Inhaled drug delivery for the targeted treatment of asthma

Enhancing blending efficiency and in vitro aerosol performance of low-dose inhalable dry powders with spray freeze dried microparticles

Carrier-based dry powder inhaler (DPI) products deliver low-dose drugs to the lungs by blending micronized drug particles with carriers. Traditional methods for obtaining fine particles, such as milling or spray drying, are not suitable for high-value, heat-sensitive drugs. Hence, we propose a novel strategy for preparing carrier-based DPI products based on spray freeze dried (SFD) particles. Due to their spherical, porous, and brittle structure, they can be easily fragmented and uniformly attached to carriers under mild blending conditions. Additionally, these low-density fragments can detach from the carrier during inhalation, potentially achieving better pulmonary delivery performance. In this work, previously developed SFD ciprofloxacin/leucine particles were chosen as model particles, and commonly used lactose as carriers, then blended via TURBULA® T2F. The effects of model particle mass content, mechanical strength, carrier size distribution, blending time, and blending speed on both blending uniformity and in vitro aerosol performance were investigated. An image analysis method based on energy dispersive spectroscopy mapping images was proposed to rapidly determine blending uniformity, showing good correlation with concentration quantification methods. Optimized formulation (SFD-C1, 3.6 % mass content) and process parameters (blending speed of 25 rpm for 10 min) render excellent blending uniformity and fine particle fraction (∼ 50.40 %). This strategy potentially expands the application field of carrier-based DPI products.

Harnessing Surface Hydrophilicity of Inhalable Nanoparticles for Precision Delivery of Glucagon-like Peptide-1 Receptor Agonists or Anti-Asthmatic Therapeutics

Rational adjustment of surface physicochemical properties of inhalable nanocarriers significantly influences their in vivo fate during pulmonary delivery. Among these, surface hydrophilicity/hydrophobicity has been recognized as a critical factor in the transmucosal process. However, the impacts of surface hydrophilicity/hydrophobicity on the transcellular performance and ultimate therapeutic effects of pulmonary-delivered nanosystems still remain unelucidated. In this study, we developed a series of liposomes with varying surface hydrophilicity to investigate the effect of surface properties on both local and systemic drug delivery. Interestingly, low-hydrophilic liposomes exhibited enhanced systemic absorption, whereas high-hydrophilic liposomes demonstrated prolonged pulmonary residence after inhalation. To validate this principle, we applied two disease models. In a type II diabetes mellitus model, low hydrophilic liposomes loaded with GLP-1 receptor agonists (Liraglutide or Semaglutide) showed excellent systemic drug delivery and hypoglycemic effects. In an OVA-induced allergic asthma model, budesonide-loaded high hydrophilic liposomes significantly alleviated symptoms while reducing dosing frequency. Mechanistic studies further revealed that liposomes with lower surface hydrophilicity could enhance the transcellular transport efficiency of the drug through alveolar epithelial cells, while those with higher surface hydrophilicity prolonged the pulmonary residence of the drug by decreasing alveolar epithelium transportation and the avoidance of macrophage clearance. Lastly, we evaluated the biocompatibility of these liposomes following inhalation. Overall, tuning the surface hydrophilicity/hydrophobicity of inhalable nanocarriers to suit local or systemic delivery goals offers valuable insights for the rational design of advanced pulmonary delivery systems.

Clinical Translation Challenges and Strategies for Tumour Vaccines Considering Multiple Delivery Routes

BACKGROUND

The high incidence and mortality rates of cancer have kept it at the top of the research agenda for the global healthcare industry, as well as put serious economic pressure on families and society. It has gradually been recognised that reducing the incidence of cancer through various interventions and that combining prevention and treatment are the key to alleviating the burden of cancer.

METHODS

Retrieve and summarize the literature related to the delivery methods of tumor vaccines, and investigate whether these delivery methods have been applied clinically or have been used in clinical trials.

RESULTS

there are a variety of methods for cancer vaccine development, but only a very small number of studies have been able to make strides towards implementing these methods in the clinic, which is closely linked to drawbacks with the means of vaccine delivery.

CONCLUSIONS

This review analyses the reasons why it is difficult to apply these methods in the clinic from the point of view of the delivery method rather than the design of the cancer vaccine. It also describes some of the delivery methods that have not yet been applied for cancer vaccines and, considering this in conjunction with those that are currently used for this purpose, predicts their prospects for future application.

