Stage fright: don't get over it, get used to it

Many can feel empathy with the situation Banerjee describes: facing “a room full of scientists, who for whatever reason, did not look very happy that Read more

Beyond birthmarks and beta blockers, to cancer prevention

Ahead of this week’s Morningside Center conference on repurposing drugs, we wanted to highlight a recent paper in NPJ Precision Oncology by dermatologist Jack Arbiser. It may represent a new chapter in the story of the beta-blocker propranolol. Several years ago, doctors in France accidentally discovered that propranolol is effective against hemangiomas: bright red birthmarks made of extra blood vessels, which appear in infancy. Hemangiomas often don’t need treatment and regress naturally, but some can lead Read more

Drying up the HIV reservoir

Wnt is one of those funky developmental signaling pathways that gets re-used over and over again, whether it’s in the early embryo, the brain or the Read more

Emory Transplant Center

Challenges in islet transplantation

Two recent research papers from the Emory Transplant Center describe research on pancreatic islet transplantation, an experimental procedure that could help people with type I diabetes live without daily insulin injections.

Islet transplantation may offer people with type I diabetes the ability to produce their own insulin again

As with other types of transplantation, the challenge with islet transplantation is to avoid rejection of the donated organ and to balance that goal against side effects from the drugs needed to control the immune system. These papers illustrate how that balancing act is especially complex.

In the last decade, transplant specialists developed a method for islet transplantation named the “Edmonton protocol” after pioneers at the University of Alberta. While the emergence of this method was a major step forward, there are limitations:

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Posted on by Quinn Eastman in Uncategorized 3 Comments

Regulatory B cells: old dogs reveal their new tricks

B cells are workhorses of the immune system. Their main function is to produce antibodies against bacteria or viruses when they encounter something that they recognize. But recently researchers have been getting hints that certain kinds of B cells can also have a calming effect on the immune system. This property could come in handy with hard-to-treat conditions such as graft-vs-host disease, multiple sclerosis, or Crohn’s disease.

Hematologist Jacques Galipeau has found that B cells treated with an artificial hybrid molecule called GIFT15 turn into “peacemakers”. These specially treated B cells can tamp down the immune system in an experimental animal model of multiple sclerosis, suggesting that they could accomplish a similar task with the human disease.

Galipeau’s paper in Nature Medicine from August 2009 says succinctly: “We propose that autologous GIFT15 B regulatory cells may serve as a new treatment for autoimmune ailments.” Galipeau, a recent arrival to Emory from McGill University in Montreal, explains this tactic and other aspects of personalized cell therapy in the video above. Read more

Posted on by Quinn Eastman in Immunology Leave a comment

Creative program expands kidney transplant options

The Emory Transplant Center at Emory University Hospital recently opened its innovative Paired Donor Kidney Exchange Program, providing greater hope for patients in need of kidney transplants.

A multi-patient organ swap, known as a paired donor exchange, can now save the lives of numerous people while matching each patient with the very best kidney for his or her blood profile.

Nearly 85,000 Americans are on a waiting list for a donated kidney – nearly 3,000 in Georgia alone. The opportunity to quickly identify and match more organ donors and recipients is critical to saving more lives.

This month, Emory’s transplant team performed this type of exchange involving a total of six patients – three donors and three recipients – from Texas, Colorado and Georgia.

In April, Howard Irving Scott, III, received a new kidney at Emory University Hospital. The kidney came to him as part of a six-person paired kidney transplant “chain,” in which three recipients and three donors were cross-matched. One of the participants was a friend of his, Casey Campbell. Although Scott did not receive Campbell’s kidney, her participation in the program made the “chain” transplant possible, saving Scott the possibility of waiting five years on a kidney.

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Posted on by Lance Skelly in Uncategorized Leave a comment

Pig stem cells: hope for Type 1 diabetes treatment

University of Georgia researchers recently reported on their work to create pigs with induced pluripotent stem cells. This type of cell, first developed about five years ago, has the ability to turn into any other kind of cell in the body.

An Emory transplant team, working with the UGA group, hopes to use this technology to develop pig islet cells as an alternative to human islets to treat patients with Type 1 diabetes. Type 1 diabetes usually occurs early in life and affects more than one million Americans who are unable to manufacture their own insulin because their pancreatic islets do not function.

Emory islet transplant team

The Emory Transplant Center has conducted clinical trials since 2003 transplanting human pancreatic islet cells into patients with Type I diabetes. Some of these patients have been able to give up insulin injections, either temporarily or permanently. Other sources of islets are needed for transplant though because of the large number of potential patients and because each transplant typically requires islets from several pancreases.

