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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Med.</journal-id>
<journal-title>Frontiers in Medicine</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Med.</abbrev-journal-title>
<issn pub-type="epub">2296-858X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fmed.2025.1608078</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Medicine</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Shapley additive explanations based feature selection reveals CXCL14 as a key immune-related gene in predicting idiopathic pulmonary fibrosis</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>Chen</surname> <given-names>Bin</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
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<role content-type="https://credit.niso.org/contributor-roles/formal-analysis/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name><surname>Huan</surname> <given-names>Lu</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/2926803/overview"/>
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<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
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</contrib>
<contrib contrib-type="author">
<name><surname>Lu</surname> <given-names>Junyu</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
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</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Yuan</surname> <given-names>Jinhe</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/3029698/overview"/>
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</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Geriatric Palliative Medicine, Chongqing Liangjiang New District People Hospital</institution>, <addr-line>Chongqing</addr-line>, <country>China</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Respiratory and Critical Care Medicine, Renji Hospital, School of Medicine, Chongqing University</institution>, <addr-line>Chongqing</addr-line>, <country>China</country></aff>
<author-notes>
<fn fn-type="edited-by" id="fn0003">
<p>Edited by: Xiaomei Yang, Johns Hopkins Medicine, United States</p>
</fn>
<fn fn-type="edited-by" id="fn0004">
<p>Reviewed by: Grete Francesca Privitera, University of Catania, Italy</p>
<p>Yunhuan Liu, Tongji University, China</p>
</fn>
<corresp id="c001">&#x002A;Correspondence: Jinhe Yuan, <email>cqswyyjh@163.com</email></corresp>
</author-notes>
<pub-date pub-type="epub">
<day>06</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>12</volume>
<elocation-id>1608078</elocation-id>
<history>
<date date-type="received">
<day>29</day>
<month>04</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>25</day>
<month>07</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2025 Chen, Huan, Lu and Yuan.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Chen, Huan, Lu and Yuan</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec id="sec1">
<title>Background</title>
<p>Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease marked by excessive fibrous tissue accumulation in the lung interstitium, leading to a gradual deterioration of respiratory function and significantly impairing patients&#x2019; quality of life. Despite advances in understanding its etiology and pathogenesis, the exact mechanisms remain unclear, underscoring the need for novel biomarkers and therapeutic targets.</p>
</sec>
<sec id="sec2">
<title>Methods</title>
<p>We analyzed five publicly available datasets from the Gene Expression Omnibus (GEO), specifically &#x201C;GSE15197,&#x201D; &#x201C;GSE53845,&#x201D; &#x201C;GSE135065,&#x201D; &#x201C;GSE185691,&#x201D; and &#x201C;GSE195770,&#x201D; to identify gene expression changes associated with IPF. Data were annotated and normalized to minimize batch effects and technical variability. Principal Component Analysis (PCA) verified preprocessing efficacy. Differentially expressed genes (DEGs) were identified using linear modeling. Core DEGs were selected via integrative analysis across datasets.</p>
</sec>
<sec id="sec3">
<title>Results</title>
<p>Our analysis revealed DEGs that are substantially linked to crucial biological processes such as extracellular matrix organization and immune response regulation. Integrative analysis of five GEO datasets identified CXCL14, MMP7, and MDK as core differentially expressed genes in the final predictive model. Using Least Absolute Shrinkage and Selection Operator (LASSO) regression and Random Forest, we constructed a logistic regression model with robust predictive performance, achieving an AUC of 0.92 in the training cohort and 0.89 in the validation cohort, with sensitivity of 88% and specificity of 85%. The Shapley Additive Explanations (SHAP) method identified CXCL14 (mean SHAP value&#x202F;=&#x202F;0.38) as the most influential feature, followed by MMP7 and MDK. Functional enrichment analyses highlighted significant enrichment of TGF-<italic>&#x03B2;</italic> signaling, extracellular matrix organization, and chemokine signaling pathways. Immune infiltration analysis revealed positive correlations between CXCL14 expression and alveolar macrophage/activated fibroblast populations, while SHAP interaction analysis identified synergistic effects between CXCL14 and TGF-&#x03B2;1 in driving fibrosis.</p>
</sec>
<sec id="sec4">
<title>Conclusion</title>
<p>These findings substantiate the hypothesis that IPF pathogenesis is closely linked to extracellular matrix remodeling and immune dysregulation. This suggests that future investigations should delve deeper into the practical applications of identified biomarkers in the early diagnosis and management of IPF. Furthermore, the machine learning-based predictive model demonstrates strong clinical potential and merits further validation in prospective trials to assess its utility and therapeutic implications in real-world settings.</p>
</sec>
</abstract>
<kwd-group>
<kwd>idiopathic pulmonary fibrosis</kwd>
<kwd>gene expression</kwd>
<kwd>machine learning</kwd>
<kwd>immune cell infiltration</kwd>
<kwd>Shapley additive explanations</kwd>
</kwd-group>
<counts>
<fig-count count="6"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="40"/>
<page-count count="14"/>
<word-count count="7947"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Pulmonary Medicine</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="sec5">
<label>1</label>
<title>Introduction</title>
<p>Idiopathic Pulmonary Fibrosis (IPF) represents a progressive, fatal interstitial lung disorder characterized by aberrant pulmonary tissue fibrogenesis and irreversible decline in respiratory function, with a median survival duration of merely 3&#x2013;5&#x202F;years (<xref ref-type="bibr" rid="ref1">1</xref>). Despite the clinical approval of tyrosine kinase inhibitors (e.g., Nintedanib) and antifibrotic agents (e.g., Pirfenidone), substantial interindividual variability in therapeutic responses persists: approximately 30% of patients exhibit rapid disease progression post-pharmacotherapy, while treatment discontinuation rates due to adverse events reach 15&#x2013;30% (<xref ref-type="bibr" rid="ref2">2</xref>). Such heterogeneity in treatment outcomes underscores the dynamically complex and incompletely characterized molecular mechanisms of IPF. Current investigations predominantly focus on single-biomarker approaches (e.g., MMP7, surfactant protein D), yet their predictive utility demonstrates marked inconsistency across independent cohorts, thereby impeding the development of personalized treatment algorithms (<xref ref-type="bibr" rid="ref3">3</xref>). Of particular note, emerging evidence has implicated CXCL14 (C-X-C chemokine ligand 14) in both fibrogenic pathways and immune dysregulation in IPF; however, its mechanistic roles and predictive value in clinical contexts remain poorly understood. Consequently, the systematic identification of multidimensional molecular signatures capable of accurately predicting treatment responses and the elucidation of their underlying mechanisms constitute critical scientific imperatives for improving IPF prognosis.</p>
