Targeting mTORC1 and AMPK Signaling: Potential Therapeutic Approaches for Idiopathic Pulmonary Fibrosis
DOI:
https://doi.org/10.71204/99f36029Keywords:
Idiopathic Pulmonary Fibrosis, AMPK, mTORC1, Metabolic ReprogrammingAbstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease characterized by increasing incidence and mortality. The underlying mechanisms of IPF remain poorly understood, contributing to the limited availability of effective treatments. Current therapies mainly slow disease progression but fail to provide a cure. Consequently, increasing attention has been directed toward modulating signaling pathways such as mammalian target of rapamycin complex 1(mTORC1) and Adenosine monophosphate–activated protein kinase (AMPK), both of which are key regulators of metabolic reprogramming in IPF. This review summarizes recent advances in therapeutic strategies that target cellular metabolism by modulating mTORC1 and AMPK.
References
Akhter, M. S., & Uppal, P. (2020). Toxicity of Metformin and Hypoglycemic Therapies. Advances in Chronic Kidney Disease, 27(1), 18–30. DOI: https://doi.org/10.1053/j.ackd.2019.08.004
Andrianifahanana, M., Hernandez, D. M., Yin, X., Kang, J.-H., Jung, M.-Y., Wang, Y., Yi, E. S., Roden, A. C., Limper, A. H., & Leof, E. B. (2016). Profibrotic up-regulation of glucose transporter 1 by TGF-β involves activation of MEK and mammalian target of rapamycin complex 2 pathways. The FASEB Journal, 30(11), 3733–3744. DOI: https://doi.org/10.1096/fj.201600428R
Aroda, V. R., Edelstein, S. L., Goldberg, R. B., Knowler, W. C., Marcovina, S. M., Orchard, T. J., Bray, G. A., Schade, D. S., Temprosa, M. G., White, N. H., & Crandall, J. P. (2016). Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. The Journal of Clinical Endocrinology and Metabolism, 101(4), 1754–1761. DOI: https://doi.org/10.1210/jc.2015-3754
Bondue, B., Castiaux, A., Van Simaeys, G., Mathey, C., Sherer, F., Egrise, D., Lacroix, S., Huaux, F., Doumont, G., & Goldman, S. (2019). Absence of early metabolic response assessed by 18F-FDG PET/CT after initiation of antifibrotic drugs in IPF patients. Respiratory Research, 20, 10. DOI: https://doi.org/10.1186/s12931-019-0974-5
Brackett, C. C. (2010). Clarifying metformin’s role and risks in liver dysfunction. Journal of the American Pharmacists Association, 50(3), 407–410. DOI: https://doi.org/10.1331/JAPhA.2010.08090
Castellano, B. M., Thelen, A. M., Moldavski, O., Feltes, M., van der Welle, R. E. N., et al. (2017). Lysosomal cholesterol activates mTORC1 via an SLC38A9-Niemann-Pick C1 signaling complex. Science (New York, N.Y.), 355(6331), 1306–1311. DOI: https://doi.org/10.1126/science.aag1417
Chen, Q., Wang, Y., Sheng, L., & Huang, Y. (2022). Metformin suppresses proliferation and differentiation induced by BMP9 via AMPK signaling in human fetal lung fibroblast-1. Frontiers in Pharmacology, 13, 984730. DOI: https://doi.org/10.3389/fphar.2022.984730
Cheng, Y., Mei, X., Shao, W., Zheng, J., Yin, X., Zhang, Q., Li, J., & Zhao, P. (2024). Nobiletin alleviates macrophage M2 polarization by activating AMPK-mTOR-mediated autophagy in pulmonary fibrosis mice. International Immunopharmacology, 139, 112792. DOI: https://doi.org/10.1016/j.intimp.2024.112792
Ding, Y., Wang, L., Liu, B., Ren, G., Okubo, R., Yu, J., & Zhang, C. (2022). Bryodulcosigenin attenuates bleomycin‐induced pulmonary fibrosis via inhibiting AMPK ‐mediated mesenchymal epithelial transition and oxidative stress. Phytotherapy Research, 36(10), 3911–3923. DOI: https://doi.org/10.1002/ptr.7535
DUAN, Q., LIU, Y., & ROCKWELL, S. (2013). Fenbendazole as a Potential Anticancer Drug. Anticancer Research, 33(2), 355–362.
