregulation; early-life exposure
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