First in Human Study to Assess an Implant to Treat Severe Emphysema

Inclusion Criteria:

1. Age ≥ 35 and ≤ 80 years old

2. Computed tomography (CT) scan evidence of homogeneous or heterogeneous emphysema

3. At least one target lobe with > 35% destruction (percent of voxels with < -950Hounsfield units on CT)

4. Post-bronchodilator ratio of FEV1/FVC < 0.7 at screening

5. Post-bronchodilator FEV1 percent predicted ≥20% and ≤50% of predicted at screening

6. Post-bronchodilator RV > 180% predicted

7. Post-bronchodilator RV/TLC ≥ 0.55 at screening

8. Marked dyspnea, scoring ≥ 2 on the modified Medical Research Council scale of 0-4

9. Cotinine testing at screening indicates nonsmoker and stopped smoking at least 8weeks before entering the trial and agrees to refrain from smoking for duration ofstudy participation

10. Participation in a pulmonary rehabilitation program and/or confirmed to have beenengaged or attempted regular physical activity in the 12 months prior to the firstApreo Procedure and agrees to continue or restart regular physical activity for theduration of the study

11. Fully vaccinated for Covid-19 (up to date per Australian Government Guidelines) andhas current pneumococcus and influenza vaccination (or documented clinicalintolerance)

12. Cognitively and physically able to provide written informed consent and completeparticipant questionnaires

Exclusion Criteria:

1. Arterial blood PaCO2 > 60 mmHg (8 kPa) or PaO2 ≤ 45 mmHg (6 kPa)

2. DLCO <20% at screening

3. Steroid therapy of 10 mg prednisolone (prednisone) or more per day

4. Three or more acute exacerbations of COPD in the past year before enrollment

5. Two or more hospitalizations for acute exacerbations of COPD or respiratoryinfections in the past year before enrollment

6. Any acute exacerbation of COPD or respiratory infection less than 4 weeks before thefirst Apreo Procedure

7. Previous lung volume reduction surgery or lobectomy, segmentectomy or bullectomy,vapor, glue, or other pulmonary device implant

8. Known history of pulmonary arterial hypertension

9. Presence of a giant bulla (≥ 30% of hemithorax)

10. History of excessive dynamic airway collapse of the trachea or main bronchi

11. History of adult asthma or chronic bronchitis

12. Presence of suspicious pulmonary nodule/infiltrate that requires additionalfollow-up, diagnostics or treatment

13. Unequivocal and symptomatic bronchiectasis

14. Unequivocal lung cancer or other current cancer diagnosis except non-metastasizedbasal cell skin cancer

15. Uncontrolled hypertension (blood pressure that is inadequately treated or resistantto treatment) with a systolic > 200 mmHg or diastolic > 110 mmHg at screening orprior to first Apreo Procedure

16. Uncorrectable coagulopathy or other condition likely to increase risk of peri- orpost- Apreo Procedure bleeding

17. On anticoagulant or antiplatelet therapy and unable or unwilling to hold for ApreoProcedure

18. Coronary artery disease with angina

19. History of myocardial infarction within 6 months

20. History of a stroke less than 1 year before the first Apreo Procedure

21. Clinical history of heart failure with documented LVEF ≤ 40%

22. Clinical history of diabetes with a HbA1c > 9.0%

23. Estimated glomerular filtration rate (eGFR) <30 mL/min/1.73m2 (CKD-EPI) ORparticipant with kidney failure (Stage 5 kidney disease)

24. Mechanical ventilator dependence except participants using nocturnal bi-levelpositive airway pressure (biPAP) or continuous positive airway pressure (CPAP) areallowed if it would not preclude safe implantation of the study device

25. Pregnant, lactating, or women of childbearing potential who plan to become pregnantwithin the study duration

26. Known hypersensitivity to nitinol

27. Significantly immunocompromised, such as organ transplant recipients, those withcongenital immune deficiencies, AIDS, or severe rheumatoid arthritis

28. Any disease or condition likely to limit survival to less than one year

29. Concomitant illnesses or medications that may pose a significant increased risk forcomplications following an Apreo Procedure

30. Currently enrolled in another trial and actively receiving experimental treatment

31. Any condition in the opinion of the investigator that would interfere with safe andcomplete collection of study data including the safe conduction of bronchoscopyprocedures