Dusabimana, T., Kim, S. R., Kim, H. J., Park, S. W., & Kim, H. (2019). Nobiletin ameliorates hepatic ischemia and reperfusion injury through the activation of SIRT-1/FOXO3a-mediated autophagy and mitochondrial biogenesis. Experimental & Molecular Medicine, 51(4), 51. DOI: https://doi.org/10.1038/s12276-019-0245-z
Eid, W., Dauner, K., Courtney, K. C., Gagnon, A., Parks, R. J., Sorisky, A., & Zha, X. (2017). mTORC1 activates SREBP-2 by suppressing cholesterol trafficking to lysosomes in mammalian cells. Proceedings of the National Academy of Sciences, 114(30), 7999–8004. DOI: https://doi.org/10.1073/pnas.1705304114
Feng, J., Wang, X., Ye, X., Ares, I., Lopez-Torres, B., Martínez, M., Martínez-Larrañaga, M.-R., Wang, X., Anadón, A., & Martínez, M.-A. (2022). Mitochondria as an important target of metformin: The mechanism of action, toxic and side effects, and new therapeutic applications. Pharmacological Research, 177, 106114. DOI: https://doi.org/10.1016/j.phrs.2022.106114
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., Parkin, D. M., Forman, D., & Bray, F. (2015). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), 359-386. DOI: https://doi.org/10.1002/ijc.29210
Gamad, N., Malik, S., Suchal, K., Vasisht, S., Tomar, A., Arava, S., Arya, D. S., & Bhatia, J. (2018). Metformin alleviates bleomycin-induced pulmonary fibrosis in rats: Pharmacological effects and molecular mechanisms. Biomedicine & Pharmacotherapy, 97, 1544–1553. DOI: https://doi.org/10.1016/j.biopha.2017.11.101
Garcia-Calvo, M., Lisnock, J., Bull, H. G., Hawes, B. E., Burnett, D. A., et al. (2005). The target of ezetimibe is Niemann-Pick C1-Like 1 (NPC1L1). Proceedings of the National Academy of Sciences of the United States of America, 102(23), 8132–8137. DOI: https://doi.org/10.1073/pnas.0500269102
Gonnelli, F., Bonifazi, M., & Hubbard, R. (2024). Mortality trends in idiopathic pulmonary fibrosis in Europe between 2013 and 2018. The European Respiratory Journal, 64(2), 2302080. DOI: https://doi.org/10.1183/13993003.02080-2023
Groves, A. M., Win, T., Screaton, N. J., Berovic, M., Endozo, R., Booth, H., Kayani, I., Menezes, L. J., Dickson, J. C., & Ell, P. J. (2009). Idiopathic Pulmonary Fibrosis and Diffuse Parenchymal Lung Disease: Implications from Initial Experience with18 F-FDG PET/CT. Journal of Nuclear Medicine, 50(4), 538–545. DOI: https://doi.org/10.2967/jnumed.108.057901
Gu, X., Han, Y.-Y., Yang, C.-Y., Ji, H.-M., Lan, Y.-J., Bi, Y.-Q., Zheng, C., Qu, J., Cheng, M.-H., & Gao, J. (2021). Activated AMPK by metformin protects against fibroblast proliferation during pulmonary fibrosis by suppressing FOXM1. Pharmacological Research, 173, 105844. DOI: https://doi.org/10.1016/j.phrs.2021.105844
Gwinn, D. M., Shackelford, D. B., Egan, D. F., Mihaylova, M. M., Mery, A., Vasquez, D. S., Turk, B. E., & Shaw, R. J. (2008). AMPK phosphorylation of raptor mediates a metabolic checkpoint. Molecular Cell, 30(2), 214–226. DOI: https://doi.org/10.1016/j.molcel.2008.03.003
Hardie, D. G. (2011). AMPK and autophagy get connected. The EMBO Journal, 30(4), 634–635. DOI: https://doi.org/10.1038/emboj.2011.12
Humphries, S. M., Yagihashi, K., Huckleberry, J., Rho, B.-H., Schroeder, J. D., Strand, M., Schwarz, M. I., Flaherty, K. R., Kazerooni, E. A., Beek, E. J. R. van, & Lynch, D. A. (2017). Idiopathic Pulmonary Fibrosis: Data-driven Textural Analysis of Extent of Fibrosis at Baseline and 15-Month Follow-up. Radiology, 285, 270–278. DOI: https://doi.org/10.1148/radiol.2017161177
