Inclusion Criteria:
1. Eligible participants must meet all of the following inclusion criteria:
2. Adult \>18 yrs old (inclusive).
3. Female participants:
* A female participant is eligible to participate if she is not pregnant or breastfeeding, and one of the following conditions applies:
* Is a woman of nonchildbearing potential (WONCBP) OR
* Is a woman of childbearing potential (WOCBP) and using an acceptable contraceptive method from screening until 30 days after the last dose of study intervention.
* A WOCBP must have a negative highly sensitive pregnancy test (urine or serum as required by local regulations) at Screening and on Day 1, prior to administration of study intervention.
If a urine test cannot be confirmed as negative (e.g., an ambiguous result), a serum pregnancy test is required. In such cases, the participant must be excluded from participation if the serum pregnancy result is positive.
• The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.
Male participants:
• Male participants are eligible to participate if they agree to the following during the study intervention period and for at least 30 days after the last dose of study intervention:
* Refrain from donating fresh unwashed semen.
* Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long-term and persistent basis) and agree to remain abstinent OR must agree to use contraception/barrier (male condom).
4. Has a diagnosis of moderate to severe COPD-C (cigarette smoking COPD) or COPD-P (biomass and pollution exposure COPD) according to the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria \[1, 2\].
Lung impairment will be determined with post-bronchodilator FEV1 spirometry.
5. Has previously received treatment for COPD-C or COPD-P.
6. Has stable COPD disease state, defined as no exacerbations in the 4 weeks prior to screening, no hospitalizations in the 4 weeks prior to screening, and no changes in COPD medication in the 28 days prior to screening.
7. Agrees to comply with study specific procedures and visits, including non-smoking during the treatment and follow-up periods of the study.
8. Willing and able to provide written informed consent.
Exclusion Criteria:
Participants must not meet any of the exclusion criteria.
1. Previous or current diagnosis of COPD-G, COPD-D, COPD-I, COPD-A, or COPD-U; asthma, congestive heart failure, bronchiectasis, tuberculosis, obliterative bronchiolitis, or diffuse panbronchiolitis.
2. Previous or current history of respiratory failure other than due to COPD (e.g., restrictive lung disease, sarcoidosis, tuberculosis, idiopathic pulmonary fibrosis, bronchiectasis, CMV pneumonitis, cystic fibrosis, asbestosis, silicosis, or farmer's lung disease), or detection of any of these conditions through screening CT scanning.
3. History of COVID-associated pneumonia with hypoxemic respiratory failure in the 12 weeks prior to screening.
4. Current use, or use within 21 days of screening, of systemic or inhaled corticosteroids. Participants on inhaled corticosteroids or combined inhaled therapies can be included; however, they must schedule inhaled therapies 12 hours prior to dosing IP and 12 hours post-dosing IP.
5. History of chronic renal insufficiency, defined as an eGFR \< 90 mL/min/1.73 m² \[3\] and/or defined as abnormalities of kidney structure or function, present for \>3 months. Participants without a history of chronic renal insufficiency, who at screening have an eGFR detected between 60-89 mL/min/1.73 m², may be enrolled and receive IP per the investigator's discretion.
6. Uncontrolled hypertension, or current hypertension controlled on more than two medications.
7. History of coronary artery disease, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, severe peripheral arterial disease, cerebrovascular disease (including history of transient ischemic attack or cerebrovascular accident).
8. Type 1 or Type 2 diabetes mellitus with glycosylated hemoglobin (HbA1c \> 7.5%) at screening.
9. History or active malignancy, including any potential neoplasm detected via high-resolution CT scan (nodule \> 5 mm) detected as part of the screening process.
People with a history of basal cell or squamous cell carcinoma of the skin are eligible.
10. History of HIV or other immunosuppressed conditions, Hepatitis B or Hepatitis C, or use of immunosuppressive medications within 14 days prior to screening, and for 3 weeks after the last dose of study intervention is administered.
11. Active infection requiring systemic antibiotic treatment within 12 weeks prior to screening.
12. Body mass index (BMI) \> 60 kg/m2.
13. Active smoking of tobacco, cannabis or vaping in the 28 days prior to screening as indicated by results of cotinine urine testing, performed at screening. Use of nicotine containing products such as nicotine patches, oral nicotine products or nicotine chewing gum is permitted, noting that cotinine results will be positive. Positive results will be documented by the investigator as: "attributed to permitted nicotine products".
14. History of alcohol or other substance abuse, with sobriety less than one year, or that in the opinion of the investigator, will impact participation in the study.
15. Pregnant or breastfeeding.
16. Any severe medication allergy, including an allergy to bovine products.
17. Any other medical condition, psychiatric condition or illness, that according to the Principal Investigator might render the subject unlikely to tolerate the inhalation of SORT-COPD (SMS cells), or to complete the study.
18. Received an experimental therapy (drug or biologic) for any indication within 12 months prior to enrollment.
19. Unable or unwilling to comply with study specific schedules or procedures.
20. Positive test for COVID-19, Influenza A, Influenza B or RSV on day 1.
