Isolated lung perfusion for targeted therapies: applications in acute respiratory distress syndrome, acute lung injury, and transplantation.

INTRODUCTION

Isolated lung perfusion (ILP) is a platform equipped for localized delivery, assessment, and optimization of lung-targeted therapies to manage acute respiratory distress syndrome (ARDS), acute lung injury, and transplantation. Here we review platform capabilities, therapeutic potential, and translational pathways with particular focus on ARDS.

AREAS COVERED: A systematic search was performed in the PubMed database to identify relevant works. From this comprehensive review, we discuss the historical application of ILP in lung transplantation and thoracic oncology, and its progression to treating acute lung injury. Recent preclinical studies have demonstrated the efficacy of pharmacological interventions, gene therapy, and cell-based approaches delivered via ILP. Molecular investigations have revealed mechanisms underlying ILP effects, including modulation of inflammatory pathways, enhancement of cellular repair processes, and activation of tissue protection mechanisms. Significant technical refinements have extended perfusion durations, improved monitoring capabilities, and enhanced delivery systems.

EXPERT OPINION: ILP has surfaced as the ideal platform for precision medicine approaches to ARDS management. Despite significant advances, challenges to clinical translation persist. Issues of standardization, cost analysis, and minimally invasive techniques need to be addressed to continue expanding in diagnostic utility and therapeutic benefit with a focus on personalized approaches based on ARDS etiology and patient-specific biomarkers.