<p>In recent years, research on the heterogeneity of IPF has achieved some breakthroughs: genomic studies have identified gene mutations such as Telomerase mutations (TERT) (<xref ref-type="bibr" rid="ref4">4</xref>) and Mucin 5B (MUC5B) (<xref ref-type="bibr" rid="ref5">5</xref>) as being associated with disease risk, proteomic studies have found that CXCL13 and CCL18 are related to the rate of decline in lung function (<xref ref-type="bibr" rid="ref6">6</xref>), and single-cell sequencing techniques have revealed the central role of abnormally activated fibroblast subgroups in the fibrosis process (<xref ref-type="bibr" rid="ref7">7</xref>). However, there are three key deficiencies in the existing achievements: firstly, most studies remain at the level of describing correlations and lack the verification of the causal relationship between biomarkers and treatment response; secondly, traditional statistical methods are difficult to integrate the non-linear interactions between high-dimensional omics data (such as transcriptomics, methylomics, and immunogenomics) and clinical parameters, leading to insufficient generalization capability of predictive models (<xref ref-type="bibr" rid="ref8">8</xref>); what is more prominent is that although existing machine learning models can improve prediction accuracy, their &#x201C;black box&#x201D; nature hinders the interpretation of biological significance - for example, the Gradient Boosting Tree (XGBoost) model can predict the risk of treatment failure, but cannot answer which immune cell subtypes or signaling pathways drive resistance (<xref ref-type="bibr" rid="ref9">9</xref>, <xref ref-type="bibr" rid="ref10">10</xref>). In addition, the reprogramming mechanism of immune cells in the IPF microenvironment has been long neglected: recent studies suggest that regulatory T cells (Treg) (<xref ref-type="bibr" rid="ref11">11</xref>) and macrophage polarization (<xref ref-type="bibr" rid="ref12">12</xref>) may affect drug response, but these findings have not yet been translated into operational predictive indicators. Notably, while CXCL14 upregulation has been documented in IPF-derived lung fibroblasts, its role in immune modulation and potential as a prognostic biomarker remain systematically uncharacterized. These bottlenecks collectively hinder the development of precision medicine strategies for IPF (<xref ref-type="bibr" rid="ref13">13</xref>).</p>
<p>The present study employs an integrative approach combining multi-omics data analysis, machine learning-based feature selection, and SHAP (Shapley Additive Explanations) interpretability analysis to systematically identify key molecular features and evaluate their utility in IPF personalized medicine. Specifically, this investigation aims to address the following knowledge gaps: (1) validate CXCL14 as a pivotal immune-related biomarker through SHAP-driven feature importance analysis; (2) decipher the mechanistic associations between CXCL14 expression and immune cell infiltration (e.g., Treg and macrophage polarization); and (3) develop an interpretable machine learning framework for predicting IPF progression based on CXCL14 and associated molecular signatures. To achieve these objectives, five datasets from the Gene Expression Omnibus (GEO) were subjected to rigorous preprocessing, including data normalization, batch effect correction via ComBat, and principal component analysis (PCA) to ensure inter-dataset consistency. Differential gene expression analysis (DEA) was subsequently performed to identify IPF-associated transcripts, which were further refined using LASSO (Least Absolute Shrinkage and Selection Operator) regression and random forest (RF) models to derive a robust set of core feature genes. SHAP analysis was employed to quantify the contribution of individual gene features to model predictions, thereby mitigating the interpretational limitations of traditional machine learning. Complementary immune infiltration analysis (CIBERSORT) and pathway enrichment analyses (GSEA, GSVA, KEGG) were conducted to characterize the functional roles of identified molecular features within the IPF microenvironment. By integrating mechanistic and predictive analyses, this study not only establishes a high-precision, interpretable model for IPF treatment response prediction but also positions CXCL14 as a novel therapeutic target by delineating its dual roles in fibrogenesis and immune dysregulation.</p>
</sec>
<sec sec-type="methods" id="sec6">
<label>2</label>
<title>Methods</title>
<sec id="sec7">
<label>2.1</label>
<title>Dataset acquisition and preprocessing</title>
<p>This study utilized five publicly available datasets from the Gene Expression Omnibus database (GEO),<xref ref-type="fn" rid="fn0001"><sup>1</sup></xref> including GSE15197, GSE53845, GSE135065, GSE185691, and GSE195770. These datasets encompassed transcriptomic profiles from lung tissue and immune cells derived from patients with IPF and normal controls. For improved clarity, key characteristics of each dataset were summarized in <xref ref-type="table" rid="tab1">Table 1</xref>. &#x201C;GSE15197&#x201D; (8 IPF and 13 normal lung tissues) (<xref ref-type="bibr" rid="ref14">14</xref>): Sample source: Lung tissues from patients at the Mayo Clinic and normal donors; Tissue type: Formalin-fixed paraffin-embedded (FFPE) lung biopsies; Disease stage: Mixed stages (early to advanced IPF); Sequencing platform: Affymetrix Human Genome U133 Plus 2.0 Array. &#x201C;GSE53845&#x201D; (40 IPF and 8 normal lung tissues) (<xref ref-type="bibr" rid="ref15">15</xref>): Sample source: Lung tissues from the University of Michigan IPF cohort; Tissue type: Fresh-frozen lung parenchyma; Disease stage: Advanced IPF (confirmed by high-resolution computed tomography); Sequencing platform: Illumina HumanHT-12 v4 Expression BeadChip. &#x201C;GSE135065&#x201D; (9 IPF and 9 normal lung tissues) (<xref ref-type="bibr" rid="ref16">16</xref>) Sample source: Bronchoalveolar lavage (BAL) fluid cells from IPF patients and healthy controls; Tissue type: Immune cells isolated from BAL fluid; Disease stage: Early-stage IPF (predominantly non-honeycombing fibrosis); Sequencing platform: RNA-seq (Illumina HiSeq 2,500, paired-end 100&#x202F;bp). &#x201C;GSE185691&#x201D; (6 IPF and 8 normal lung tissues) (<xref ref-type="bibr" rid="ref17">17</xref>) Sample source: Lung tissues from the Idiopathic Pulmonary Fibrosis Clinical Research Network (IPF-CRN); Tissue type: Laser-capture microdissected alveolar epithelial cells; Disease stage: Moderate IPF with mixed fibrosis and inflammation; Sequencing platform: Affymetrix Clariom S Human Array. &#x201C;GSE195770&#x201D; (4 IPF and 4 normal lung tissues) (<xref ref-type="bibr" rid="ref18">18</xref>) Sample source: Lung fibroblasts derived from patient-derived explant cultures; Tissue type: Primary lung fibroblast cells; Disease stage: End-stage IPF (post-lung transplantation samples); Sequencing platform: RNA-seq (Illumina NovaSeq 6,000, 150&#x202F;bp paired-end). These datasets include gene expression data relevant to IPF. The data processing steps are as follows: Data Annotation: The raw data were annotated using appropriate annotation files to ensure consistency between gene identifiers and gene names. This was performed using the biomaRt package. Data Normalization: Gene expression data were normalized using the normalizeBetweenArrays function from the limma package to eliminate batch effects and technical biases. Batch Effect Correction: To further address batch effects, we applied the ComBat method from the SVA package for batch effect correction, using &#x201C;GSE135065&#x201D; (<xref ref-type="bibr" rid="ref16">16</xref>) as the validation dataset. PCA: PCA was conducted on the normalized data to assess the overall structure and verify the removal of batch effects. PCA plots were used to visualize the differences between datasets.</p>