Hutchinson, J., Fogarty, A., Hubbard, R., & McKeever, T. (2015). Global incidence and mortality of idiopathic pulmonary fibrosis: A systematic review. European Respiratory Journal, 46(3), 795–806. DOI: https://doi.org/10.1183/09031936.00185114
Ji, H., Dong, H., Lan, Y., Bi, Y., Gu, X., Han, Y., Yang, C., Cheng, M., & Gao, J. (2023). Metformin attenuates fibroblast activation during pulmonary fibrosis by targeting S100A4 via AMPK-STAT3 axis. Frontiers in Pharmacology, 14, 1089812. DOI: https://doi.org/10.3389/fphar.2023.1089812
Kalafatis, D., Gao, J., Pesonen, I., Carlson, L., Sköld, C. M., & Ferrara, G. (2019). Gender differences at presentation of idiopathic pulmonary fibrosis in Sweden. BMC Pulmonary Medicine, 19, 222. DOI: https://doi.org/10.1186/s12890-019-0994-4
Kang, H. J., Lee, K. J., Woo, J., Kim, J., Kim, Y. K., Lee, C.-H., Yoo, C.-G., & Lee, K.-H. (2021). Cereblon contributes to the development of pulmonary fibrosis via inactivation of adenosine monophosphate-activated protein kinase α1. Experimental & Molecular Medicine, 53(5), 885–893. DOI: https://doi.org/10.1038/s12276-021-00619-6
Kang, S. A., Pacold, M. E., Cervantes, C. L., Lim, D., Lou, H. J., Ottina, K., Gray, N. S., Turk, B. E., Yaffe, M. B., & Sabatini, D. M. (2013a). mTORC1 Phosphorylation Sites Encode Their Sensitivity to Starvation and Rapamycin. Science, 341(6144), 1236566.
Kang, S. A., Pacold, M. E., Cervantes, C. L., Lim, D., Lou, H. J., Ottina, K., Gray, N. S., Turk, B. E., Yaffe, M. B., & Sabatini, D. M. (2013b). mTORC1 phosphorylation sites encode their sensitivity to starvation and rapamycin. Science (New York, N.Y.), 341(6144), 1236566. DOI: https://doi.org/10.1126/science.1236566
Kheirollahi, V., Wasnick, R. M., Biasin, V., Vazquez-Armendariz, A. I., Chu, X., Moiseenko, A., Weiss, A., Wilhelm, J., Zhang, J.-S., Kwapiszewska, G., Herold, S., Schermuly, R. T., Mari, B., Li, X., Seeger, W., Günther, A., Bellusci, S., & El Agha, E. (2019). Metformin induces lipogenic differentiation in myofibroblasts to reverse lung fibrosis. Nature Communications, 10, 2987. DOI: https://doi.org/10.1038/s41467-019-10839-0
Kim, J. S., Murray, S., Yow, E., Anstrom, K. J., Kim, H. J., Flaherty, K. R., Martinez, F. J., & Noth, I. (2024). Comparison of Pirfenidone and Nintedanib. Chest, 165(5), 1163–1173. DOI: https://doi.org/10.1016/j.chest.2023.11.035
Kim, Y. C., & Guan, K.-L. (2015). mTOR: A pharmacologic target for autophagy regulation. Journal of Clinical Investigation, 125(1), 25–32. DOI: https://doi.org/10.1172/JCI73939
Lederer, D. J., & Martinez, F. J. (2018). Idiopathic Pulmonary Fibrosis. New England Journal of Medicine, 378(19), 1811–1823. DOI: https://doi.org/10.1056/NEJMra1705751
Lee, C., Kwak, S. H., Han, J., Shin, J. H., Yoo, B., Lee, Y. S., Park, J. S., Lim, B. J., Lee, J. G., Kim, Y. S., Kim, S. Y., & Bae, S. H. (2024). Repositioning of ezetimibe for the treatment of idiopathic pulmonary fibrosis. The European Respiratory Journal, 63(5), 2300580. DOI: https://doi.org/10.1183/13993003.00580-2023
Lee, J.-U., Chang, H. S., Shim, E.-Y., Park, J.-S., Koh, E.-S., Shin, H.-K., Park, J.-S., & Park, C.-S. (2020). The S100 calcium-binding protein A4 level is elevated in the lungs of patients with idiopathic pulmonary fibrosis. Respiratory Medicine, 171, 105945. https://doi.org/10.1016/j.rmed.2020.105945 DOI: https://doi.org/10.1016/j.rmed.2020.105945
