CHEST Guidelines-Response_chest

Response_chest_27 (5)

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The article discusses the use of allogeneic human mesenchymal stem cells (MSCs) for treating idiopathic pulmonary fibrosis (IPF). Drs. Thangakunam and Christopher acknowledge the work by Glassberg and colleagues on the safety of this treatment, noting it as a significant scientific advancement. However, they warn about potential anaphylactic reactions upon subsequent MSC infusions, based on their own experiences with a patient. They recommend administering the second infusion in an intensive care setting to manage potential reactions from sensitization to proteins, peptides, or preservatives like dimethyl sulfoxide (DMSO).<br /><br />Furthermore, Thangakunam and Christopher call for more studies involving repeated administration of MSCs, especially for patients with severe fibrosis, who often seek experimental treatments when lung transplantation is not an option. They expect these studies to address safety and efficacy, given that initial trials excluded patients with very advanced disease.<br /><br />In the response, Glassberg et al. agree with the importance of conducting future MSC studies under close monitoring due to compromised pulmonary function in IPF patients. They emphasize that prior trials have shown safe administration of allogeneic cells, with current practices minimizing unknown constituents and reducing DMSO concentrations. While supporting experimental treatments, they stress patient safety and the necessity for efficacy trials before MSC therapies can be fully endorsed.<br /><br />Separately, a study evaluates the reliability of routine coagulation tests like prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT) in excluding significant levels of direct oral anticoagulants (DOACs) in emergency situations. The study found that normal screening tests are often unreliable in excluding certain DOAC levels and emphasize using specific assays with drug-specific calibrators for accurate measurement. These results suggest a need for clearer guidelines on the negative predictive value of these tests to avoid misleading clinical conclusions.

Keywords

allogeneic mesenchymal stem cells

idiopathic pulmonary fibrosis

anaphylactic reactions

intensive care

dimethyl sulfoxide

lung transplantation

direct oral anticoagulants

coagulation tests

experimental treatments

efficacy trials