{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:51:03Z","timestamp":1787791863916,"version":"build-2784847793"},"reference-count":81,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>Post-Infectious Bronchiolitis Obliterans (PIBO) is a rare chronic obstructive lung disease characterized by irreversible airflow limitation due to inflammation, fibrosis, and obliteration of the small airways following severe lower respiratory tract infection. Adenovirus is the most frequently associated pathogen, followed by other viruses and atypical bacteria. PIBO pathogenesis appears to result from a complex interaction between severe epithelial injury, dysregulated immune response, persistent neutrophilic inflammation, abnormal tissue repair, and genetic susceptibility. Epithelial damage triggers the release of inflammatory cytokines and epithelial-derived alarmins, promoting chronic inflammation and airway remodeling through fibrosis and airway obliteration driven by activation of the TGF-\u03b2\/CTGF pathway, epithelial\u2013mesenchymal transition, macrophage\u2013fibroblast interactions, and extracellular matrix deposition. Genetic factors affecting mucociliary clearance, innate immunity, and fibrotic pathways may further predispose certain individuals to abnormal repair and fibrosis consequently. Histologically, PIBO progresses from inflammatory bronchiolitis to fibroproliferative remodeling and constrictive bronchiolitis with luminal obliteration. Understanding these mechanisms supports a stage-based therapeutic approach targeting inflammation in early disease and fibrotic remodeling in advanced stages.<\/jats:p>","DOI":"10.3390\/biom16071061","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T09:32:54Z","timestamp":1784539974000},"page":"1061","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Narrative Review of the Pathophysiology of Post-Infectious Bronchiolitis Obliterans"],"prefix":"10.3390","volume":"16","author":[{"given":"Alessandro","family":"Zago","sequence":"first","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3910-4121","authenticated-orcid":false,"given":"Caterina","family":"Cocchi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Maschio","sequence":"additional","affiliation":[{"name":"Department of Pediatric, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4050-0731","authenticated-orcid":false,"given":"Laura","family":"Badina","sequence":"additional","affiliation":[{"name":"Department of Pediatric, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Policastro","sequence":"additional","affiliation":[{"name":"Department of Pediatric, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Amaddeo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy"},{"name":"Department of Pediatric, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6343-846X","authenticated-orcid":false,"given":"Egidio","family":"Barbi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy"},{"name":"Department of Pediatric, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6329-4208","authenticated-orcid":false,"given":"Sergio","family":"Ghirardo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Health Sciences, University of Trieste, 34137 Trieste, Italy"},{"name":"Department of Pediatric, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref_1","first-page":"00181","article-title":"Cardiorespiratory fitness in patients with post-infectious bronchiolitis obliterans: A cross-sectional study","volume":"11","year":"2025","journal-title":"ERJ Open Res."},{"key":"ref_2","first-page":"7790381","article-title":"Postinfectious Bronchiolitis Obliterans in Children","volume":"2025","author":"Wan","year":"2025","journal-title":"Can. 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