Lee, Y. S., Park, J. S., Lee, D. H., Han, J., & Bae, S. H. (2020). Ezetimibe ameliorates lipid accumulation during adipogenesis by regulating the AMPK–mTORC1 pathway. The FASEB Journal, 34(1), 898–911. DOI: https://doi.org/10.1096/fj.201901569R
Li, L., Huang, W., Li, K., Zhang, K., Lin, C., Han, R., Lu, C., Wang, Y., Chen, H., Sun, F., & He, Y. (2015). Metformin attenuates gefitinib-induced exacerbation of pulmonary fibrosis by inhibition of TGF-β signaling pathway. Oncotarget, 6(41), 43605–43619. DOI: https://doi.org/10.18632/oncotarget.6186
Li, R., Xu, G., Cao, J., Liu, B., Xie, H., Ishii, Y., & Zhang, C. (2019). Alpha-Mangostin Ameliorates Bleomycin-Induced Pulmonary Fibrosis in Mice Partly Through Activating Adenosine 5′-Monophosphate-Activated Protein Kinase. Frontiers in Pharmacology, 10, 1305. DOI: https://doi.org/10.3389/fphar.2019.01305
Liu, B., Yang, J., Hao, J., Xie, H., Shimizu, K., Li, R., & Zhang, C. (2021). Natural product mogrol attenuates bleomycin-induced pulmonary fibrosis development through promoting AMPK activation. Journal of Functional Foods, 77, 104280. DOI: https://doi.org/10.1016/j.jff.2020.104280
Liu, N., Song, Y., Liu, T., Wang, H., Yu, N., & Ma, H. (2024). Metformin enhanced the effect of pirfenidone on pulmonary fibrosis in mice. The Clinical Respiratory Journal, 18(1), e13731. DOI: https://doi.org/10.1111/crj.13731
Lukey, P. T., Harrison, S. A., Yang, S., Man, Y., Holman, B. F., Rashidnasab, A., et al. (2019). A randomised, placebo-controlled study of omipalisib (PI3K/mTOR) in idiopathic pulmonary fibrosis. European Respiratory Journal, 53(3), 1801992. DOI: https://doi.org/10.1183/13993003.01992-2018
Maldonado, F., Moua, T., Rajagopalan, S., Karwoski, R. A., Raghunath, S., Decker, P. A., Hartman, T. E., Bartholmai, B. J., Robb, R. A., & Ryu, J. H. (2014). Automated quantification of radiological patterns predicts survival in idiopathic pulmonary fibrosis. The European Respiratory Journal, 43(1), 204–212. DOI: https://doi.org/10.1183/09031936.00071812
Mei, Q., Liu, Z., Zuo, H., Yang, Z., & Qu, J. (2022). Idiopathic Pulmonary Fibrosis: An Update on Pathogenesis. Frontiers in Pharmacology, 12, 797292. DOI: https://doi.org/10.3389/fphar.2021.797292
Mercer, P. F., Woodcock, H. V., Eley, J. D., Platé, M., Sulikowski, M. G., Durrenberger, P. F., Franklin, L., Nanthakumar, C. B., Man, Y., Genovese, F., McAnulty, R. J., Yang, S., Maher, T. M., Nicholson, A. G., Blanchard, A. D., Marshall, R. P., Lukey, P. T., & Chambers, R. C. (2016). Exploration of a potent PI3 kinase/mTOR inhibitor as a novel anti-fibrotic agent in IPF. Thorax, 71(8), 701–711. DOI: https://doi.org/10.1136/thoraxjnl-2015-207429
Nigdelioglu, R., Hamanaka, R. B., Meliton, A. Y., O’Leary, E., Witt, L. J., Cho, T., et al. (2016). Transforming Growth Factor (TGF)-β Promotes de Novo Serine Synthesis for Collagen Production. The Journal of Biological Chemistry, 291(53), 27239–27251. DOI: https://doi.org/10.1074/jbc.M116.756247
Noble, P. W., Albera, C., Bradford, W. Z., Costabel, U., du Bois, R. M., Fagan, E. A., et al. (2016). Pirfenidone for idiopathic pulmonary fibrosis: Analysis of pooled data from three multinational phase 3 trials. The European Respiratory Journal, 47(1), 243–253. DOI: https://doi.org/10.1183/13993003.00026-2015