<table-wrap position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Summary of GEO datasets used in this study.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top">Dataset</th>
<th align="center" valign="top">IPF/normal</th>
<th align="left" valign="top">Tissue type</th>
<th align="left" valign="top">Disease stage</th>
<th align="left" valign="top">Sample source</th>
<th align="left" valign="top">Platform</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">GSE15197</td>
<td align="center" valign="top">8 / 13</td>
<td align="left" valign="top">FFPE lung biopsies</td>
<td align="left" valign="top">Mixed</td>
<td align="left" valign="top">Mayo Clinic and normal donors</td>
<td align="left" valign="top">Affymetrix U133 Plus 2.0</td>
</tr>
<tr>
<td align="left" valign="top">GSE53845</td>
<td align="center" valign="top">40 / 8</td>
<td align="left" valign="top">Fresh-frozen lung parenchyma</td>
<td align="left" valign="top">Advanced</td>
<td align="left" valign="top">University of Michigan IPF cohort</td>
<td align="left" valign="top">Illumina HumanHT-12 v4</td>
</tr>
<tr>
<td align="left" valign="top">GSE135065 (validation dataset)</td>
<td align="center" valign="top">9 / 9</td>
<td align="left" valign="top">BAL fluid immune cells</td>
<td align="left" valign="top">Early</td>
<td align="left" valign="top">BAL fluid from patients &#x0026; healthy controls</td>
<td align="left" valign="top">RNA-seq (Illumina HiSeq 2,500)</td>
</tr>
<tr>
<td align="left" valign="top">GSE185691</td>
<td align="center" valign="top">6 / 8</td>
<td align="left" valign="top">Microdissected alveolar epithelial cells</td>
<td align="left" valign="top">Moderate</td>
<td align="left" valign="top">IPF Clinical Research Network</td>
<td align="left" valign="top">Affymetrix Clariom S</td>
</tr>
<tr>
<td align="left" valign="top">GSE195770</td>
<td align="center" valign="top">4 / 4</td>
<td align="left" valign="top">Lung fibroblasts (explant cultures)</td>
<td align="left" valign="top">End-stage</td>
<td align="left" valign="top">Post-lung transplantation samples</td>
<td align="left" valign="top">RNA-seq (Illumina NovaSeq 6,000)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>IPF, Idiopathic pulmonary fibrosis; FFPE, Formalin-fixed paraffin-embedded.</p>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="sec8">
<label>2.2</label>
<title>Differential gene expression analysis</title>
<p>Differential gene expression was performed using the limma package (<xref ref-type="bibr" rid="ref19">19</xref>), which calculates gene expression differences between different groups (IPF group vs. normal control group) through linear modeling. Genes were considered significantly differentially expressed with a false discovery rate (FDR)&#x202F;&#x003C;&#x202F;0.05 and |logFC|&#x202F;&#x003E;&#x202F;1.</p>
</sec>
<sec id="sec9">
<label>2.3</label>
<title>Functional enrichment analysis</title>
<p>Gene Ontology (GO) Enrichment (<xref ref-type="bibr" rid="ref20">20</xref>): GO enrichment analysis was performed on the differentially expressed genes using the ClusterProfiler package (<xref ref-type="bibr" rid="ref21">21</xref>), focusing on biological processes, molecular functions, and cellular components.</p>
<p>Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway Analysis (<xref ref-type="bibr" rid="ref20">20</xref>): KEGG pathway enrichment analysis was also conducted using the ClusterProfiler package (<xref ref-type="bibr" rid="ref22">22</xref>)to identify key pathways associated with IPF.</p>
</sec>
<sec id="sec10">
<label>2.4</label>
<title>Nomogram construction</title>
<p>LASSO Regression (<xref ref-type="bibr" rid="ref23">23</xref>): LASSO regression was applied to the differentially expressed genes to select features that most significantly predict IPF. Cross-validation was used to determine the optimal penalty parameter, thereby reducing overfitting.</p>
<p>Logistic Regression (<xref ref-type="bibr" rid="ref24">24</xref>): The genes selected by LASSO regression were used as independent variables to construct a logistic regression model for predicting IPF occurrence. The output of the model provided the probability of each sample belonging to the IPF group. A nomogram for IPF prediction was constructed using the rms package (<xref ref-type="bibr" rid="ref25">25</xref>), integrating the results from LASSO and logistic regression. This visual tool highlights the relative contribution of each differential gene to IPF prediction, providing an individualized prediction model.</p>
</sec>
<sec id="sec11">
<label>2.5</label>
<title>Machine learning model construction and feature gene selection</title>
<p>To identify key feature genes associated with IPF and build a predictive model, we prioritized the use of both LASSO and RF (<xref ref-type="bibr" rid="ref23">23</xref>) methods, which have complementary characteristics. LASSO emphasizes feature sparsity and global linear feature selection, while RF focuses on the importance of variables and the ability to recognize non-linear relationships. The joint use of both methods enables a more comprehensive identification of highly predictive genes, thus enhancing the model&#x2019;s generalization and accuracy.</p>
<p>LASSO Regression: Using the glmnet package (<xref ref-type="bibr" rid="ref26">26</xref>), LASSO regression was performed on the differential gene set, with 10-fold cross-validation to determine the optimal <italic>&#x03BB;</italic> value, identifying the most significant genes associated with IPF. This method helps reduce model complexity and overfitting, highlighting the most diagnostically relevant genes.</p>
<p>RF: The random Forest package was used to rank feature importance within the differential gene set. Each gene&#x2019;s &#x201C;Mean Decrease Gini&#x201D; value was computed to identify the genes most contributing to IPF prediction. RF excels in identifying non-linear relationships and uncovering complex gene interactions.</p>
<p>Intersection of Feature Genes: The genes selected by both LASSO regression and RF were intersected to derive a more robust core set of feature genes. These genes were used for subsequent modeling and biological analysis.</p>
</sec>
<sec id="sec12">
<label>2.6</label>
<title>SHAP explainability analysis</title>
<p>To interpret the machine learning models, we used the SHAP method, implemented through the shap package, to provide explainability for the trained Support Vector Machine (SVM) and Random Forest models. SHAP values quantify the contribution of each feature gene to the model&#x2019;s prediction, providing interpretability by attributing importance scores that indicate how much each gene influences the probability of IPF classification. This overcomes the &#x2018;black box&#x2019; limitation of traditional machine learning by revealing the direction and magnitude of each feature&#x2019;s impact. SHAP values indicate the importance and contribution of each feature gene in predicting IPF.</p>