Optimization, In Vitro, and In Silico Characterization of Theophylline Inhalable Powder Using Raffinose-Amino Acid Combination as Fine Co-Spray-Dried Carriers

Background/Objectives: Dry powder inhalation is an attractive research area for development. Therefore, this work aimed to develop inhalable co-spray-dried theophylline (TN) microparticles, utilizing raffinose-amino acid fine carriers intended for asthma therapy. The study addressed enhancing TN's physicochemical and aerodynamic properties to ensure efficient lung deposition. Methods: The process involves spray-drying each formulation's solution using a mini spray drier. A rigorous assessment was conducted on particle size distribution, structural and thermal analysis, morphology study, in vitro and in silico aerodynamic investigation, and aerodynamic particle counter in addition to the solubility, in vitro dissolution, and diffusion of TN. Results: The carriers containing leucine and glycine revealed superior characteristics (mass median aerodynamic diameter (MMAD): 4.6-5 µm, fine particle fraction (FPF): 30.6-35.1%, and amorphous spherical structure) as candidates for further development of TN-DPIs, while arginine was excluded due to intensive aggregation and hygroscopicity, which led to poor aerodynamic performance. TN co-spray-dried samples demonstrated fine micronized particles (D [0.5]: 3.99-5.96 µm) with predominantly amorphous structure (crystallinity index: 24.1-45.2%) and significant solubility enhancement (~19-fold). Formulations containing leucine and leucine-glycine revealed the highest FPF (45.7-47.8%) and in silico lung deposition (39.3-40.1%), rapid in vitro drug release (~100% within 10 min), and improved in vitro diffusion (2.29-2.43-fold), respectively. Moreover, the aerodynamic counter confirmed the development of fine microparticles (mean number particle size = 2.3-2.02 µm). Conclusions: This innovative formulation possesses enhanced physicochemical, morphological, and aerodynamic characteristics of low-dose TN for local asthma treatment and could be applied as a promising carrier for dry powder inhaler development.

Integrated transcriptomics and network pharmacology to reveal the mechanism of Physochlainae Radix in the treatment of asthma

BACKGROUND

Physochlainae Radix (PR), a valuable traditional Chinese medicine, has been historically applied for the treatment of bronchitis and asthma in clinic, yet its mechanisms have not been clearly elucidated.

PURPOSE

This study aims to reveal the underlying mechanisms of PR in treating asthma, employing transcriptomics and network pharmacology approaches.

METHODS

To evaluate the therapeutic effects of PR on asthma, we established the asthmatic model in ICR mice by using OVA. Firstly, we employed LC-MS and GNPS to analyze the major chemical constituents in PR. Subsequently, the effects of PR in asthma treatment were assessed through histology, biochemical analysis, and immunofluorescence (IF) assay. Further, an integrated approach of transcriptomics and network pharmacology was applied to identify the target proteins and related pathways of PR against asthma. IF, immunohistochemical (IHC), enzyme-linked immunosorbent assay (ELISA), and western blotting (WB) were utilized for experimental validation and mechanistic studies.

RESULTS

Using UPLC/Q-Orbitrap-MS and GNPS, we eventually identified 23 potential active components from PR. It was discovered for the first time that PR contains a large number of steroidal saponins. PR treatment has been shown to improve lung function, histomorphological changes, and inflammation in the OVA-induced asthma model. According to the results of the transcriptomics and network pharmacology research, PR targeted CXCR2, CCR1, MMP3, MMP9, and IL-17 as crucial elements for treating asthma through the TLR4/MyD88/NF-κB, MAPK, and IL-17 pathways. The key proteins of these pathways were validated by IF and/or WB. Additionally, it was verified that the therapeutic effect of PR on asthmatic mice was related to the inhibition of the activation of the TLR4/MyD88 pathway by introducing TAK-242, an inhibitor of TLR4.

CONCLUSIONS

This research revealed that PR improves asthma through the TLR4/MyD88/NF-κB, MAPK, and IL-17 pathways. It is worth noting that this is the first time that transcriptomics and network pharmacology have been comprehensively used to explore the mechanism of PR in treating asthma. This finding advances our understanding of the pharmacological mechanisms underlying PR and lends support to its usage as a treatment agent for asthma.

