AzTrials
AzTrials

Lung TransplantPhase 2TIGER-LungNCT07538336

Targeting Interferon Gamma With Emapalumab to Lung Transplant Recipients With Interferon Gamma-high Acute Lung Allograft Dysfunction

A Phase 2 study testing Emapalumab in people with Lung Transplant, run by University of California, San Francisco at 2 sites in United States.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

This study is testing a medication called emapalumab to see if it can help people who have had a lung transplant and are experiencing a sudden drop in lung function, called acute lung allograft dysfunction (ALAD). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Lung Transplant
What is being tested?
Emapalumab
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
40 participants
Where
2 sitesUnited States
Study dates
2 Nov 2026to 1 Nov 2028
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Recipients ≥10 months post-lung transplant who are enrolled in existing biorepository study (IRB #13-10738) will be approached if they have ALAD and elevated AI2 and CXCL9 levels
  • Age: ≥18 years old
  • Informed Consent: Ability to provide written informed consent to participate in the study.

Who cannot join

  • Active Bacterial Infection: Positive bacterial cultures from bronchoalveolar lavage (BAL) samples at the time of ALAD diagnosis. Viral infections, which are typically treated in lung transplant recipients with a steroid taper and cleared by type I interferons, are not exclusion criteria per se.
  • Active CMV or EBV Infection: Active reactivation of cytomegalovirus (CMV) or Epstein-Barr virus (EBV) based on plasma PCR testing.
  • Severe Comorbidities: Presence of severe conditions likely to compromise study participation or outcomes (e.g., terminal illness).
  • Pregnancy or Breastfeeding: Women who are pregnant or breastfeeding at the time of screening.
  • Concurrent Immunosuppressive Therapy Trials: Use of investigational agents or therapies other than standard of care post-transplant immunosuppression.
  • Allergy to Study Drug: Known hypersensitivity to emapalumab or any of its components.
  • Insufficient Baseline Data: Lack of prior baseline FEV1 data for comparison.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Principal Investigator contact

john.greenland@ucsf.edu

United States2 sites
  • University of California, Los Angeles

    Los Angeles, California, 90095

  • University of California, San Francisco

    San Francisco, California, 94143

Other trials in United States

About this study

This study is testing a medication called emapalumab to see if it can help people who have had a lung transplant and are experiencing a sudden drop in lung function, called acute lung allograft dysfunction (ALAD).

ALAD is a serious condition that can happen after a lung transplant and can lead to worsening breathing and other complications. Right now, there is no approved treatment for ALAD.

The main goal is to see if lung function improves, meaning it returns close to your usual (baseline) level within 90 days.

Read the detailed description

You may be able to join if:

You had a lung transplant more than 10 months ago, and Your lung function has dropped by 10% or more compared to your best level in the past 6 months.

What will happen in the study?

As part of your usual care, you will have a procedure called a bronchoscopy (a test that looks inside your lungs). During this test, doctors will collect samples to check for infection and measure certain markers in your lungs and blood.

These results will help determine if you can join the study.

People with certain lung infections will not be able to participate.

Study treatment

The study has two parts:

Part 1 (finding the right dose):

Small groups of participants will receive different doses of emapalumab through an IV (into a vein). The goal is to find the dose that best blocks harmful inflammation in the lungs.

Part 2 (testing how well it works):

Participants will receive the selected dose of emapalumab. Doctors will:

Monitor blood and lung markers, Check for viruses, Follow your progress weekly for about 4 weeks.

Study goals:

The main goal is to see if lung function improves, meaning it returns close to your usual (baseline) level within 90 days.

The study will also look at:

Whether the condition gets worse or improves, How safe the treatment is, Overall outcomes after treatment.

Conditions
Lung Transplant
Being tested
Emapalumab, Placebo
Keywords
ALAD, Acute Lung Allograft Dysfunction, Lung Transplant

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EmapalumabDrug

    This is a one-time infusion

  • PlaceboDrug

    This is a one-time infusion of inactive drug

Study groups in NCT07538336
Study groupRoleWhat they receive
Part I (finding the right dose)Active comparatorSmall groups of participants will receive different doses of emapalumab through an IV (into a vein). The goal is to find the dose that best blocks harmful inflammation in the lungs.
Receives: Drug: Emapalumab
Part 2 (testing how well it works)OtherParticipants will receive the selected dose of emapalumab or placebo. Doctors will: Monitor blood and lung markers Check for viruses Follow your progress weekly for about 4 weeks
Receives: Drug: Emapalumab; Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Recovery from Acute Lung Allograft Dysfunction, defined by International Society for Heart and Lung Transplantation guidelines as a return to within 10% of baseline FEV1 within 90 days

    Measured: 90 days

Secondary outcomes (1)
  1. CXCL9 area under the curve (AUC), safety outcomes and retransplant-free survival will be used to measure ALAD Progression

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Apr 2026
  2. Study start2 Nov 2026 (estimated)
  3. Primary completion1 Nov 2028 (estimated)
  4. Study completion1 Nov 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Sequential
Model description
This is a multi-center, prospective, biomarker-driven, placebo-controlled, randomized interventional study.
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07538336
Sponsor's protocol ID
25-45438
Acronym
TIGER-Lung
Status last verified
Apr 2026
First submitted
9 Apr 2026
Last updated
20 Apr 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Herlong HF, Maddrey WC, Walser M. The use of ornithine salts of branched-chain ketoacids in portal-systemic encephalopathy. Ann Intern Med. 1980 Oct;93(4):545-50. doi: 10.7326/0003-4819-93-4-545.