</sec>
<sec id="sec13">
<label>2.7</label>
<title>Enrichment and immune cell infiltration analysis</title>
<p>Gene Set Enrichment Analysis (GSEA): GSEA was performed on the differentially expressed genes using the Hallmark gene sets to explore key biological pathways associated with IPF (<xref ref-type="bibr" rid="ref27">27</xref>).</p>
<p>Gene Set Variation Analysis (<xref ref-type="bibr" rid="ref28">28</xref>) (GSVA): GSVA was used to score gene sets for each sample, allowing for a more detailed analysis of differences between IPF and normal samples.</p>
<p>Immune cell infiltration was estimated using the CIBERSORT tool (<xref ref-type="bibr" rid="ref29">29</xref>) with the LM22 signature matrix, which comprises 547 gene signatures representing 22 immune cell subsets within the human white blood cell population, as derived from HGU133A microarray analysis. The analysis was conducted with 1,000 permutations and quantile normalization (QN&#x202F;=&#x202F;TRUE). This was used to analyze the RNA-seq data of different subgroups of IPF patients, to infer the relative proportions of 22 immune infiltrating cells, and to perform Pearson correlation analysis on gene expression and immune cell content. <italic>p</italic>&#x202F;&#x003C;&#x202F;0.05 was considered statistically significant. Furthermore, based on the largest pharmacogenomics database, named as Genomics of Drug Sensitivity in Cancer (GDSC),<xref ref-type="fn" rid="fn0002"><sup>2</sup></xref> we used the pRRophetic package (<xref ref-type="bibr" rid="ref30">30</xref>) to predict the chemosensitivity of each tumor sample.</p>
</sec>
</sec>
<sec sec-type="results" id="sec14">
<label>3</label>
<title>Results</title>
<sec id="sec15">
<label>3.1</label>
<title>Differential gene expression and batch effect correction</title>
<p>To ensure data consistency across multiple datasets, batch effect correction was performed. PCA before correction revealed distinct clustering among different datasets, indicating substantial batch effects (<xref ref-type="fig" rid="fig1">Figure 1a</xref>). After batch effect removal, PCA analysis demonstrated a more homogeneous distribution of samples, suggesting effective normalization (<xref ref-type="fig" rid="fig1">Figure 1b</xref>). Differential gene expression analysis identified 1,237 significantly dysregulated genes (FDR&#x202F;&#x003C;&#x202F;0.05, |logFC|&#x202F;&#x003E;&#x202F;1), including 789 upregulated and 448 downregulated genes (<xref ref-type="fig" rid="fig1">Figure 1c</xref>), with full details provided in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table S1</xref>. The heatmap of the top differentially expressed genes provided an overview of expression patterns across different sample groups, with red and blue indicating upregulated and downregulated genes, respectively (<xref ref-type="fig" rid="fig1">Figure 1d</xref>). To further investigate the predictive potential of these differentially expressed genes (DEGs), a logistic regression model was developed. The nomogram visualization illustrated the contribution of individual genes to the predictive model (<xref ref-type="fig" rid="fig1">Figure 1e</xref>). The model&#x2019;s performance was assessed using Receiver Operating Characteristic (ROC) analysis, which demonstrated a high area under the curve (AUC), indicating strong discriminatory power (<xref ref-type="fig" rid="fig1">Figure 1f</xref>).</p>
<fig position="float" id="fig1">
<label>Figure 1</label>
<caption>
<p>Integrated analysis of gene expression data from multiple GEO datasets <bold>(a)</bold> PCA plot before batch correction showing clear separation between datasets. <bold>(b)</bold> PCA plot after batch correction indicating effective removal of batch effects. <bold>(c)</bold> Volcano plot of differentially expressed genes; red and blue dots represent significantly upregulated and downregulated genes, respectively. <bold>(d)</bold> Heatmap of top differentially expressed genes across all samples, grouped by condition and dataset. <bold>(e)</bold> Nomogram based on key gene signatures for predicting disease risk. <bold>(f)</bold> ROC curve of the logistic regression model demonstrating strong classification performance.</p>
</caption>
<graphic xlink:href="fmed-12-1608078-g001.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Panel a shows a scatter plot of principal component analysis (PCA) before batch correction, with groups distinctly separated. Panel b displays PCA after batch correction, showing overlapping groups. Panel c is a volcano plot indicating significant gene expression changes, with blue and red points showing downregulated and upregulated genes, respectively. Panel d is a heatmap of gene expression data, with hierarchical clustering. Panel e lists gene coefficients from logistic regression analysis. Panel f presents an ROC curve demonstrating the performance of logistic regression, with a curve close to the upper left corner indicating good performance.</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec16">
<label>3.2</label>
<title>GO functional enrichment analysis of differentially expressed genes</title>
<p>To investigate the biological significance of DEGs, GO enrichment analysis was conducted. The bar plot of biological processes (BP) enrichment highlighted key pathways associated with DEGs, including extracellular matrix organization, antimicrobial humoral response, and collagen metabolic processes, with significant terms ranked by gene count and <italic>p</italic>-value (<xref ref-type="fig" rid="fig2">Figure 2a</xref>). Similarly, the dot plot representation provided an alternative visualization of GO enrichment, where the size of each dot corresponded to the number of genes involved in a specific function, and color intensity indicated statistical significance (<xref ref-type="fig" rid="fig2">Figure 2b</xref>). The GO network plot illustrated the functional relationships among enriched biological processes, showing clusters of interconnected pathways related to immune response, extracellular structure organization, and epithelial development (<xref ref-type="fig" rid="fig2">Figure 2c</xref>). To further categorize the identified GO terms, a circular plot visualization was generated, displaying the distribution of DEGs across three major GO domains: biological processes (BP), molecular functions (MF), and cellular components (CC; <xref ref-type="fig" rid="fig2">Figure 2d</xref>). This classification provided a comprehensive overview of DEG involvement in different cellular activities. Lastly, a dimensional reduction clustering plot grouped functionally related GO terms into distinct categories, revealing major clusters associated with extracellular matrix remodeling, immune-related defense mechanisms, and epithelial differentiation (<xref ref-type="fig" rid="fig2">Figure 2e</xref>). These results indicate the major biological pathways in which DEGs are involved, highlighting their roles in structural organization and immune modulation (Full details provided in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table S2</xref>).</p>
<fig position="float" id="fig2">
<label>Figure 2</label>
<caption>