Oh, C. K., Murray, L. A., & Molfino, N. A. (2012). Smoking and Idiopathic Pulmonary Fibrosis. Pulmonary Medicine, 2012, 808260. DOI: https://doi.org/10.1155/2012/808260
O’Leary, E. M., Tian, Y., Nigdelioglu, R., Witt, L. J., Cetin-Atalay, R., Meliton, A. Y., et al. (2020). TGF-β Promotes Metabolic Reprogramming in Lung Fibroblasts via mTORC1-dependent ATF4 Activation. American Journal of Respiratory Cell and Molecular Biology, 63(5), 601–612. DOI: https://doi.org/10.1165/rcmb.2020-0143OC
Olmastroni, E., Scotti, S., Galimberti, F., Xie, S., & Casula, M. (2024). Ezetimibe: Integrating Established Use with New Evidence - A Comprehensive Review. Current Atherosclerosis Reports, 27(1), 10. DOI: https://doi.org/10.1007/s11883-024-01248-w
Park, Y., Ahn, C., & Kim, T.-H. (2021). Occupational and environmental risk factors of idiopathic pulmonary fibrosis: A systematic review and meta-analyses. Scientific Reports, 11(1), 4318. DOI: https://doi.org/10.1038/s41598-021-81591-z
Penke, L. R., Speth, J. M., Dommeti, V. L., White, E. S., Bergin, I. L., & Peters-Golden, M. (n.d.). (2018). FOXM1 is a critical driver of lung fibroblast activation and fibrogenesis. The Journal of Clinical Investigation, 128(6), 2389–2405. DOI: https://doi.org/10.1172/JCI87631
Qiao, X., Wang, Z., Chen, Y., Peng, N., Zhang, H., Niu, C., & Cheng, C. (2024). Combined metformin and simvastatin therapy inhibits SREBP2 maturation and alters energy metabolism in glioma. Cell Death & Disease, 15(11), 809. DOI: https://doi.org/10.1038/s41419-024-07169-5
Raghu, G., Remy-Jardin, M., Myers, J. L., Richeldi, L., Ryerson, C. J., Lederer, D. J., et al. (2018). Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine, 198(5), 44–68.
Raghu, G., Remy-Jardin, M., Richeldi, L., Thomson, C. C., Inoue, Y., Johkoh, T., et al. (2022). Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. American Journal of Respiratory and Critical Care Medicine, 205(9), e18–e47. DOI: https://doi.org/10.1164/rccm.202202-0399ST
Rangarajan, S., Bone, N. B., Zmijewska, A. A., Jiang, S., Park, D. W., Bernard, K., et al. (2018). Metformin reverses established lung fibrosis in a bleomycin model. Nature Medicine, 24(8), 1121–1131. DOI: https://doi.org/10.1038/s41591-018-0087-6
Richeldi, L., Du Bois, R. M., Raghu, G., Azuma, A., Brown, K. K., Costabel, U., et al. (2014). Efficacy and Safety of Nintedanib in Idiopathic Pulmonary Fibrosis. New England Journal of Medicine, 370(22), 2071–2082. DOI: https://doi.org/10.1056/NEJMoa1402584
Rindlisbacher, B., Schmid, C., Geiser, T., Bovet, C., & Funke-Chambour, M. (2018). Serum metabolic profiling identified a distinct metabolic signature in patients with idiopathic pulmonary fibrosis – a potential biomarker role for LysoPC. Respiratory Research, 19(1), 7. DOI: https://doi.org/10.1186/s12931-018-0714-2
Sack, C., & Raghu, G. (2019). Idiopathic pulmonary fibrosis: Unmasking cryptogenic environmental factors. European Respiratory Journal, 53(2). DOI: https://doi.org/10.1183/13993003.01699-2018
Sato, N., Takasaka, N., Yoshida, M., Tsubouchi, K., Minagawa, S., Araya, J., Saito, N., et al. (2016). Metformin attenuates lung fibrosis development via NOX4 suppression. Respiratory Research, 17(1), 107. DOI: https://doi.org/10.1186/s12931-016-0420-x
Saxton, R. A., & Sabatini, D. M. (2017). mTOR Signaling in Growth, Metabolism, and Disease. Cell, 168(6), 960–976. DOI: https://doi.org/10.1016/j.cell.2017.02.004