    PubMed 7001971
  • Concepcion J, Marti M, Vehar S, Corbitt K. Refractory MDA-5 dermatomyositis rapidly progressive interstitial lung disease successfully treated with emapalumab. Ann Rheum Dis. 2025 May;84(5):879-880. doi: 10.1016/j.ard.2025.01.010. Epub 2025 Jan 31. No abstract available.

    PubMed 39893100
  • Liu G, Qian S, Liu J, Ma H, Wang Q. Efficacy of emapalumab in treating 3 pediatric patients with epstein-barr virus-associated hemophagocytic lymphohistiocytosis complicated by multiple organ dysfunction. Ann Med. 2025 Dec;57(1):2569991. doi: 10.1080/07853890.2025.2569991. Epub 2025 Oct 9.

    PubMed 41066671
  • Shino MY, Todd JL, Neely ML, Kirchner J, Frankel CW, Snyder LD, Pavlisko EN, Fishbein GA, Schaenman JM, Mason K, Kesler K, Martinu T, Singer LG, Tsuang W, Budev M, Shah PD, Reynolds JM, Williams N, Robien MA, Palmer SM, Weigt SS, Belperio JA. Plasma CXCL9 and CXCL10 at allograft injury predict chronic lung allograft dysfunction. Am J Transplant. 2022 Sep;22(9):2169-2179. doi: 10.1111/ajt.17108. Epub 2022 Jun 15.

    PubMed 35634722
  • Groom JR, Luster AD. CXCR3 in T cell function. Exp Cell Res. 2011 Mar 10;317(5):620-31. doi: 10.1016/j.yexcr.2010.12.017.

    PubMed 21376175
  • Feng H, Zhang YB, Gui JF, Lemon SM, Yamane D. Interferon regulatory factor 1 (IRF1) and anti-pathogen innate immune responses. PLoS Pathog. 2021 Jan 21;17(1):e1009220. doi: 10.1371/journal.ppat.1009220. eCollection 2021 Jan.

    PubMed 33476326
  • Tellides G, Pober JS. Interferon-gamma axis in graft arteriosclerosis. Circ Res. 2007 Mar 16;100(5):622-32. doi: 10.1161/01.RES.0000258861.72279.29.

    PubMed 17363708
  • Zhang H, Zhang D, Xu Y, Zhang H, Zhang Z, Hu X. Interferon-gamma and its response are determinants of antibody-mediated rejection and clinical outcomes in patients after renal transplantation. Genes Immun. 2024 Feb;25(1):66-81. doi: 10.1038/s41435-024-00254-x. Epub 2024 Jan 22.

    PubMed 38246974
  • D'Elios MM, Josien R, Manghetti M, Amedei A, de Carli M, Cuturi MC, Blancho G, Buzelin F, del Prete G, Soulillou JP. Predominant Th1 cell infiltration in acute rejection episodes of human kidney grafts. Kidney Int. 1997 Jun;51(6):1876-84. doi: 10.1038/ki.1997.256.

    PubMed 9186878
  • Wiseman AC, Pietra BA, Kelly BP, Rayat GR, Rizeq M, Gill RG. Donor IFN-gamma receptors are critical for acute CD4(+) T cell-mediated cardiac allograft rejection. J Immunol. 2001 Nov 1;167(9):5457-63. doi: 10.4049/jimmunol.167.9.5457.

    PubMed 11673565
  • Moshkelgosha S, Duong A, Wilson G, Andrews T, Berra G, Renaud-Picard B, Liu M, Keshavjee S, MacParland S, Yeung J, Martinu T, Juvet S. Interferon-stimulated and metallothionein-expressing macrophages are associated with acute and chronic allograft dysfunction after lung transplantation. J Heart Lung Transplant. 2022 Nov;41(11):1556-1569. doi: 10.1016/j.healun.2022.05.005. Epub 2022 May 20.

    PubMed 35691795
  • Brunet-Ratnasingham E, Yellamilli S, Guo R, Mohanty RP, Duong A, Kolaitis NA, Hays SR, Shah RJ, Venado A, Maheshwari JA, Kleinhenz ME, Leard LE, McDyer J, Martinu T, Combes AJ, Calabrese DR, Singer JP, Greenland JR. Persistent and progressive acute lung allograft dysfunction is linked to cell compositional and transcriptional changes in small airways. J Heart Lung Transplant. 2025 Sep;44(9):1482-1492. doi: 10.1016/j.healun.2025.03.010. Epub 2025 Apr 28.

    PubMed 40293382
  • Calabrese DR, Ekstrand CA, Yellamilli S, Singer JP, Hays SR, Leard LE, Shah RJ, Venado A, Kolaitis NA, Perez A, Combes A, Greenland JR. Macrophage and CD8 T cell discordance are associated with acute lung allograft dysfunction progression. J Heart Lung Transplant. 2024 Jul;43(7):1074-1086. doi: 10.1016/j.healun.2024.02.007. Epub 2024 Feb 15.

    PubMed 38367738

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Emapalumab in people with Lung Transplant, run by University of California, San Francisco at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 20 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Legna Betancourt ((415) 476-8073, legna.betancourt@ucsf.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recovery from Acute Lung Allograft Dysfunction, defined by International Society for Heart and Lung Transplantation guidelines as a return to within 10% of baseline FEV1 within 90 days (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07538336, which also lists 13 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Apr 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in