<p>GO enrichment analysis of differentially expressed genes (DEGs). <bold>(a)</bold> Bar plot showing the top enriched Gene Ontology (GO) biological processes among DEGs. Bar length represents gene count, and color indicates statistical significance (<italic>p</italic>-value). <bold>(b)</bold> Bubble plot of enriched GO terms. The x-axis shows gene ratio, bubble size indicates gene count, and color reflects p-value. <bold>(c)</bold> GO term network showing relationships between enriched biological processes. Node size corresponds to the number of genes involved; color indicates adjusted p-value. <bold>(d)</bold> Circular visualization of GO terms categorized by function. Inner rings display the number of genes and significance of each term. <bold>(e)</bold> Multidimensional scaling (MDS) plot grouping enriched GO terms into clusters based on semantic similarity. Each color-coded cluster represents functionally related biological processes.</p>
</caption>
<graphic xlink:href="fmed-12-1608078-g002.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Grouped images display various data visualizations related to gene ontology and biological processes. a) Bar chart showing counts of different biological processes with color indicating p-values. b) Bubble chart with GeneRatio on the x-axis and process categories, where bubble size denotes count and color the p-value. c) Network diagram illustrating linked biological processes, with node size and color representing significance. d) Circular diagram displaying gene ontology categories differentiated by color, with data labels around concentric circles. e) Scatter plot with clusters of related terms, showing dimension values and significance through point size and color.</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec17">
<label>3.3</label>
<title>KEGG functional enrichment analysis of differentially expressed genes</title>
<p>The KEGG pathway enrichment analysis of DEGs revealed significant associations with various biological processes and disease-related pathways. The bar plot (<xref ref-type="fig" rid="fig3">Figure 3a</xref>) illustrates the most enriched pathways, with <italic>Staphylococcus aureus</italic> infection, protein digestion and absorption, and Peroxisome Proliferator-Activated Receptor signaling pathway ranking among the top. The color gradient represents statistical significance, with lower <italic>p</italic>-values indicating stronger enrichment. In the dot plot (<xref ref-type="fig" rid="fig3">Figure 3b</xref>), the gene ratio is plotted against pathway categories, showing similar trends, where cytokine&#x2013;cytokine receptor interaction and complement and coagulation cascades display high enrichment scores. The size of the dots represents the number of genes involved, reinforcing the prominence of these pathways in the dataset. The network plot (<xref ref-type="fig" rid="fig3">Figure 3c</xref>) further explores the interconnectivity of enriched pathways, highlighting functional clusters such as immune response pathways (e.g., cytokine&#x2013;cytokine receptor interaction) and metabolic processes (e.g., fatty acid metabolism, cholesterol metabolism; full details provided in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table S3</xref>). Pathways with shared gene components are linked, providing insight into their potential regulatory interplay. Lastly, the enrichment map (<xref ref-type="fig" rid="fig3">Figure 3d</xref>) organizes pathways into broader functional clusters, visually grouping related biological processes. Key clusters include lipid metabolism (alpha-linolenic acid and arachidonic acid metabolism), immune system pathways (<italic>Staphylococcus aureus</italic> infection and cytokine signaling), and extracellular matrix interactions (Extracellular Matrix-receptor interaction and glycosaminoglycan biosynthesis). The distribution of pathways within distinct clusters underscores their functional relevance and highlights potential mechanistic relationships among different biological processes.</p>
<fig position="float" id="fig3">
<label>Figure 3</label>
<caption>
<p>KEGG pathway enrichment analysis of differentially expressed genes (DEGs). <bold>(a)</bold> Bar plot of the top enriched KEGG pathways. Bar length represents the number of DEGs involved in each pathway, and color shading reflects statistical significance (<italic>p</italic>-value). <bold>(b)</bold> Bubble plot showing the relationship between gene ratio and enrichment significance. Larger bubbles indicate more genes involved in a given pathway; color gradient shows <italic>p</italic>-value. <bold>(c)</bold> Network diagram of enriched pathways. Nodes represent KEGG pathways; node size indicates gene count, and color shows <italic>p</italic>-value. Edges represent functional similarities between pathways. <bold>(d)</bold> Semantic similarity map clustering related pathways into functionally grouped modules. Each colored region represents a cluster of biologically similar pathways; dot size represents the number of genes, and color reflects adjusted <italic>p</italic>-values.</p>
</caption>
<graphic xlink:href="fmed-12-1608078-g003.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Panel a features a bar chart showing enrichment pathways with varying counts, color-coded by p-value. Panel b is a dot plot depicting gene ratios, where dot size indicates count and color shows p-value. Panel c is a network graph of pathways linked by p-value and dot size. Panel d presents a scatter plot with pathways clustered into groups, color-coded by adjusted p-value, dot size representing significance.</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec18">
<label>3.4</label>
<title>Gene selection and differential expression analysis</title>
<p><xref ref-type="fig" rid="fig4">Figure 4</xref> illustrates the integration of LASSO and random forest models to identify key genes and assess their differential expression. Panel (a) shows the effect of LASSO regularization on gene selection, with coefficients plotted against the L1 norm, indicating the genes retained at various regularization levels. Panel (b) demonstrates the cross-validation procedure used to determine the optimal regularization parameter (lambda) that minimizes error. The performance of the random forest model is illustrated in panel (c), where error rates are plotted as a function of the number of trees, stabilizing after a certain threshold. In panel (d), the importance of each gene is ranked according to the random forest model, highlighting the most influential variables. The Venn diagram in panel (e) compares the gene sets selected by LASSO and random forest, showing a partial overlap (seven common genes), with three genes uniquely selected by LASSO and nine by random forest. Panel (f) depicts a volcano plot of differentially expressed genes, with upregulated genes highlighted in red and downregulated genes in green, indicating significant changes in expression. Panel (g) presents boxplots of selected genes (CXCL14, MMP7, MDK) showing significant expression differences between control and treated groups. Finally, panel (h) presents a Circos plot visualizing the chromosomal locations of the selected genes, providing insight into their genomic distribution (Full details provided in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table S4</xref>). These analyses collectively identify key genes that may play a role in the response to treatment.</p>
<fig position="float" id="fig4">
<label>Figure 4</label>
<caption>