Allergy Treatment: A Comprehensive Review of Nanoparticle-based Allergen Immunotherapy

Allergic disorders rising in prevalence globally, affecting a substantial proportion of individuals in industrialized nations. The imbalance in the immune system, characterized by elevated allergen-specific T helper 2 (Th2) cells and immunoglobulin E (IgE) antibodies, is a key factor in allergy development. Allergen-specific immunotherapy (AIT) is the only treatment capable of alleviating allergic symptoms, preventing new sensitizations, and reducing asthma risk in allergic rhinitis patients. Traditional AIT, however, faces challenges such as frequent administration, adverse effects, and inconsistent patient outcomes. Nanoparticle-based approaches have emerged as a promising strategy to enhance AIT. This review explores the utilization of nanoparticles in AIT, highlighting their ability to interact with the immune system and improve therapeutic outcomes. Various types of nanoparticles, including polyesters, polysaccharide polymers, liposomes, protamine-based nanoparticles (NPs), and polyanhydrides, have been employed as adjuvants or carriers to enhance AIT's efficacy and safety. Nanoparticles offer advantages such as allergen protection, improved immune response modulation, targeted cell delivery, and reduced side effects. This review provides an overview of the current landscape of nanoparticle-based allergen immunotherapy, discussing its potential to revolutionize allergy treatment compared to traditional immunotherapy.

AAV-mediated MUC5AC siRNA delivery to prevent mucociliary dysfunction in asthma

The main structural components of mucus produced in the lung are mucin 5B (MUC5B) and mucin 5AC (MUC5AC) where a relatively higher expression of MUC5B is typical in health. In the lungs of individuals with asthma, there is a shift from MUC5B to MUC5AC as the predominantly secreted mucin which has been shown to impair mucociliary clearance (MCC) and increase mucus plug formation in the airways. Given its role in asthmatic lung disease, MUC5AC represents a potential therapeutic target where a gene delivery approach could be leveraged to modulate its expression. For these purposes, we explored adeno-associated virus serotype 6 (AAV6), as a lung-tropic viral gene vector to target airway epithelial cells and reduce MUC5AC expression via siRNA delivery. We confirmed that AAV6 was able to transduce epithelial cells in the airways of healthy mice with high transgene expression in mucus-secreting goblet cells. Using multiple particle tracking analysis, we observed that AAV6 was capable of penetrating both normal and MUC5AC-enriched mucus barriers. Successful transduction with AAV6 was also achieved in IL-13 stimulated human airway epithelial (HAE) cells differentiated at air-liquid interface (ALI). AAV6 expressing MUC5AC-targeting siRNA was evaluated as a prophylactic treatment in HAE cell cultures before IL-13 challenge. IL-13 stimulated HAE cultures treated with AAV6-MUC5AC siRNA had significantly reduced MUC5AC mRNA and protein expression compared to untreated controls. Mucociliary transport in IL-13 stimulated HAE cultures was also maintained and comparable to healthy controls following AAV6-MUC5AC siRNA treatment. Together, these findings support that AAV6 may be used as an inhaled gene therapy to suppress MUC5AC overexpression and restore normal airway clearance function in asthma.

Innovative approaches to asthma treatment: harnessing nanoparticle technology

In the domain of respiratory illnesses, asthma remains a critical obstacle. The heterogeneous nature of this chronic inflammatory disease poses challenges during its treatment. Glucocorticoid-based combination drug therapy now dominates clinical treatments for asthma; however, glucocorticoid resistance, numerous adverse effects, the incidence of inadequate drug delivery, and other factors need the development of more effective therapies. In recent years, there has been extensive research on nanotechnology in medicine. It has been shown in studies that these drug delivery systems can greatly enhance targeting and bioavailability and decrease the toxicity of medication. Nanoparticle drug delivery systems offer improved therapeutic efficacy compared to conventional administration techniques. Nanotechnology enables advancements in precision medicine, offering benefits for heterogeneous conditions such as asthma. This review will examine the critical factors of asthma to consider when formulating medications, as well as the role of nanomaterials and their mechanisms of action in pulmonary medicine for asthma treatment.

Novel strategies in systemic and local administration of therapeutic monoclonal antibodies

Monoclonal antibodies (mAbs) are an evolving class of biopharmaceuticals, with advancements evident across various stages of their development. While discovery, mAb chemical optimization, production and purification processes have been thoroughly reviewed, this paper aims to offer a summary of novel strategies in administration of mAbs. At present, systemic delivery of mAbs is available through parenteral administration routes with focus on subcutaneous administration. In addition, oriented toward patient-friendly therapy, other less invasive administration routes of mAbs, such as inhalation, nasal, transdermal, and oral administration, are explored. Literature data reveals the potential for local delivery of mAbs via inhalation, nasal, transdermal, intratumoral, intravitreal and vaginal administration, offering high efficacy with fewer systemic adverse effects. However, to date, only mAb medicines are available for intravitreal administration, mainly due to higher bioavailability, and an intranasal spray is authorised as a medical device. The review highlights the promising data in approval of novel administration routes, likely through inhalation, but further intensive research considering the current obstacles, is essential.

