Human trials start next year in Toronto on a gene and stem cell therapy that could make a transplanted lung “look more like itself,” a first step toward what Dr. Shaf Keshavjee calls the ultimate goal: an organ that is you so that your body doesn’t reject it. Keshavjee, Surgeon-in-Chief of the Sprott Department of Surgery and director of the Toronto Lung Transplant Program at UHN, is building on the Ex Vivo Lung Perfusion (EVLP) platform developed at Toronto General Hospital, which keeps donor lungs breathing outside the body so they can be assessed and repaired. “We interrogate them, we can assess them, and we can fix them with gene therapy and stem cells,” he said in an interview with Your Morning. The donor lungs are placed inside of a protective dome and supplied all critical components so it can breathe on its own for 12 hours. “I think if we can do that, if we move it into in vivo or inside the body lung perfusion, where we are now fixing lungs inside people, and I think that transition will be to the point where we find disease, we will fix it inside you.” Of the more than 4,600 lung transplants performed worldwide each year, Keshavjee says about 80 per cent of donor lungs are not clinically acceptable for transplant, and patients who do receive one live a median of roughly six and a half years. His long-term aim is to fix damaged organs by using gene therapy and stem cells, as well as see if there is a way to create a different source of organs. “There are many sources. They could be growing new organs from stem cells, or you could actually use artificial lungs or lungs from animals, and so on,” Keshavjee said. “And then introduce human stem cells into them, or epithelial cells, lining cells of the lung, so that you can create a new lung.” When human trials start next year, the surgeon says he will explain to the patients that receiving a transplant is “not a normal solution to a very difficult problem.” “Once we transplant the lung into you, you spend the rest of your life trying to reject that organ, so the first gene therapy attempts that we’re going to do next year is: can we make that organ look more like itself so you won’t reject it, and so on,” he said. “Then you can go to the next step of saying: can we make an organ where you don’t need any immunosuppressant? Can we make that organ that is you?” The surgeon says the long-term goal is that they reach a point where lungs can be fixed inside of a human’s body, without the need of having a transplant. Keshavjee was in the room when the first-ever successful lung transplant in the world was performed in 1983, which was done so at Toronto General Hospital, and then again in 1986 for a double lung transplant.
