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

Abstract

Several bronchoscopic lung volume reduction (BLVR) treatments have been developed to reduce hyperinflation in emphysema patients. Lung bio-adhesives are among the most promising new BLVR treatment options, as they potentially provide a permanent solution for emphysematous patients after only a single application. To date, bio-adhesives have mainly been used as haemostats and tissue sealants, while their application in permanently contracting and sealing hyperinflated lung tissue has recently been identified as a novel and enticing opportunity. However, a major drawback of the current adhesive technology is the induction of severe inflammatory responses and adverse events upon administration. In our review, we distinguish between and discuss various natural, semi-synthetic and synthetic tissue haemostats and sealants that have been used for pulmonary applications such as sealing air/fluid leaks. Furthermore, we present an overview of the different materials including AeriSeal and autologous blood that have been used to achieve lung volume reduction and discuss their respective advantages and drawbacks. In conclusion, we describe the key biological (therapeutic benefit and biocompatibility) and biomechanical (degradability, adhesive strength, stiffness, viscoelasticity, tunability and self-healing capacity) characteristics that are essential for an ideal lung bio-adhesive material with the potential to overcome the concerns related to current adhesives.

Surgical and bronchoscopic pulmonary function-improving procedures in lung emphysema

“…An attempt to reduce inflammatory side-effects by a staged approach, with lower doses of sealant, was not successful and could not show clinically significant volume reduction [ 107 ]. The development of bio-adhesives capable of reducing static and dynamic hyperinflation, without inducing a pronounced inflammatory reaction, is challenging but worth exploring because it may induce durable LVR effects without the concern of interlobar collateral ventilation [ 108 ]. Furthermore, reversing collateral ventilation by using low doses of AeriSeal, thereby making patients eligible for EBV treatment, is attractive and under investigation (NCT04256408, NCT04559464) [ 109 ].…”

Lung‐Mimetic Hydrofoam Sealant to Treat Pulmonary Air Leak

“…[8] Available surgical sealants intended for other indications (e.g., BioGlue, Evicel, and TISSEEL) are sometimes used off-label to treat air leak but are ineffective due to poor adhesion or insufficient physicomechanical properties that are mismatched with the surrounding lung tissue (Table S1, Supporting Information). [8][9][10][11][12][13][14][15][16][17][18][19][20] A surgical sealant that effectively seals air leak and promotes tissue repair has the potential to significantly reduce post-operative burden, risk of complications, hospital length of stay, and/or healthcare costs currently associated with management of air leak.…”

Recent advances in bronchoscopic lung volume reduction for severe COPD patients

“…In Patel et al .’s 2▪ systematic review and meta-analysis, consistent results on improving pulmonary function, exercise capacity and health-related quality of life were demonstrated. Different techniques exist to reduce hyperinflation bronchoscopically, and while vapour ablation, sealants and coils are available and being researched, the currently most widely implemented are one-way endobronchial valves (EBVs), which have progressed from experimental therapy to standard of care 1,3 . BLVR is still a relatively novel technique in full development and has only recently been upgraded to the highest level of evidence in the Global Initiative for Chronic Obstructive Lung Disease 2023 report 1 .…”