Diagnostic value of IgE, fractional of exhaled nitric oxide, and peripheral blood eosinophils in adult bronchial asthma and their relationship with disease severity

OBJECTIVE

To investigate the diagnostic value of immunoglobulin E (IgE), fractional of exhaled nitric oxide (FeNO), and peripheral blood eosinophils (EOS) in adult bronchial asthma and to analyze their relationship with asthma severity.

METHODS

A retrospective analysis was conducted on 336 patients diagnosed with bronchial asthma and admitted to Xi'an Fourth Hospital from January 2022 to January 2024, forming the asthma group. Additionally, another 127 healthy subjects were selected as the non-asthmatic control group. The patients in the asthma group were categorized into a mild asthma group (n=138), a moderate asthma group (n=115), and a severe asthma group (n=83) according to the severity of the disease. Clinical data, lung function indices, and IgE, FeNO, and EOS levels were compared across groups. ROC curves were used to assess the diagnostic value of IgE, FeNO, and EOS levels for bronchial asthma. Spearman's rank correlation analysis was used to analyze the correlation between IgE, FeNO, EOS and other indicators and asthma severity.

RESULTS

The levels of IgE, FeNO, and EOS were significantly higher in the asthma group than those in the non-asthma group, while lung function indices, peak expiratory flow rate (PEF) and forced expiratory volume in 1 s (FEV1), were significantly lower (all P < 0.05). The areas under curve (AUCs) of IgE, FeNO, and EOS for the diagnosis of asthma were 0.79, 0.93, and 0.88, respectively. Significant differences were observed in smoking history, family history of asthma, co-existing allergic rhinitis, and combined atopic eczema across different severity groups (all P < 0.05). Spearman's rank correlation analysis showed that IgE, FeNO, and EOS were positively correlated with asthma severity (all P < 0.05), with r s values of 0.718, 0.679, and 0.540, respectively.

CONCLUSION

IgE, FeNO, and EOS are valuable in diagnosing bronchial asthma in adults. Higher levels of IgE, FeNO, and EOS correspond to increased asthma severity, making these biomarkers useful for assessing asthma severity.

LungVis 1.0: an automatic AI-powered 3D imaging ecosystem unveils spatial profiling of nanoparticle delivery and acinar migration of lung macrophages

Targeted (nano-)drug delivery is essential for treating respiratory diseases, which are often confined to distinct lung regions. However, spatio-temporal profiling of drugs or nanoparticles (NPs) and their interactions with lung macrophages remains unresolved. Here, we present LungVis 1.0, an AI-powered imaging ecosystem that integrates light sheet fluorescence microscopy with deep learning-based image analysis pipelines to map NP deposition and dosage holistically and quantitatively across bronchial and alveolar (acinar) regions in murine lungs for widely-used bulk-liquid and aerosol-based delivery methods. We demonstrate that bulk-liquid delivery results in patchy NP distribution with elevated bronchial doses, whereas aerosols achieve uniform deposition reaching distal alveoli. Furthermore, we reveal that lung tissue-resident macrophages (TRMs) are dynamic, actively patrolling and redistributing NPs within alveoli, contesting the conventional paradigm of TRMs as static entities. LungVis 1.0 provides an advanced framework for exploring pulmonary delivery dynamics and deepening insights into TRM-mediated lung immunity.

Enhancing peptide and PMO delivery to mouse airway epithelia by chemical conjugation with the amphiphilic peptide S10

Delivery of antisense oligonucleotides (ASOs) to airway epithelial cells is arduous due to the physiological barriers that protect the lungs and the endosomal entrapment phenomenon, which prevents ASOs from reaching their intracellular targets. Various delivery strategies involving peptide-, lipid-, and polymer-based carriers are being investigated, yet the challenge remains. S10 is a peptide-based delivery agent that enables the intracellular delivery of biomolecules such as GFP, CRISPR-associated nuclease ribonucleoprotein (RNP), base editor RNP, and a fluorescent peptide into lung cells after intranasal or intratracheal administrations to mice, ferrets, and rhesus monkeys. Herein, we demonstrate that covalently attaching S10 to a fluorescently labeled peptide or a functional splice-switching phosphorodiamidate morpholino oligomer improves their intracellular delivery to airway epithelia in mice after a single intranasal instillation. Data reveal a homogeneous delivery from the trachea to the distal region of the lungs, specifically into the cells lining the airway. Quantitative measurements further highlight that conjugation via a disulfide bond through a pegylated (PEG) linker was the most beneficial strategy compared with direct conjugation (without the PEG linker) or conjugation via a permanent thiol-maleimide bond. We believe that S10-based conjugation provides a great strategy to achieve intracellular delivery of peptides and ASOs with therapeutic properties in lungs.

