Autologous airway basal cell transplantation for destroyed lung repair.

BACKGROUND

Destroyed lung is an irreversible end-stage condition with limited treatment options: current care is palliative and transplants are scarce. Airway basal cells offer promise for autologous repair due to their regenerative potential and minimally invasive accessibility.

METHODS

This study enrolled four patients with asymmetric lung remodeling following injury: unilateral progressive destruction and contralateral compensatory enlargement. Basal cells were obtained via bronchoscopic brushing from the contralateral lung. In an investigator-initiated trial (ChiCTR2000036648), two patients received autologous basal cell transplantation (2 × 10⁶ cells/kg). Patient 1 received a single dose; Patient 2 received four doses over two years. Efficacy and safety were assessed by serial CT imaging and pulmonary function tests.

FINDINGS: In vitro, basal cells from the contralateral non-atrophic lung showed preserved colony-forming, proliferative, and differentiation capacities toward airway and distal lung lineages. Clinically, Patient 1 (single transplant) exhibited new aerated tissue and improved lung function within 6 months, but benefits waned by 13 months. In contrast, Patient 2 (four transplants over 2 years) showed progressive lung expansion and sustained functional improvement without subsequent reversal.

INTERPRETATION: This study provides preliminary validation functionally intact airway basal cells as a viable autologous cell source. A single transplantation drove lung tissue repair, while repeated doses sustained longer-term benefits. These findings offer proof-of-concept evidence for reversing functional loss and initiating regeneration in destroyed lung.