Shorter telomere length is associated with a usual interstitial pneumonia radiologic pattern in patients with interstitial lung disease (ILD).
RT’s Three Key Takeaways:
- Pattern Correlation: Shorter telomere length is associated with a specific scarring pattern in patients with interstitial lung disease, but not with the overall extent of lung fibrosis, according to new research.
- Machine-Learning Detection: Artificial intelligence-driven imaging tools successfully identified patients with telomere shortening, demonstrating the potential for imaging biomarkers to recognize distinct disease subtypes.
- Mechanistic Insight: The findings suggest that cellular aging mechanisms may influence the structural presentation of lung damage rather than the total volume of scar tissue.
Shorter telomere length is associated with a usual interstitial pneumonia (UIP) radiologic pattern in patients with interstitial lung disease (ILD), but not with the overall extent of fibrosis, according to a study presented at CHEST 2026.
Investigators evaluated the relationship between whole-genome sequencing-derived telomere length (WGS-TL) and radiologic features among participants enrolled in the Pulmonary Fibrosis Foundation Patient Registry. The cohort included individuals who had age-adjusted WGS-TL and chest computed tomography (CT) scans obtained within one year of enrollment, the study authors stated.
Radiologic and Genetic Findings
The analysis included 503 participants, of whom 339 had idiopathic pulmonary fibrosis (IPF), and 164 had non-IPF ILD, the investigators reported. Among the full study cohort, 138 participants, or 27%, had age-adjusted WGS-TL falling below the 10th percentile.
To assess imaging characteristics, the researchers evaluated visual CT patterns alongside two machine learning-derived metrics: multiple instance learning–usual interstitial pneumonia (MIL-UIP) and data-driven texture analysis (DTA) fibrosis. Higher MIL-UIP scores predict histologically confirmed UIP, whereas higher DTA fibrosis scores reflect a greater overall extent of fibrosis, according to the researchers.
Patients with telomere lengths below the 10th percentile were more likely to present with a radiologic UIP pattern compared to those above the threshold (62% vs 50%), according to the report. Participants with shorter telomeres also demonstrated higher MIL-UIP scores (0.73 vs 0.66). However, researchers observed no significant difference in the total extent of lung fibrosis, as measured by DTA fibrosis scores, between individuals above and below the 10th percentile.
Implications for Clinical Phenotyping
“MIL-UIP may help identify patients with telomere shortening, supporting a role for imaging-derived biomarkers in recognizing biologically distinct ILD phenotypes,” said Samuel B Konkol, MD, a CHEST 2026 presenting author.
According to the research team, these results suggest that telomere shortening specifically associates with the spatial pattern of fibrosis rather than the total fibrotic burden, supporting a distinct mechanistic biological pathway linking telomere dysfunction to UIP-predominant lung disease.
