The most critical complication to watch out for after receiving a lung transplant is Chronic Lung Allograft Dysfunction (CLAD). Once CLAD develops, there are no universally effective treatments available. Therefore, preventing this complication takes top priority for those who have undergone a lung transplant. One of the primary immunosuppressing medications used in lung transplant recipients is calcineurin inhibitors.

There are only two calcineurin inhibitors: cyclosporine and tacrolimus. Each has different formulations, such as once-daily slow-release tacrolimus, twice-daily immediate-release tacrolimus, and twice-daily cyclosporine. While these medications share the same goal of preventing rejection, it is unclear whether they are equally effective. CLAD encompasses a range of clinical manifestations that ultimately lead to the transplanted lung losing its normal function.

The presentation of CLAD can vary among patients, with some experiencing an obstructive ventilatory defect, others having a restrictive defect, and some exhibiting a combination of both. Unfortunately, once CLAD develops, lung function does not improve. In the absence of effective treatments, strategies to prevent CLAD are crucial.

A recent study published in the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry data found a significant survival benefit between using tacrolimus versus cyclosporine after lung transplantation. Out of 22,222 individuals with data on chronic lung allograft dysfunction treatment, 88.6% received immediate-release tacrolimus. The participants taking immediate-release tacrolimus had a much lower rate of experiencing CLAD than those who took twice-daily cyclosporine.

Michael Combs, an assistant professor of pulmonary diseases and internal medicine at Michigan Medicine, led the research team conducting this study. Combs highlighted the positive findings for twice-daily immediate-release tacrolimus in this study, stating that it should reassure transplant patients and providers that using this formulation is the superior treatment to cyclosporine.

“This present study should reassure transplant patients and providers twice-daily tacrolimus — and not only once-daily tacrolimus — is the superior treatment to cyclosporine,” said Combs. “Importantly, in our study we found that twice-daily tacrolimus not only resulted in lower rates of CLAD relative to cyclosporine, but it was also associated with improved overall survival after lung transplantation. This is an important, patient-centered finding which has not been previously demonstrated.”

In conclusion, the most effective prevention method for complications post-lung transplant is using tacrolimus, regardless of its formulation. This treatment offers a significant advantage over cyclosporine in preventing CLAD and improving overall survival after lung transplantation. Future research will need to investigate whether once-daily medication regimens are superior to twice-daily formulations.

The fight against inflammatory lung diseases has taken a significant turn with the discovery of a groundbreaking approach to treating pulmonary sarcoidosis. This condition, characterized by granulomas – tiny clumps of immune cells that form in response to inflammation – affects around 200,000 patients in the U.S. and has been largely unchanged for the past 70 years.

In a recent study published in Science Translational Medicine, scientists at Scripps Research and aTyr Pharma have identified a protein called HARSWHEP that can soothe the inflammation associated with sarcoidosis. By regulating white blood cells, HARSWHEP reduces inflammation, slowing the disease’s progression and resulting in less scarring.

The key to this discovery lies in HARSWHEP’s gentle nature. Unlike other treatments that suppress the immune system, HARSWHEP “nudges” it in a certain way, quieting the inflammation without causing significant harm. This approach has shown promising results in a phase 1b/2a clinical trial of efzofitimod, a therapeutic form of HARSWHEP.

Researchers believe that HARSWHEP could be used to treat other interstitial lung diseases (ILDs), a family of conditions characterized by inflammation and scarring of the lungs. While more research is needed, this breakthrough offers new hope for patients suffering from these debilitating diseases.

The study’s senior author, Paul Schimmel, Professor of Molecular Medicine and Chemistry at Scripps Research, says that the results validate a new way to approach immune regulation in chronic lung disease. His colleague, Leslie A. Nangle, Vice President of Research at aTyr Pharma, adds that HARSWHEP’s mechanism of action is unique and has never been characterized before.

The team’s findings have significant implications for patients with ILDs. Current treatments often involve long-term steroid use, which can lead to weight gain, organ damage, and increased vulnerability to infection. By providing an alternative treatment option, HARSWHEP could improve the lives of those affected by these conditions.

As researchers continue to explore the potential of HARSWHEP, this breakthrough serves as a reminder that even in the face of seemingly insurmountable challenges, innovative approaches can lead to groundbreaking discoveries.

The Xpert MTB/RIF Ultra molecular diagnostic test for stool samples, previously recommended only for children, has shown potential as an additional tool for diagnosing tuberculosis (TB) in adults living with HIV. A study led by the Barcelona Institute for Global Health (ISGlobal), in collaboration with several institutions, has demonstrated that this test can be used to detect TB in people with advanced AIDS, where the risk of TB is higher.

Tuberculosis, caused by the bacterium Mycobacterium tuberculosis, remains a significant global health concern, with 1.25 million deaths reported in 2023, including 13% among people living with HIV. Current diagnostic strategies focus on sputum samples, but access to these diagnostics remains limited, and they are not effective for all individuals living with HIV.

The study, published in The Lancet Microbe, recruited 677 patients over 15 years old with HIV and suspected TB from medical centers in three African countries: Eswatini, Mozambique, and Uganda. Participants provided sputum, urine, stool, and blood samples. The results showed that the stool ultra test had a sensitivity of 23.7% and a specificity of 94.0%, compared with a microbiological reference standard consisting of three WHO-recommended tests: TB-LAM in urine, liquid culture, and Xpert Ultra from sputum.

In patients with CD4 counts below 200 cells/μl, sensitivity increased to 45.5%. This suggests that the stool ultra test can be used as a complementary tool for diagnosing TB in people living with HIV, especially in those with advanced AIDS, where the risk of TB is higher.

The study’s findings support the use of the Stool Ultra test as a valuable diagnostic tool in areas where access to standard tests is limited. The potential of this sample to confirm disease in cases where respiratory tests are negative offers hope for improving diagnosis and treatment outcomes in vulnerable populations.