Understanding the role of swirling flow in dry powder inhalers: Implications for design considerations and pulmonary delivery

Dry powder inhalers (DPIs) are widely employed to treat respiratory diseases, offering numerous advantages such as high dose capacity and stable formulations. However, they usually face challenges in achieving sufficient pulmonary drug delivery and minimizing excessive oropharyngeal deposition. This review provides a new viewpoint to address these challenges by focusing on the role of swirling flow, a crucial yet under-researched aspect that induces strong turbulence. In the review, we comprehensively discuss both key classic designs (tangential inlet, swirling chamber, grid mesh, and mouthpiece) and innovative designs in inhalers, exploring how the induced swirling flow initiates powder dispersion and promotes delivery efficiency. Valuable design considerations to effectively coordinate inhalers with formulations and patients are also provided. It is highlighted that the delicate manipulation of swirling flow is essential to maximize benefits. By emphasizing the role of swirling flow and its potential application, this review offers promising insights for advancing DPI technology and optimizing therapeutic outcomes in inhaled therapy.

Reshaping respiratory care: potential advances in inhaled pharmacotherapy in asthma

INTRODUCTION

Asthma is a common disease with a global burden of 358 million patients. Despite improvements in pharmacological and non-pharmacological treatments, many patients still do not achieve complete asthma control. Therefore, innovative pharmacotherapy is important.

AREAS COVERED

Following a semi-structured search in Pubmed, an overview of advances in inhaled asthma therapy is provided, looking at innovations in digital inhalers, eco-friendly inhalers and novel inhaled biologic therapies, antibiotics and vaccines, as well as other potential novel asthma therapy targets.

EXPERT OPINION

Digital inhalers, sending reminders and monitoring inhalation technique electronically, can support medication adherence and improve asthma control. To reduce the global warming potential of traditional aerosols used in pressurized metered-dose inhalers (HFA-134a, HFA-227ea), greener alternatives are under development (HFA-152a, HFO-1234ze) that are expected to be available by 2025. Current pharmacological advances in asthma therapy are mainly achieved by novel biologicals (anti-IgE, anti-IL5, anti-IL4/13, and anti-TSLP) targeting specific severe asthma phenotypes. While injection is the usual administration route for biologics and vaccines used in asthma, inhalation is an option being explored, although several (mainly formulation) challenges need to be overcome. Other potential novel future inhaled asthma therapies include anti-IL-33/ST2 biologicals and JAK inhibitors, all still requiring more clinical evidence.

A review of the safety profile, antioxidant, anti-inflammatory, and bronchorelaxant activities of Waltheria indica Linn (Malvaceae): A potential antiasthmatic phytomedicine

Introduction

Waltheria indica Linn (Malvaceae) is a widely distributed plant in West Africa. It is commonly used in Burkina Faso to treat inflammation-related diseases, including asthma. Previous reviews have focused on the ethnobotanical, traditional uses, phytochemistry, and pharmacological properties of Waltheria indica. This report aims to compile the biological and pharmacological activities that highlight the anti-asthmatic properties of Waltheria indica L. (W. indica).

Method

Electronic databases, such as PubMed, Scopus, Hinari, SciFinder, Google Scholar, and ScienceDirect, were used to gather data on Watheria indica. Data on the toxicological, anti-inflammatory, antioxidant, and bronchorelaxant effects of W. indica were collected.

Results

Twenty-three studies describing the biological and pharmacological activities relevant to assessing the anti-asthmatic properties of W. indica were found. Nine articles investigated the anti-inflammatory effects, and three manuscripts were found to have bronchorelaxant activity. Five publications reported the antioxidant activity of the plant extracts. Research on the extracts revealed a tolerable safety profile in rats and mice with an LD50 ranging from 300 to 5000 mg/kg body weight, depending on the parts of the plant used. Phenolic compounds, particularly flavonoids, alkaloids, and saponins, were found to be responsible for the activities involved in the assessment of anti-asthmatic properties.

