Lung transplantation: Current insights and outcomes

Claudio Napoli ¹, Giuditta Benincasa ², Alfonso Fiorelli ³

⁰Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", 80138 Naples, Italy; U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Clinical Department of Internal Medicine and Specialistics, University of Campania "L. Vanvitelli,", Naples, Italy.

Transplant Immunology +

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June 18, 2024

View abstract on PubMed

Summary

Predicting lung transplant rejection remains challenging due to limited biomarkers. Donor-derived cell-free DNA and transcriptomics show promise for early diagnosis of acute rejection and chronic lung allograft dysfunction (CLAD).

Area Of Science

Immunology
Transplantation Medicine
Biomarker Discovery

Background

Immune-mediated rejection complicates lung transplantation outcomes.
Chronic lung allograft dysfunction (CLAD) is a leading cause of mortality, necessitating early diagnostic tools.

Purpose Of The Study

To review novel and existing technologies for identifying immune-mediated rejection mechanisms in lung transplantation.
To highlight emerging biomarkers for improved precision medicine in lung allograft recipients.

Main Methods

Review of omics technologies (genomics, epigenomics, transcriptomics) and bioinformatic platforms.
Analysis of clinical trial data for biomarker performance.
Discussion of emerging biomarkers like exosomes, telomere length, DNA methylation, and neutrophil extracellular traps (NETs).

Main Results

Genomic biomarkers, particularly donor-derived cell-free DNA in plasma and bronchoalveolar lavage fluid, show diagnostic potential for acute rejection and CLAD phenotypes.
Transcriptomic analysis led to the Molecular Microscope® Diagnostic System (MMDx) for interpreting molecular signatures in lung biopsies.
Several other potential biomarkers are under investigation but have not yet entered clinical trials.

Conclusions

Omics technologies are crucial for understanding lung allograft rejection pathways and discovering specific biomarkers.
Donor-derived cell-free DNA and transcriptomic signatures represent promising avenues for early detection and management of lung transplant rejection.
Further research into novel biomarkers is essential for advancing precision medicine in lung transplantation.

Keywords:

Acute rejection Biomarkers Chronic rejection Clinical trials Immune system Lung transplantation Omics

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