Diagnostic Tool Predicts Bronchiolitis Obliterans Syndrome

A new diagnostic tool, which predicts bronchiolitis obliterans syndrome (BOS) in lung transplant patients, will allow doctors to intervene earlier and, ultimately, to provide life-saving treatments.

BOS is the leading cause of death for those who survive one year after lung transplantation; more than half of recipients will develop BOS within five years. There is currently no cure.

Vibha Lama, MD, MS, assistant professor of pulmonary and critical care medicine at the University of Michigan (U-M) Medical School (Ann Arbor, MI, USA), led a team of U-M investigators who recently discovered that patients who had a high number of stem cells in their lungs six months after transplantation were much more likely to develop BOS than those with lower counts.

The exact relationship between mesenchymal stromal cells and BOS remains unclear but doctors know that most of the cells originate with the donor and not the recipient. Spikes in cell counts are seen shortly after transplantation as the body responds to the injury; those levels usually taper off, but a second rise of cell counts after about six months is linked to a patient's likelihood of developing BOS.

A lung transplant can mean a new chance at life. But many who receive one develop a debilitating, fatal condition that causes scar tissue to build up in the lungs and chokes off the ability to breathe.

"Our study provides the first indication of the important role these cells play in both human repair and disease," Dr. Lama said. "It's very important from the clinical perspective because we didn't previously have any strong biomarkers for BOS."

The translational study also highlighted the importance of the lab-to-bedside cooperation of basic and clinical research, Dr. Lama noted. Having the biomarker will also allow scientists to readily identify a population of patients ideal for testing new drug interventions and therapies.

The findings were published online ahead of print publication in the American Journal of Respiratory and Critical Care Medicine.

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