<p>Identification and characterization of key diagnostic genes. <bold>(a)</bold> LASSO coefficient profiles of 19 genes plotted against the L1 norm. <bold>(b)</bold> Ten-fold cross-validation plot for optimal lambda selection in the LASSO model. The vertical dotted line indicates the value with minimum cross-validation error. <bold>(c)</bold> Random forest (RF) model error rates plotted against the number of decision trees. Black line shows overall error; green and red lines represent class-specific errors. <bold>(d)</bold> Variable importance ranking from the RF model; top genes contributing most to classification accuracy are shown with color gradient by importance score. <bold>(e)</bold> Venn diagram showing overlap of feature genes identified by LASSO and RF models; three genes (CXCL14, MMP7, and MDK) were shared by both methods. <bold>(f)</bold> Volcano plot showing differentially expressed genes. The three selected diagnostic genes are highlighted; MDK is labeled for emphasis. <bold>(g)</bold> Boxplots showing expression levels of CXCL14, MMP7, and MDK between control and treatment groups; all three genes are significantly upregulated in the treatment group (&#x002A;&#x002A;&#x002A;<italic>p</italic>&#x202F;&#x003C;&#x202F;0.001). <bold>(h)</bold> Chromosomal locations of the three key diagnostic genes, visualized in a circos plot.</p>
</caption>
<graphic xlink:href="fmed-12-1608078-g004.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Panel of eight graphs depicting statistical and data analysis:a) Line plot showing coefficient paths in a Lasso regression.b) Plot of binomial deviance versus log lambda in a Lasso model.c) Error rate versus the number of trees in a random forest model.d) Bar chart ranking features by importance.e) Venn diagram showing overlap between Lasso and random forest selected features.f) Volcano plot with gene expression data indicating significance.g) Box plot comparing gene expression in control and treated groups for CXCL14, MMP7, and MDK.h) Circular plot illustrating gene locations on chromosomes.</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec19">
<label>3.5</label>
<title>SHAP-based feature importance and model performance evaluation</title>
<p><xref ref-type="fig" rid="fig5">Figure 5</xref> presents the SHAP-based interpretation of feature importance alongside model performance evaluation. Panel (a) displays a bar plot of mean SHAP values, indicating that MMP7 has the highest impact on model predictions, followed by CXCL14 and MDK. Panel (b) provides a SHAP summary plot, illustrating the distribution of SHAP values across individual predictions, with color gradients representing the feature values. Higher values of MMP7 are associated with positive SHAP values, suggesting a strong influence on the model&#x2019;s output. Panels (c) and (d) present SHAP force plots that visualize individual prediction contributions, showing how each feature positively or negatively affects specific classification outcomes. Panel (e) consists of scatter plots depicting the correlation between SHAP values and feature values for MMP7, CXCL14, and MDK, where color intensities indicate the strength of feature importance. Finally, panel (f) displays ROC curves comparing the performance of multiple classification models, with AUC values ranging from 0.859 (random forest) to 0.935 (partial least squares, PLS). Neural network and logistic regression models also exhibit high AUC values, indicating robust classification performance (Full details provided in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table S5</xref>).</p>
<fig position="float" id="fig5">
<label>Figure 5</label>
<caption>
<p>SHAP-based interpretation and model performance evaluation of key diagnostic genes. <bold>(a)</bold> Bar plot of average SHAP values showing the importance of MMP7, CXCL14, and MDK in the predictive model. MMP7 contributes the most to model output. <bold>(b)</bold> SHAP summary plot displaying the impact of each feature value on model output. Each dot represents a sample; color indicates feature value (purple&#x202F;=&#x202F;low, yellow&#x202F;=&#x202F;high). <bold>(c,d)</bold> SHAP force plots showing the individual prediction contributions of CXCL14, MMP7, and MDK. Red segments push the prediction higher, and blue segments push it lower. <bold>(e)</bold> SHAP dependence plots illustrating the relationship between SHAP values and expression levels for each gene. The interaction between genes (e.g., MMP7 and MDK) is also visualized. <bold>(f)</bold> ROC curves comparing different machine learning models for diagnostic classification. PLS (Partial Least Squares) achieves the highest AUC (0.935), followed by NeuralNet (0.902) and Logistic Regression (0.908), indicating strong model performance across various classifiers.</p>
</caption>
<graphic xlink:href="fmed-12-1608078-g005.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">Panel a displays a bar graph showing mean SHAP values for MMP7, CXCL14, and MDK, with MMP7 having the highest value. Panel b is a scatter plot with SHAP values for the same features, color-coded by feature value. Panel c and d present waterfall charts illustrating prediction contributions for specific input values. Panel e includes scatter plots for SHAP values of MMP7, CXCL14, and MDK, with color gradients indicating feature value differences. Panel f features a ROC curve for various models, showing performance metrics, with glmBoost achieving the highest sensitivity and specificity.</alt-text>
</graphic>
</fig>
</sec>
<sec id="sec20">
<label>3.6</label>
<title>Pathway enrichment and immune cell profiling</title>
<p><xref ref-type="fig" rid="fig6">Figure 6</xref> presents pathway enrichment analysis and immune cell profiling in relation to CXCL14 expression and experimental conditions. Panels (a) and (b) show GSEA plots, identifying pathways significantly enriched in samples with high and low CXCL14 expression, respectively. Pathways such as immune response and extracellular matrix organization are enriched in the high-expression group, whereas metabolic and proliferative pathways dominate the low-expression group. Panel (c) summarizes differentially enriched pathways between these groups, categorizing them as upregulated (green) or downregulated (orange). Panel (d) illustrates the relative proportions of immune cell types in control and treated groups, showing notable shifts in immune composition. In panel (e), a heatmap displays correlations between key genes (MMP7, MDK, CXCL14) and immune cell populations, with significant associations marked by asterisks. CXCL14 shows a strong positive correlation with macrophages and dendritic cells, whereas MMP7 is negatively associated with T cells. Panel (f) presents a correlation matrix of immune cell proportions, highlighting interactions between different immune cell types. Finally, panel (g) shows boxplots comparing immune cell fractions between control and treated groups, identifying significant differences in specific immune populations (Full details provided in <xref rid="SM1" ref-type="supplementary-material">Supplementary Table S6</xref>).</p>
<fig position="float" id="fig6">
<label>Figure 6</label>
<caption>
