. While the proportion
of the patient population with lung disease is increasing, the number of
donor organs available for transplantation remains inadequate. The
when transplants began.
Clinicians and scientists have been constantly attempting to find ways to
counter this shortage.
Currently, around 80 percent of donor's lungs are being rejected
because of serious injuries that could potentially be reversible. For the
first time, a multi-disciplinary team of researchers have identified an
approach that would allow the use of injured lungs for transplantation. The
research team has been able to demonstrate in a clinically relevant model that,
in order to make them
meet the transplant criteria.
The study,
published on the website of
Nature
Communications, has the research team describing the cross-circulation
platform that was used to maintain the viability and function of the donor lung
and stability of the recipient for 36 to 56 hours.
A lead author
of the study, Brandon Guenthart explains,
"To
support lung recovery and to demonstrate cellular regeneration, we had to
pursue a radically different approach and develop more minimally invasive
diagnostics." The procedures available currently for lung support are
limited to only 6 to 8 hours, which is a very short period for therapeutic
interventions that may help in regenerating an injured lung and improve its
function.
The Research Team and Their Work
Gordana
Vunjak-Novakovic, University Professor and The Mikati Foundation Professor of
Biomedical Engineering and Medical Sciences from Columbia and Matthew
Bacchettaunjak-Novakovic, H. William Scott Professor of Surgery at Vanderbilt
University, and Adjunct Professor - Department of Biomedical Engineering at
Columbia University have co-led the team.
New diagnostic tools that could be used to
evaluate the regenerating lungs in a non-invasive manner were also developed by
the team.
The team is expecting that their work, which allows for the recovery of damaged
lungs that are considered unsuitable for clinical use, would lead to more donor
lungs becoming available for transplants.
In order to
help patients with end-stage lung diseases, for a long time now, the team has
been focusing on developing methods to recover lungs that get rejected for
transplant because of injuries.
"We have
been fortunate to assemble a highly talented, interdisciplinary team of
bioengineers, surgeons, pulmonologists, and pathologists, who have designed a
durable physiologic support system for a donor lung outside the body, along
with new technologies to achieve and monitor lung recovery," remarked
Bacchetta.
Treating Lung Injuries
In an earlier
study, the team had exhibited a cross-circulation platform that allowed the
viability and function of donor's lung to be maintained for 36 hours. In
this case, the research team was able to use their advanced support system to
completely recover the functionality of lungs injured by ischemia and turn them
suitable for transplant.
In the
current study, using new diagnostics and conventional therapies in combination
with its platform technology, the team has attempted recovering lungs
afflicted by gastric aspiration. Gastric aspiration is the most frequent injury
that leads to rejection of donor's lungs and is caused when
gastric material enters the respiratory tract, severely injuring the pulmonary
epithelium, thereby rendering the lung unsuitable for transplant.
The existing
devices and methods currently do not allow for severely damaged donor lungs to
be salvaged. The findings of this study have shown that it is possible to
maintain the lungs injured by gastric aspiration, outside the body for several
days. The lungs also become responsive to repeated therapeutic interventions
and exhibit evidence of cellular regeneration and improved function. The lungs
that regenerated on this platform met all the criteria for transplant.
Way Forward
"For seven years, we have diligently worked to
develop new technologies for the maintenance and recovery of donor organs. This
paper represents a culmination of fundamental and translational studies of lung
bioengineering that have converged into a system capable to recover severely
damaged lungs. We now have the team and technology to bring this research to
the patients, by making more donor lungs available for transplant,"
Vunjak-Novakovic was quoted saying.
Conducting
further studies to assess the functional capacity of the lungs after
transplant, evaluating the safety of the method and using a clinically relevant
large animal model with immunosuppression are on the agenda of the team.
"We envision that interventional
cross-circulation may be used to investigate regeneration of other damaged
organs, such as hearts, kidneys, and livers, expanding donor pools by salvaging
severely damaged organs and leading to more organ transplants," Bacchetta
said in conclusion.
References : - Regeneration of Severely Damaged Lungs using an Interventional Cross-circulation Platform - (https://doi.org/10.1038/s41467-019-09908-1)
Source: Medindia