To create pigs using pluripotent stem cells, the UGA team injected new genes into pig bone marrow cells to reprogram the cells into functioning like embryonic stem cells. The resulting pluripotent cells were inserted into blastocysts (developing embryos), and the embryos were implanted into surrogate mothers. The resulting pigs had cells from the stem cell lines as well as the embryo donor in multiple tissue types.

The pluripotent stem cell process could allow researchers to make genetic changes to dampen or potentially eliminate the rejection of the pig islets by the human immune system.

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Posted on by Holly Korschun in Uncategorized Leave a comment

Non-invasive tests for organ transplant rejection

Even with better immune suppressing drugs being developed for organ transplants, patients still require regular monitoring to prevent graft rejection. Kidney transplant recipients sometimes can be at risk even when standard blood tests for rejection appear stable.

To improve accuracy and avoid the need for frequent biopsies, several teams of transplant specialists are developing new urine tests for diagnosing acute organ rejection. These tests are non-invasive, could be administered often, and could identify immune events in real time.

At the American Transplant Congress this week in San Diego, Jennifer Jackson, MD, a nephrology fellow on the Emory kidney transplant team, presented research on a new urine-based test for the protein osteoprotegerin (OPG) and the chemokines CSCL9 and CXCL10.

Researchers found levels for all three markers elevated in patients experiencing acute rejection, but also in some patients whose grafts were supposedly “stable.” This smoldering inflammation could be responsible for chronic graft deterioration that goes undetected.

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Tailoring transplant drugs for children

For adult organ transplant recipients, juggling a lifetime regimen of immunosuppressant drugs is difficult enough, but for children it presents an even greater challenge.  These drugs, which also can have toxic side effects, must strike a delicate balance between preventing organ rejection and protecting from infections.

But children’s immune systems are still “learning” what distinguishes them from the world around them, and children are constantly developing and changing, both physically and emotionally. This puts them at greater risk for complications either through inappropriate medication or failure to take these drugs properly.

A grant from the National Institute of Allergy and Infectious Diseases (NIAID), through the American Recovery and Reinvestment Act (ARRA), will support new studies at Emory University and Children’s Healthcare of Atlanta to help clinicians tailor therapies specifically for children receiving transplants.  The project will include hiring of additional personnel to undertake these studies.

Allan D. Kirk, MD, PhD, is principal investigator of the project, which is supported by a two-year grant of nearly $1.65 million. Kirk is professor of surgery and pediatrics in Emory University School of Medicine and a Georgia Research Alliance Eminent Scholar. He also is vice chair of research in the Department of Surgery and scientific director of the Emory Transplant Center.

The ARRA-funded project will not only help determine which medications children should take, but also will give them the support to care for their transplanted organs.  The Emory scientists are studying new biological monitoring technologies that can identify unique ways to determine exactly how much medication a child really needs. These studies are being combined with a novel transition care clinic specializing in helping children cope with their illness and assuming responsibility for their care.

“This award indicates exceptional insight by the NIAID into the critical link between a child’s physical well-being and their emotional maturity,” says Kirk. “It will accelerate progress in this vital area of research for a very deserving subset of chronically ill children.”

Posted on by Holly Korschun in Uncategorized 1 Comment

New tool in the fight for scarce donor organs

With so many men, women and children desperately awaiting a life-saving donor liver through traditional means – those donated by a deceased individual – transplant surgeons at Emory University Hospital looked for ways to improve the odds. transplantcenterlogo

Recently, Emory doctors were the first in Georgia to perform a rare “domino” liver transplant procedure – in effect saving two lives with one donor organ. The doctors had a opportunity to discuss the procedure at a media briefing held a few days ago.

The United Network for Organ Sharing (UNOS) says there are currently more than 16,000 Americans currently awaiting a liver transplant.

Domino liver transplant procedures are aptly named for the sequential, one-after-the-other nature of the process in which a viable liver from a deceased donor is transplanted into the first recipient, and the first recipient’s organ is then transplanted into a second recipient. The procedure is still extremely unusual, with fewer than 100 done in the United States since the first in 1996.

According to Stuart Knechtle, MD, professor of surgery in the Emory School of Medicine and director of the Emory liver transplant program, domino transplants are a rare but effective way of overcoming the national shortage of organs available for transplant. In most cases of domino liver transplants, one of the donated livers is transplanted from a patient with another type of disorder that does not affect the organ recipient.

“This successful domino liver transplant is something that simply does not start or end in a hospital operating room,” says Knechtle.

Liver recipient Bob Massie discusses his “miracle.”

Liver recipient Jean Handler discusses being “thankful and shocked.”

“This procedure, which saved two lives,” says Knechtle, “and will impact both families for many years to come, is the end result of a long chain of special events, starting with the decision by one person to donate the gift of life upon his untimely demise, which in turn allowed the recipient of that person’s organ to then donate hers to another patient.”

You can view the full briefing at this web site.

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