Could the use of patients own ‘treated’ immune cells help prevent lung transplant rejection?
That’s what researchers will attempt to find out thanks to £1.86M in funding from the National Institute for Health Research’s (NIHR) through its Efficacy and Mechanism Evaluation (EME) programme.
The multi-centre trial, led nationally by Professor Andrew Fisher at Newcastle Upon Tyne Hospitals NHS Trust, will be carried out at five centres cross the UK, including at Harefield Hospital where it will be led by Dr Martin Carby (pictured), respiratory consultant.
Lung transplants are sometimes the only option for patients with severe chronic lung diseases who are no longer responding to other methods of treatment.
Lung transplant surgery is complex and carries a high risk of complications. One complication is the patient’s own immune system rejecting the donated lungs, leading to Chronic lung allograft dysfunction (CLAD).
CLAD can cause a transplanted lung to not achieve or maintain normal function, causing airflow restriction and/or obstruction, and in some cases leading to premature death.
To reduce the risk of the body rejecting the lung, patients are given immunosuppressants to dampen the effects of the immune system. However, approximately 50% of lung transplant patients are still affected by CLAD within 5 years and there are currently no other proven treatments for it.
Extracorporeal Photopheresis therapy
One potential treatment is Extracorporeal Photopheresis (ECP) therapy, which makes use of the patients own immune cells.
ECP involves using the immune cells isolated from a patient’s blood and combining it with a photoactive drug. The cells are then exposed to ultraviolet light which “activate” the drug before being reintroduced into the patient.
Previous small studies into ECP have shown that these treated immune cells slow down the progression of CLAD in some patients. However, more robust evidence is needed to determine if it works, exactly how it works and in which patients.
For this study, ECP therapy will be compared against standard of care in lung transplant recipients with progressive CLAD.
90 patients will be recruited and randomised to either receive ECP therapy and standard care for 6 months or standard of care only. The researchers will look primarily at lung function, quality of life and survival.
Dr Carby said;
“This is an exciting opportunity to collaborate with other UK centres and try to refine the use of ECP moving forward.
“It will help us to answer important questions about who may respond and who may not and to identify how ECP has an effect and therefore to be able to measure that effect. This will help us tailor treatment better to individuals and increase our confidence that this is the best rescue treatment for those patients whose lung function deteriorates despite best first line treatment”
In addition to Harefield Hospital, the study will be conducted at four other centres across the UK, including the Freeman Hospital in Newcastle, Wythenshawe Hospital in Manchester, Queen Elizabeth Hospital in Birmingham and Royal Papworth Hospital in Cambridge.
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