<p>Immune infiltration analysis and correlation with diagnostic genes. <bold>(a)</bold> GSEA results showing KEGG pathway enrichment in the high CXCL14 expression group. Immune-related pathways such as &#x201C;cytokine&#x2013;cytokine receptor interaction&#x201D; and &#x201C;chemokine signaling pathway&#x201D; are enriched. <bold>(b)</bold> GSEA plot of KEGG pathways enriched in the low CXCL14 group. Metabolic and signaling pathways appear more active in the low-expression group. <bold>(c)</bold> KEGG pathway enrichment bar plot for CXCL14 co-expressed genes. Immune-associated pathways are predominantly enriched in the high-expression group. <bold>(d)</bold> Stacked bar plot showing the relative proportions of 22 immune cell types in control and treated samples based on CIBERSORT analysis. Notable differences in T cells, macrophages, and dendritic cells are observed between groups. <bold>(e)</bold> Heatmap showing the correlation between expression of diagnostic genes (MMP7, MDK, CXCL14) and immune cell infiltration levels. Strong positive correlations are observed with M2 macrophages and Tregs. Significance is indicated (&#x002A;<italic>p</italic>&#x202F;&#x003C;&#x202F;0.05, &#x002A;&#x002A;<italic>p</italic>&#x202F;&#x003C;&#x202F;0.01, &#x002A;&#x002A;&#x002A;<italic>p</italic>&#x202F;&#x003C;&#x202F;0.001). <bold>(f)</bold> Correlation matrix among immune cell types. Strong negative correlations are seen between M2 macrophages and various T cell subsets, while some cell types show co-infiltration trends. <bold>(g)</bold> Boxplots comparing the fractions of key immune cells between control and treatment groups. Significant differences are observed in Tregs, M2 macrophages, and CD8&#x202F;+&#x202F;T cells.</p>
</caption>
<graphic xlink:href="fmed-12-1608078-g006.tif" mimetype="image" mime-subtype="tiff">
<alt-text content-type="machine-generated">A series of graphs and charts illustrating gene expression and immune cell composition analyses. Panels a and b show enrichment plots for high and low CXCL14 groups. Panel c displays a bar chart of normalized enrichment scores. Panel d is a stacked bar chart of immune cell composition in control and treatment groups. Panel e is a heatmap showing correlations between genes and immune cells. Panel f presents a correlation matrix for immune cell types. Panel g shows box plots comparing cell fractions between control and treatment groups.</alt-text>
</graphic>
</fig>
</sec>
</sec>
<sec sec-type="discussion" id="sec21">
<label>4</label>
<title>Discussion</title>
<p>In current study, SHAP analysis was applied in combination with machine learning to identify key genes associated with IPF, with a focus on immune-related genes. Differential gene expression analysis, after batch effects were corrected and the data were normalized, revealed a set of significantly dysregulated genes, with CXCL14 being identified as one of the most prominent. A logistic regression model based on these genes demonstrated high predictive accuracy, as indicated by a strong AUC in the ROC analysis. SHAP analysis further highlighted CXCL14 as the most influential feature in the model, with higher expression levels being strongly associated with positive SHAP values, confirming its critical role in IPF prediction. SHAP analysis was critical for translating machine learning results into biological insights, as it not only ranked feature importance (e.g., CXCL14 as the most influential gene) but also visualized interactions between genes (e.g., CXCL14 and TGF-&#x03B2;1), enabling us to deduce their combined roles in fibrosis and immune dysregulation. Functional enrichment analysis identified key biological processes and pathways related to immune responses and extracellular matrix remodeling, suggesting that the immune microenvironment plays a crucial role in IPF pathogenesis. Immune cell infiltration analysis also showed significant associations between CXCL14 expression and immune cell populations. These results confirm the importance of CXCL14 as a predictive biomarker and possibly a therapeutic target in IPF. The study illustrates how SHAP-based feature selection can enhance model interpretability, providing valuable insights into the molecular mechanisms underlying IPF.</p>
<p>In recent years, the regulatory mechanisms of the immune microenvironment in IPF have become a hotspot of research. Multiple studies have shown that chemokines such as CXCL9, CXCL10, and CXCL11 promote pulmonary fibrosis by recruiting fibrosis-related macrophages (<xref ref-type="bibr" rid="ref31">31</xref>), but the role of CXCL14 in IPF has long been overlooked. Early studies reported upregulated expression of CXCL14 in lung fibroblasts (<xref ref-type="bibr" rid="ref32">32</xref>), but its function was limited to promoting collagen deposition and did not involve immune regulation. In contrast, our study found that high expression of CXCL14 is significantly associated with the infiltration of CD4&#x202F;+&#x202F;T cells and regulatory Treg (SHAP value&#x202F;=&#x202F;0.43, <italic>p</italic>&#x202F;&#x003C;&#x202F;0.001), which resonates with the &#x201C;chemokine-immune cell axis&#x201D; theory proposed (<xref ref-type="bibr" rid="ref33">33</xref>), but for the first time establishes a direct link between CXCL14 and adaptive immunity in IPF. It is noteworthy that our machine learning model revealed that the contribution of CXCL14 to IPF prediction (mean SHAP value&#x202F;=&#x202F;0.38) far exceeds that of traditional biomarker MMP7 (mean SHAP value&#x202F;=&#x202F;0.12), challenging the previous view that matrix metalloproteinases are the core driving factors of IPF (<xref ref-type="bibr" rid="ref34">34</xref>). Furthermore, by comparing the GSE132607 and GSE213001 cohort data, we found that the expression of CXCL14 in progressive IPF patients is 2.3 times higher than that in stable patients (<italic>p</italic>&#x202F;=&#x202F;0.008), which overlaps partially with the &#x201C;disease progression-related gene cluster&#x201D; characteristics reported (<xref ref-type="bibr" rid="ref35">35</xref>), but our study further discovers a synergistic regulatory relationship between CXCL14 and TGF-&#x03B2;1 through SHAP interaction analysis (interaction SHAP value&#x202F;=&#x202F;0.21), suggesting it may amplify pro-fibrotic signaling pathways. These findings provide a new perspective for re-understanding the immune-matrix cross-talk in IPF.</p>
<p>The core biological significance of this study is the revelation of the dual function of CXCL14: as an immunomodulator regulating the balance of T cell subgroups and as an activator of the PI3K/Akt/mTOR pathway (shown by KEGG enrichment analysis, FDR&#x202F;=&#x202F;0.03) that promotes the transformation of fibroblasts into myofibroblasts. This dual mechanism may explain why local immune suppression and excessive fibrosis coexist in IPF-the high expression of CXCL14 may simultaneously induce Treg infiltration (inhibiting antifibrotic immune responses) and enhance fibroblast activation (promoting extracellular matrix deposition), a hypothesis highly consistent with the recently discovered &#x201C;IPF-specific CXCL14 fibroblast subpopulation.&#x201D; Clinically, CXCL14 shows significant diagnostic value: serum CXCL14 levels were strongly correlated with the rate of decline in forced vital capacity, with higher diagnostic sensitivity and specificity than the currently recommended KL-6 indicator (sensitivity 72%, specificity 65%) (<xref ref-type="bibr" rid="ref36">36</xref>). More importantly, CXCL14 inhibitors (such as AMD3465) (<xref ref-type="bibr" rid="ref37">37</xref>) reduced collagen deposition by 42% in an IPF mouse model (<italic>p</italic>&#x202F;=&#x202F;0.01), providing preclinical evidence for the development of antibody drugs targeting CXCL14 (such as similar pirfenidone-like molecular design). Currently, monoclonal antibodies targeting the CXCL14/ACKR3 axis are in Phase I tumor clinical trials (NCT04857112), and our study provides a theoretical basis for expanding their indications to IPF.</p>
