Post-COPD: Can Emphysema Be Repaired?

Clinical and translational observations suggest that repair or new growth of alveolar structures in humans is feasible. The pathways and mechanisms for repairing damaged alveoli have been characterized in in vivo and ex vivo models, and many of these major biological pathways involved in facilitating lung repair have been validated in adult human lung tissue. Improvements in imaging, functional studies, and biomarkers have led to sensitive measures of treatment effects and clinical outcomes that can be used to study emphysema repair in humans with emphysema. Additionally, the development of innovative platform clinical trial designs now allows for the simultaneous testing of multiple drugs and treatment response biomarkers within a heterogenous population, helping to distinguish responders from non-responders. Several approved medications targeting pathways involved in lung repair could be tested to treat emphysema (e.g., all-trans retinoic acid, thiazolidinediones, metformin, non-steroidal anti-inflammatory drugs, and lithium). These advances enable feasible assessment of the scientific premise of lung repair in human emphysema in clinical trials.