Selvarajah, B., Azuelos, I., Platé, M., Guillotin, D., Forty, E. J., Contento, G., et al. (2019). mTORC1 amplifies the ATF4-dependent de novo serine-glycine pathway to supply glycine during TGF-β1––induced collagen biosynthesis. Science Signaling, 12(582), eaav3048. DOI: https://doi.org/10.1126/scisignal.aav3048
Shin, H. R., Citron, Y. R., Wang, L., Tribouillard, L., Goul, C. S., Stipp, R., Sugasawa, Y., et al. (2022). Lysosomal GPCR-like protein LYCHOS signals cholesterol sufficiency to mTORC1. Science, 377(6612), 1290–1298. DOI: https://doi.org/10.1126/science.abg6621
Spagnolo, P., Kreuter, M., Maher, T. M., Wuyts, W., Bonella, F., Corte, T. J., Kopf, S., Weycker, D., Kirchgaessler, K.-U., & Ryerson, C. J. (2018). Metformin Does Not Affect Clinically Relevant Outcomes in Patients with Idiopathic Pulmonary Fibrosis. Respiration, 96(4), 314–322. DOI: https://doi.org/10.1159/000489668
Steinberg, G. R., & Hardie, D. G. (2023). New insights into activation and function of the AMPK. Nature Reviews Molecular Cell Biology, 24(4), 255–272. DOI: https://doi.org/10.1038/s41580-022-00547-x
Takehara, K., Koga, Y., Hachisu, Y., Utsugi, M., Sawada, Y., Saito, Y., Yoshimi, S., Yatomi, M., Shin, Y., Wakamatsu, I., Umetsu, K., Kouno, S., Nakagawa, J., Sunaga, N., Maeno, T., & Hisada, T. (2022). Differential Discontinuation Profiles between Pirfenidone and Nintedanib in Patients with Idiopathic Pulmonary Fibrosis. Cells, 11(1), 143. DOI: https://doi.org/10.3390/cells11010143
Tang, C.-J., Xu, J., Ye, H.-Y., & Wang, X.-B. (2021). Metformin prevents PFKFB3-related aerobic glycolysis from enhancing collagen synthesis in lung fibroblasts by regulating AMPK/mTOR pathway. Experimental and Therapeutic Medicine, 21(6), 581. DOI: https://doi.org/10.3892/etm.2021.10013
Teague, T. T., Payne, S. R., Kelly, B. T., Dempsey, T. M., McCoy, R. G., Sangaralingham, L. R., & Limper, A. H. (2022). Evaluation for clinical benefit of metformin in patients with idiopathic pulmonary fibrosis and type 2 diabetes mellitus: A national claims-based cohort analysis. Respiratory Research, 23, 91. DOI: https://doi.org/10.1186/s12931-022-02001-0
Vásquez-Pacheco, E., Marega, M., Lingampally, A., Fassy, J., Truchi, M., Goth, K., et al. (2024). Highlighting fibroblast plasticity in lung fibrosis: The WI-38 cell line as a model for investigating the myofibroblast and lipofibroblast switch. Theranostics, 14(9), 3603–3622. https://doi.org/10.7150/thno.93519 DOI: https://doi.org/10.7150/thno.93519
Verrecchia, F., Chu, M.-L., & Mauviel, A. (2001). Identification of Novel TGF-β/Smad Gene Targets in Dermal Fibroblasts using a Combined cDNA Microarray/Promoter Transactivation Approach. Journal of Biological Chemistry, 276(20), 17058–17062. DOI: https://doi.org/10.1074/jbc.M100754200
Wang, L., Xu, K., Wang, N., Ding, L., Zhao, W., Wan, R., Zhao, W., Guo, X., Pan, X., et al. (2022). Fenbendazole Attenuates Bleomycin-Induced Pulmonary Fibrosis in Mice via Suppression of Fibroblast-to-Myofibroblast Differentiation. International Journal of Molecular Sciences, 23(22), 14088. DOI: https://doi.org/10.3390/ijms232214088
Wang, Y., Sima, X., Ying, Y., & Huang, Y. (2021). Exogenous BMP9 promotes lung fibroblast HFL-1 cell activation via ALK1/Smad1/5 signaling in vitro. Experimental and Therapeutic Medicine, 22(1), 728. DOI: https://doi.org/10.3892/etm.2021.10160
