Crosslink bio-adhesives for bronchoscopic lung volume reduction: current status and future direction

What is it about?

Pulmonary emphysema is a distinctive phenotype of chronic obstructive pulmonary disease (COPD) characterized by enlarged alveoli and damaged lung tissue. This leads to trapping of excessive air and gradual hyperinflation of damaged lung tissue. To overcome this disease, several bronchoscopic lung volume reduction (BLVR) treatments have been developed to reduce hyperinflation. However, only small subgroups of patients are suitable to benefit from BLVR therapies. As a result, lung bio-adhesives are one of the most promising new BLVR treatment options. Bio-adhesives are potentially a permanent solution for emphysematous patients after only a single application. A major drawback of the current adhesive technology, however, is the induction of severe inflammatory responses and adverse events upon administration. In our review, we concisely describe the most commonly used BLVR strategies. Furthermore, we present an overview of the different materials including AeriSeal and autologous blood that has been used to achieve lung volume reduction in emphysematous patients and discuss their respective advantages and drawbacks. In conclusion, we describe the key characteristics that are anticipated to be essential for an ideal lung bio-adhesive material with the potential to overcome the concerns related to current adhesives. The development of such a bio-adhesive can potentially be a one-time solution for COPD patients affected by emphysema with minimal side effects while providing permanent lung volume reduction.

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