Potential for gene therapy in lung transplantation

Lung transplantation has become a well-established management for many end-stage pulmonary diseases; however, the same success has not been achieved as with other solid organ transplants. Despite substantial improvements in organ preservation and the perioperative management of lung transplant recipients, ischemia–reperfusion injury, acute rejection, and chronic rejection persist. Severe ischemia–reperfusion injury affects as many as 20% of lung transplant recipients, prolongs mechanical ventilation, and may result in hemodynamic compromise. Acute rejection is the most common risk factor for bronchiolitis obliterans, a manifestation of chronic graft rejection, which ultimately progresses to graft failure. Gene therapy is a promising therapeutic option for these transplant-related injuries. Potential targets include donor and recipient, with a host of available delivery options and gene constructs. This review addresses the challenges of gene therapy and reviews its experimental progress in lung transplantation.