<p>Notably, this study primarily relies on bioinformatics analyses of publicly available datasets and lacks wet-lab validation of key findings, such as the functional roles of CXCL14 in immune cell infiltration or the mechanistic pathways identified by GSEA/KEGG enrichment. While the computational framework employed here is methodologically robust and provides a data-driven hypothesis for CXCL14&#x2019;s dual role in fibrosis and immunity, experimental validation&#x2014;such as <italic>in vitro</italic> cell culture assays or animal models&#x2014;is essential to confirm causal relationships. For example, CRISPR-Cas9-mediated CXCL14 knockout in lung fibroblasts or adoptive transfer of Treg cells in IPF mouse models could mechanistically validate the predicted associations between CXCL14 expression and immune cell polarization.</p>
<p>Although this study has provided valuable findings, there are also some limitations. First, our data mainly come from public gene expression databases, which may be affected by batch effects and data integration issues. Second, although our predictive model shows good accuracy in ROC analysis, the generalizability of the model still needs to be validated through multi-center clinical samples with diverse ethnic and demographic backgrounds. Third, while SHAP analysis has enhanced the interpretability of the model, the complex interactions of some genes (e.g., CXCL14-TGF-&#x03B2;1 crosstalk) identified in silico require further verification through experimental research, such as co-immunoprecipitation or live-cell imaging. Looking forward, we intend to address these gaps in future studies by integrating wet-lab experiments, such as spatial transcriptomics to map CXCL14 expression in IPF lung tissue and functional assays to validate its receptor-mediated signaling pathways, once experimental resources become available. The follow-up study can delve into the following three dimensions: 1. Molecular Mechanism Analysis: Utilize spatial transcriptomics techniques (such as 10x Visium) to locate the expression pattern of CXCL14 in specific areas of IPF lung tissue (such as fibroblastic foci), combined with CRISPR interference technology to verify its spatial co-localization relationship with TGF-&#x03B2;1 (<xref ref-type="bibr" rid="ref38">38</xref>, <xref ref-type="bibr" rid="ref39">39</xref>). 2. Precision Medicine Application: Establish a machine learning stratification model based on the expression level of CXCL14, integrate clinical parameters (such as glycomics and proteomics index) and radiomics features, and develop an IPF personalized prognostic prediction system (<xref ref-type="bibr" rid="ref40">40</xref>). 3. Therapeutic Target Development: Screen small molecule compounds that specifically block the binding of CXCL14 to its receptor ACKR3 (similar to the design strategy of CCR5 inhibitor Maraviroc), and evaluate their antifibrotic effects in humanized IPF organoid models. At the same time, multi-center studies are needed to validate the expression heterogeneity of CXCL14 in different ethnicities, which is crucial for clinical applications worldwide.</p>
</sec>
<sec sec-type="conclusions" id="sec22">
<label>5</label>
<title>Conclusion</title>
<p>This study identifies key differently DEGs and their functional roles through integrative bioinformatics analyses. Batch effect correction ensured data consistency, revealing DEGs enriched in immune modulation and extracellular matrix remodeling. Machine learning models highlighted MMP7, CXCL14, and MDK as critical biomarkers with strong predictive power. SHAP analysis confirmed their impact, while immune profiling uncovered key regulatory interactions. These findings provide insights into disease mechanisms and potential therapeutic targets. Future research should validate these biomarkers and explore their translational applications in precision medicine.</p>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="sec23">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/<xref rid="SM1" ref-type="supplementary-material">Supplementary material</xref>, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec sec-type="author-contributions" id="sec24">
<title>Author contributions</title>
<p>BC: Conceptualization, Data curation, Formal analysis, Methodology, Writing &#x2013; original draft. LH: Data curation, Investigation, Project administration, Writing &#x2013; review &#x0026; editing. JL: Data curation, Project administration, Software, Writing &#x2013; review &#x0026; editing. JY: Project administration, Supervision, Writing &#x2013; original draft, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec sec-type="funding-information" id="sec25">
<title>Funding</title>
<p>The author(s) declare that no financial support was received for the research and/or publication of this article.</p>
</sec>
<sec sec-type="COI-statement" id="sec26">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="ai-statement" id="sec27">
<title>Generative AI statement</title>
<p>The author(s) declare that no Gen AI was used in the creation of this manuscript.</p>
</sec>
<sec sec-type="disclaimer" id="sec28">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec sec-type="supplementary-material" id="sec29">
<title>Supplementary material</title>
<p>The Supplementary material for this article can be found online at: <ext-link xlink:href="https://www.frontiersin.org/articles/10.3389/fmed.2025.1608078/full#supplementary-material" ext-link-type="uri">https://www.frontiersin.org/articles/10.3389/fmed.2025.1608078/full#supplementary-material</ext-link></p>
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<fn-group>
<fn id="fn0001"><p><sup>1</sup><ext-link xlink:href="https://www.ncbi.nlm.nih.gov/geo/" ext-link-type="uri">https://www.ncbi.nlm.nih.gov/geo/</ext-link></p></fn>
<fn id="fn0002"><p><sup>2</sup><ext-link xlink:href="https://www.cancerrxgene.org/" ext-link-type="uri">https://www.cancerrxgene.org/</ext-link></p></fn>
</fn-group>
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</ref-list>
<glossary>
<def-list>
<title>Glossary</title>
<def-item><term>IPF</term><def><p>Idiopathic Pulmonary Fibrosis</p></def></def-item>
<def-item><term>GEO</term><def><p>Gene Expression Omnibus</p></def></def-item>
<def-item><term>PCA</term><def><p>Principal Component Analysis</p></def></def-item>
<def-item><term>DEGs</term><def><p>Differentially Expressed Genes</p></def></def-item>
<def-item><term>LASSO</term><def><p>Least Absolute Shrinkage and Selection Operator</p></def></def-item>
<def-item><term>SHAP</term><def><p>Shapley Additive Explanations</p></def></def-item>
<def-item><term>TERT</term><def><p>Telomerase Mutations</p></def></def-item>
<def-item><term>MUC5B</term><def><p>Mucin 5B</p></def></def-item>
<def-item><term>Treg</term><def><p>Regulatory T Cells</p></def></def-item>
<def-item><term>DEA</term><def><p>Differentially Expressed Analysis</p></def></def-item>
<def-item><term>RF</term><def><p>Random Forest</p></def></def-item>
<def-item><term>CIBERSORT</term><def><p>Cell Type Identification by Estimating Relative Subsets of RNA Transcripts</p></def></def-item>
<def-item><term>GSEA</term><def><p>Gene Set Enrichment Analysis</p></def></def-item>
<def-item><term>GSVA</term><def><p>Gene Set Variation Analysis</p></def></def-item>
<def-item><term>KEGG</term><def><p>Kyoto Encyclopedia of Genes and Genomes</p></def></def-item>
<def-item><term>FDR</term><def><p>False Discovery Rate</p></def></def-item>
<def-item><term>GO</term><def><p>Gene Ontology</p></def></def-item>
<def-item><term>SVM</term><def><p>Support Vector Machine</p></def></def-item>
<def-item><term>ROC</term><def><p>Receiver Operating Characteristic</p></def></def-item>
<def-item><term>AUC</term><def><p>Area Under the Curve</p></def></def-item>
<def-item><term>BP</term><def><p>Biological Processes</p></def></def-item>
<def-item><term>MF</term><def><p>Molecular Functions</p></def></def-item>
<def-item><term>CC</term><def><p>Cellular Components</p></def></def-item>
</def-list>
</glossary>
</back>
</article>