Did you know that chronic obstructive pulmonary diseases (COPD) is actually the third leading cause of death worldwide? According to the World Health Organization (WHO), the lung disease – which restricts airflow and causes breathing problems – led to 3.23 million deaths in 2019 alone. This highlights the critical need for finding a treatment that could become a promising cure for COPD.
COPD is primarily caused by long-term exposure to irritants that damage the lungs, with smoking and air pollution being the most common causes of the disease. COPD falls under two main categories: emphysema and chronic bronchitis. Emphysema typically occurs when the tiny air sacs – alveoli – in the lungs become severely damaged, while chronic bronchitis refers to a chronic cough and phlegm production due to inflammation in the airways.
As COPD progresses, people find it more difficult to carry out their normal daily activities because of the resulting breathlessness. It can also be a considerable financial burden on patients due to limitation of workplace and home productivity, as well as costs of medical treatment.
At this moment in time, there is no cure for the disease. But with recent breakthroughs and advancements in treatment options, there is hope that a promising cure for COPD may soon be found.
Current standard-of-care of treatment options for COPD
COPD is considered irreversible, which means that current treatment largely focuses on the management of symptoms and preventing the progression of the disease. Several treatments are available that can do this.
The main ones are inhaled medicines that open and reduce swelling in the airways, called bronchodilators, of which there are two types. Short-acting bronchodilators are often used during flare-ups, on an as-needed basis, to alleviate acute breathing difficulties. They begin to work within seconds and the effects can last for four to six hours. Long-acting bronchodilators, on the other hand, take longer to start working, but the effects last longer. They are usually prescribed on a daily schedule to prevent breathing problems.
During flare-ups, steroids are often also used to reduce inflammation, as well as antibiotics to treat infections. Additionally, oxygen is used for people who have had COPD for a long time, or have severe COPD, and pulmonary rehabilitation can be used to strengthen the lungs. And, for people with extremely severe forms of the disease, they can undergo surgery to remove damaged lung tissue.
Breakthroughs in COPD treatments and research
Approved by the U.S. Food and Drug Administration (FDA) in 2018, there is now also an innovative new treatment for COPD that goes beyond the standard therapies mentioned: an endobronchial valve implantation.
These valves are minimally invasive, and are essentially small devices that are placed in the airways to treat conditions like COPD. During the procedure, an endotracheal tube or bronchoscope is inserted into your lung so the valve can be implanted.
The valves work by redirecting airflow away from damaged parts of the lung, allowing healthier areas to function better. They create a one-way flow, enabling trapped air to escape during exhalation, while preventing new air from entering the damaged areas during inhalation. This helps restore balanced airflow, improves lung function, and alleviates symptoms, allowing people with emphysema to take deeper breaths.
While an endobronchial valve is not a cure for COPD, it does dramatically help patients manage their discomfort and alleviate their symptoms, having a positive impact on their day-to-day lives.
There was also another recent breakthrough regarding COPD research when, last year, scientists at the University of Pennsylvania’s Perelman School of Medicine discovered a new type of cell in human lungs called respiratory airway secretory cells (RASCs).
The researchers discovered RASCs by performing single-cell RNA sequencing on lung tissue from healthy non-smoker donors. They found that the cells had a unique gene expression profile, with the cells residing in airway branches, which interweave with the alveoli.
The researchers soon identified RASCs as “secretory” cells because they produce proteins needed for the mucus lining the airway. They also found that RASCs are similar to another type of cell called alveolar epithelial type 2 (AT2) cells, which are stem cells for alveoli. In people with COPD, the function of AT2 cells is impaired, suggesting a potential role for RASCs in treating the disease.
The discovery of RASCs in the lungs is significant because it has the potential to speed up the progress of clinical trials focused on COPD, and could pave the way for new treatments that specifically target these cells to restore normal lung function.
A promising cure for COPD: transplanting patients’ own lung cells
In order to find new promising treatments for COPD – particularly treatments that could become a cure for the disease – researchers have been investigating stem cells, which are capable of differentiating into any cell in the body, as well as progenitor cells, which are descendants of stem cells and can only differentiate into the cells that belong to the same tissue or organ, and are normally used by the body to repair and replace damaged tissue.
The results of this type of research have been conflicting, especially for stem cells. That is, until recently.
In September, delegates at the European Respiratory Society’s International Congress were told that, for the first time, researchers have shown it is possible to repair damaged lung tissue in patients with COPD using the patients’ own lung cells.
The research team included Professor Wei Zuo, of the School of Medicine, Tongji University, Shanghai, China, and chief scientist at Regend Therapeutics Ltd in China, as well as his colleagues, who were investigating whether a type of cell called P63+ lung progenitor cells might be able to regenerate lung tissue damaged by COPD.
“Stem cell and progenitor cell-based regenerative medicine may be the biggest, if not the only, hope to cure COPD,” Zuo told the congress. “P63+ progenitor cells are known for their ability to regenerate the tissues of the airways, and previously we and other scientists have shown in animal experiments that they can repair the damaged epithelial tissue in the alveoli – the tiny air sacs in the lungs that play a crucial role in the exchange of gases between air breathed in and the blood supply to the lungs.”
This research was part of a phase 1 clinical trial. Here, the researchers set out to investigate the efficacy and safety of taking P63+ progenitor cells from the lungs of 20 COPD patients, using them to grow millions more in the laboratory, before transplanting them back into the patients’ lungs.
“In our trial, 35% of the patients had severe COPD and 53% had extremely severe COPD,” said Zuo. “Usually, many patients with such severe COPD will die quite quickly if their disease progresses. We used a tiny catheter that contains a brush to collect the progenitor cells from the patients’ own airways. We cloned the cells to create up to a thousand million more, and then we transplanted them back into the patients’ lungs via bronchoscopy in order to repair the damaged lung tissue.
“We found that P63+ progenitor cell transplantation not only improved the lung function of patients with COPD, but also relieved their symptoms, such as shortness of breath, loss of exercise ability and persistent coughing. This means that the patients could live a better life, and usually with longer life expectancy.”
Looking ahead, the researchers are now planning a phase 2 trial of the treatment, which will evaluate its efficacy in a larger group of patients. The trial has been approved by China’s National Medical Products Administration (NMPA), the Chinese equivalent of the U.S. Food and Drugs Administration (FDA).
A promising future for COPD treatment
Although COPD does not yet have a cure, the future looks promising when it comes to treatment options for the disease, largely due to the fact that COPD is a leading cause of death worldwide. This means that there has been a significant focus on it, with a lot of resources and effort concentrated on finding innovative, effective treatments for the disease.
Recent breakthrough treatments – as well as treatments currently in development – also mean that the quality of life and overall health of people living with COPD are constantly being improved.
And, with more research being invested specifically into regenerative medicine, a promising cure for COPD may well be on the horizon.
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