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A recently published case report detailed the first documented use of intrabronchial mesenchymal stromal cell administration in a pediatric patient on ECMO.

“To the best of our knowledge, this is the first report of intrabronchial MSC [mesenchymal stromal cell] administration in a pediatric patient on ECMO [extracorporeal membrane oxygenation],” wrote corresponding author Sylvia Belda-Hofheinz, MD, of University Hospital 12 de Octubre, Madrid, Spain, and coauthors in a case report published in Stem Cell Research & Therapy.

The case report focused on a 2-year-old male patient with end-stage interstitial lung disease (ILD) requiring ECMO. With all prior immunosuppressive therapies unsuccessful and transplantation contraindicated, the clinical team opted for regenerative and immunomodulatory therapy with MSC.

Novel Delivery Method in ECMO: Consecutive Intrabronchial Administration

Standard MSC delivery routes include intravenous, intramuscular, intralesional, topical, and intra-arterial approaches. In contrast, the team introduced a technique termed “consecutive intrabronchial administration” (CIBA).

“The intrabronchial route offers the advantage of avoiding immediate systemic circulation, thereby minimizing the risks of ECMO obstruction and coagulation activation,” the authors explained. “Moreover, this method enables direct MSC delivery to the affected lung tissue, enhancing local therapeutic effects.”

Using the CIBA method, the team infused Wharton’s jelly–derived MSCs suspended in saline with 1% dimethyl sulfoxide via video bronchoscope into each of the five lung lobes (5.1 mL per lobe; total 25.5 mL) at 0.42 mL/min over 1 hour and 5 seconds. The patient was electively intubated, sedated, and paralyzed 48 hours before and after the procedure. To minimize risks, the team did not perform pre-infusion bronchoalveolar lavage or post-infusion airway suctioning.

According to the report, intrabronchial MSC delivery was well-tolerated. The patient remained in stable condition throughout the procedure, with no adverse reactions observed.

Four weeks post-procedure, clinicians attempted to wean ECMO gas flow, but the patient demonstrated poor tolerance, the team reported. Respiratory function deteriorated. Increased ECMO support failed to reverse the decline, and following a multidisciplinary discussion with the family, the patient was disconnected from ECMO and died.

Questions & Conclusions

The authors noted that ECMO filter capacity was not affected by the administration of MSC directly into the lungs, therefore MSC did not reach the circulation, and stated that future investigation is warranted into questions regarding the potential for multiple doses, increased dose, or early administration to prevent the development of ILD.

“This case demonstrates that administering intrabronchial MSC in a patient on ECMO support is both feasible and safe, despite the procedure not reversing the patient’s interstitial lung disease,” the authors concluded.