Conclusion

The results of this review suggest that W. indica could be a valuable resource for the treatment of asthma and other respiratory diseases. However, further chemical and pharmacological investigations are needed to understand its mechanism of action in treating asthma.

Targeting type I PRMTs as promising targets for the treatment of pulmonary disorders: Asthma, COPD, lung cancer, PF, and PH

Pulmonary disorders, including asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF), pulmonary hypertension (PH), and lung cancer, seriously impair the quality of lives of patients. A deeper understanding of the occurrence and development of the above diseases may inspire new strategies to remedy the scarcity of treatments. Type I protein arginine methyltransferases (PRMTs) can affect processes of inflammation, airway remodeling, fibroblast proliferation, mitochondrial mass, and epithelial dysfunction through substrate methylation and non-enzymatic activity, thus affecting the occurrence and development of asthma, COPD, lung cancer, PF, and PH. As potential therapeutic targets, inhibitors of type I PRMTs are developed, moreover, representative compounds such as GSK3368715 and MS023 have also been used for early research. Here, we collated structures of type I PRMTs inhibitors and compared their activity. Finally, we highlighted the physiological and pathological associations of type I PRMTs with asthma, COPD, lung cancer, PF, and PH. The developing of type I PRMTs modulators will be beneficial for the treatment of these diseases.

Protein Coronas Derived from Mucus Act as Both Spear and Shield to Regulate Transferrin Functionalized Nanoparticle Transcellular Transport in Enterocytes

The epithelial mucosa is a key biological barrier faced by gastrointestinal, intraoral, intranasal, ocular, and vaginal drug delivery. Ligand-modified nanoparticles demonstrate excellent ability on this process, but their efficacy is diminished by the formation of protein coronas (PCs) when they interact with biological matrices. PCs are broadly implicated in affecting the fate of NPs in vivo and in vitro, yet few studies have investigated PCs formed during interactions of NPs with the epithelial mucosa, especially mucus. In this study, we constructed transferrin modified NPs (Tf-NPs) as a model and explored the mechanisms and effects that epithelial mucosa had on PCs formation and the subsequent impact on the transcellular transport of Tf-NPs. In mucus-secreting cells, Tf-NPs adsorbed more proteins from the mucus layers, which masked, displaced, and dampened the active targeting effects of Tf-NPs, thereby weakening endocytosis and transcellular transport efficiencies. In mucus-free cells, Tf-NPs adsorbed more proteins during intracellular trafficking, which enhanced transcytosis related functions. Inspired by soft coronas and artificial biomimetic membranes, we used mucin as an "active PC" to precoat Tf-NPs (M@Tf-NPs), which limited the negative impacts of "passive PCs" formed during interface with the epithelial mucosa and improved favorable routes of endocytosis. M@Tf-NPs adsorbed more proteins associated with endoplasmic reticulum-Golgi functions, prompting enhanced intracellular transport and exocytosis. In summary, mucus shielded against the absorption of Tf-NPs, but also could be employed as a spear to break through the epithelial mucosa barrier. These findings offer a theoretical foundation and design platform to enhance the efficiency of oral-administered nanomedicines.

On the path to predicting immune responses in the lung: Modeling the pulmonary innate immune system at the air-liquid interface (ALI)

Chronic respiratory diseases and infections are among the largest contributors to death globally, many of which still have no cure, including chronic obstructive pulmonary disorder, idiopathic pulmonary fibrosis, and respiratory syncytial virus among others. Pulmonary therapeutics afford untapped potential for treating lung infection and disease through direct delivery to the site of action. However, the ability to innovate new therapeutic paradigms for respiratory diseases will rely on modeling the human lung microenvironment and including key cellular interactions that drive disease. One key feature of the lung microenvironment is the air-liquid interface (ALI). ALI interface modeling techniques, using cell-culture inserts, organoids, microfluidics, and precision lung slices (PCLS), are rapidly developing; however, one major component of these models is lacking-innate immune cell populations. Macrophages, neutrophils, and dendritic cells, among others, represent key lung cell populations, acting as the first responders during lung infection or injury. Innate immune cells respond to and modulate stromal cells and bridge the gap between the innate and adaptive immune system, controlling the bodies response to foreign pathogens and debris. In this article, we review the current state of ALI culture systems with a focus on innate immune cells and suggest ways to build on current models to add complexity and relevant immune cell populations.