Selective Immune Clearance and Lung Repair in Pulmonary Fibrosis

Selective immune clearance could limit pulmonary fibrosis by removing disease-sustaining cells, but its value depends on preserving the capacity of the remaining tissue to repair. This narrative review examines PubMed literature searched through 10 October 2026, prioritizing studies published from 10 October 2024 to 10 October 2026 while retaining relevant earlier investigations. We compare human tissue profiling, immunopeptidomics, cell assays and animal interventions according to target recognition, effector-dependent elimination, treatment phase and retained repair capacity. Vaccination, checkpoint blockade and engineered immune cells provide different combinations of cytotoxicity, altered cell abundance and antifibrotic activity. However, repair-associated senescence and conflicting FAP-targeting outcomes show why marker expression alone cannot determine which cells should be removed. Epithelial proliferation and inferred cell trajectories are therefore assessed separately from lineage-supported differentiation, alveolar organization and sustained barrier, vascular and physiological recovery. The available studies do not yet establish that selective clearance produces lasting alveolar recovery, and clinical benefit in IPF remains unproven. Functional target validation, treatment after fibrosis is established, and follow-up after treatment withdrawal are priorities for translation.