Weinglass, A. B., Kohler, M., Schulte, U., Liu, J., Nketiah, E. O., Thomas, A., et al. (2008). Extracellular loop C of NPC1L1 is important for binding to ezetimibe. Proceedings of the National Academy of Sciences of the United States of America, 105(32), 11140–11145. DOI: https://doi.org/10.1073/pnas.0800936105
Wollin, L., Maillet, I., Quesniaux, V., Holweg, A., & Ryffel, B. (2014). Antifibrotic and Anti-inflammatory Activity of the Tyrosine Kinase Inhibitor Nintedanib in Experimental Models of Lung Fibrosis. The Journal of Pharmacology and Experimental Therapeutics, 349(2), 209–220. DOI: https://doi.org/10.1124/jpet.113.208223
Woodcock, H. V., Eley, J. D., Guillotin, D., Platé, M., Nanthakumar, C. B., Martufi, M., et al. (2019). The mTORC1/4E-BP1 axis represents a critical signaling node during fibrogenesis. Nature Communications, 10, 6. DOI: https://doi.org/10.1038/s41467-018-07858-8
Wu, X., Xiao, X., Chen, X., Yang, M., Hu, Z., Shuai, S., Fu, Q., Yang, H., & Du, Q. (2022). Effectiveness and mechanism of metformin in animal models of pulmonary fibrosis: A preclinical systematic review and meta-analysis. Frontiers in Pharmacology, 13, 948101. DOI: https://doi.org/10.3389/fphar.2022.948101
Xie, T., Xu, Q., Wan, H., Xing, S., Shang, C., Gao, Y., & He, Z. (2019). Lipopolysaccharide promotes lung fibroblast proliferation through autophagy inhibition via activation of the PI3K-Akt-mTOR pathway. Laboratory Investigation, 99(5), 625–633. DOI: https://doi.org/10.1038/s41374-018-0160-2
Yang, C., Rubin, L., Yu, X., Lazarovici, P., & Zheng, W. (2024). Preclinical evidence using synthetic compounds and natural products indicates that AMPK represents a potential pharmacological target for the therapy of pulmonary diseases. Medicinal Research Reviews, 44(3), 1326–1369. DOI: https://doi.org/10.1002/med.22014
Zaman, T., & Lee, J. S. (2018). Risk factors for the development of idiopathic pulmonary fibrosis: A review. Current Pulmonology Reports, 7(4), 118–125. DOI: https://doi.org/10.1007/s13665-018-0210-7
Zeng, M., Hu, Y., Zhao, L., Duan, C., Wu, H., Xu, Y., Liu, X., Wang, Y., Jiang, D., & Zeng, S. (2025). Design, synthesis, and pharmacological evaluation of triazine-based PI3K/mTOR inhibitors for the potential treatment of non-small cell lung cancer. European Journal of Medicinal Chemistry, 284, 117200. DOI: https://doi.org/10.1016/j.ejmech.2024.117200
Zhao, M., & Klionsky, D. J. (2011). AMPK-dependent phosphorylation of ULK1 induces autophagy. Cell Metabolism, 13(2), 119–120. DOI: https://doi.org/10.1016/j.cmet.2011.01.009
Zheng, Q., Cox, I. A., Campbell, J. A., Xia, Q., Otahal, P., Graaff, B. de, Corte, T. J., Teoh, A. K. Walters, E. H., & Palmer, A. J. (2022). Mortality and survival in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. ERJ Open Research, 8(1), 00591–2021. DOI: https://doi.org/10.1183/23120541.00591-2021
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Doudou Chen, Yu Liu, Zhihao Xu (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles published in this journal are licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are properly credited. Authors retain copyright of their work, and readers are free to copy, share, adapt, and build upon the material for any purpose, including commercial use, as long as appropriate attribution is given.
