March for Science ATL: photos

Emory scientists and supporters of science were out in substantial numbers Saturday at the March for Science Atlanta in Candler Park. March organizers, many of whom came from the Emory research community, say they want to continue their advocacy momentum and community-building after the event’s Read more

How race + TBI experience affect views of informed consent

The upcoming HBO movie of The Immortal Life of Henrietta Lacks reminds us that biomedical research has a complex legacy, when it comes to informed consent and people of color. A paper from Emory investigators touches on related issues important for conduct of clinical research Read more

Fecal transplant replants microbial garden

Emory physicians explain how FMT (fecal microbiota transplant) restores microbial balance when someone’s internal garden has been Read more

kidney transplant

Fecal transplant replants microbial garden

When facing a life-threatening infection, the “yuck factor” is a minor concern. Fecal microbiota transplant (FMT for short) has become an accepted treatment for recurrent Clostridium difficile infection, which can cause severe diarrhea and intestinal inflammation.

In a new video, Emory physicians Colleen Kraft and Tanvi Dhere explain how FMT restores microbial balance when someone’s internal garden has been disrupted.

C. difficile or “C diff” is a hardy bacterium that can barge into the intestines after another infection has been treated with antibiotics, when competition for real estate is low. In the last few years, doctors around the world have shown that FMT can resolve recurrent C diff infection better than antibiotics alone.

At Emory, Kraft and Dhere have performed almost 300 FMTs and report a 95 percent success rate when treating recurrent C diff. They have established a standard slate of stool donors, whose health is carefully screened.

Building on their experience with the procedure, Kraft and Dhere are studying whether FMT can head off other antibiotic-resistant infections besides C diff in kidney transplant patients. They have teamed up with infectious disease specialists Aneesh Mehta and Rachel Friedman-Moraco to conduct this study. Read more

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Improving long-term outcomes after kidney transplant

Twenty years of research and you start to improve outcomes for transplant patients.

The Nature paper from Chris Larsen and Tom Pearson on “costimulation blockers” and their ability to head off graft rejection in rodents first appeared in 1996.

Almost 20 years later, a seven-year study of kidney transplant recipients has shown that the drug belatacept, a costimulation blocker based on Larsen and Pearson’s research, has a better record of patient and organ survival than a calcineurin inhibitor, previously the standard of care.

Kidney transplant recipients need to take drugs to prevent their immune systems from rejecting their new organs, but the drugs themselves can cause problems. Long-term use of calcineurin inhibitors, such as tacrolimus, can damage the transplanted kidneys and lead to cardiovascular disease and diabetes.

In the accompanying video, Larsen - now dean of Emory University School of Medicine – and Pearson - executive director of Emory Transplant Center – explain.

Belatacept was approved by the FDA in 2011 and is produced by Bristol Myers Squibb. Results from the BENEFIT study of belatacept, led by Larsen and UCSF transplant specialist Flavio Vincenti, were published in the Jan. 28 issue of the New England Journal of Medicine.

To go with the paper, NEJM has an editorial with some revealing statistics (more than 14,000 of the 101,000 patients listed for kidney transplantation are waiting for a repeat transplant) and a explanatory video. MedPage Today has an interview with Larsen, and HealthDay has a nice discussion of the issues surrounding post-transplant drugs. Read more

Posted on by Quinn Eastman in Immunology Leave a comment

Catching up on Emory transplant advances

While preparing to discuss Ebola virology with Emory infectious disease specialist Aneesh Mehta next week, we noticed two recent research papers on which he is a co-author. Both have to do with organ transplantation, since Mehta is Assistant Director of Transplant Infectious Diseases.

Fecal microbiota transplantation for refractory Clostridium difficile colitis in solid organ transplant recipients

Fecal transplant is gaining ground as a remedy for C. difficile-driven diarrheal infections, which can appear in patients whose normal intestinal bacteria are wiped out by antibiotics. Fecal transplant has not been widely studied in organ transplant recipients, who must take drugs to keep their immune systems from rejecting the transplanted organ, because of concerns about infectious disease complications. This paper describes two patients, one a lung transplant recipient and one a kidney transplant recipient, who received fecal transplants to resolve their C. difficile diarrhea without complications. The lead authors are infectious disease specialists Rachel Friedman-Moraco and Colleen Kraft. Kraft has been a pioneer in this area of research.

Renal transplantation using belatacept without maintenance steroids or calcineurin inhibitors

Medical school dean Chris Larsen and Emory Transplant Center executive director Tom Pearson (both co-authors) were key members on the team that developed belatacept, a FDA-approved drug since 2011. Belatacept was designed to get away from the cruel paradox where a kidney recipient, to prevent transplant rejection, has to take calcineurin inhibitor drugs that slowly poison the kidney and cardiovascular health. Belatacept inhibits the immune response by a different mechanism. Yet transplant specialists have generally been cautious in moving toward a regimen that relies on it.

As reported in this paper, Emory transplant doctors took off the training wheels, aiming to get to the point where kidney transplant recipients are taking a once-a-month infusion of belatacept only. With some patients, it was possible to reach that goal, but not all. In fact, as the authors describe, some patients chose not to try to wean themselves off the other drugs, and doctors advised against the attempt for a handful. This clinical trial was also notable because some transplant recipients received immune-educational cells from their organ donors in the form of bone marrow.

The lead author, former Emory Transplant Center scientific director Allan Kirk, moved to Duke this spring.

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Kidney donation kicks off life-saving chain reaction


In this video, players in this extraordinary transplant exchange tell their story.
You can also watch “The Mother of All Swaps,” a news report from 11 Alive Atlanta

When Jon Pomenville of Anderson, SC, decided to donate a kidney altruistically to someone – anyone in need, anywhere in the country – little did he know his selfless sacrifice would in turn change the lives of not one, but numerous individuals and their families, including one little boy from Atlanta.

And little did he know that the selfless, anonymous act would quickly become not so anonymous. During a recent post-surgical clinic visit to Emory University Hospital, Pomenville met by accident – right in the transplant clinic waiting room – many of the individuals whose lives were changed. Soon the patients – recipients and donors – two father and son combinations and Pomenville, the man who would give to anyone – were hugging, shaking hands, and recounting their backgrounds and experiences.

Pomenville and the others, who were all part of what is called a paired kidney exchange, were unwittingly scheduled for appointments within a short period of one another. As one person began recounting the experience, eyes and ears began to focus on the tale being told from across a crowded room.

People involved in the six-person kidney exchange

A chance meeting in a doctors’ waiting room led to a meeting between most of the people involved in the paired kidney exchange.

The Emory Transplant Center created and opened its innovative Paired Donor Kidney Exchange Program in 2009, providing greater hope for patients in need of kidney transplants. According to Kenneth Newell, MD, director of Emory’s living donor program, a paired exchange donation allows healthy individuals to donate a kidney to either a friend, loved one, or even altruistically to a stranger, despite incompatible blood matches. In paired donation, a donor and recipient are matched with another incompatible donor and recipient and the kidneys are exchanged between the pairs.

The procedure is another form of living donor transplantation. Donated kidneys also come from recently deceased donors. While most kidneys from deceased donors function well, studies have shown that a kidney from a living donor, either a blood relative or an unrelated person, provides the greatest chance for long-term success.

“Paired donor exchanges allow us to cast a much wider net to find compatible donors and recipients,” says Newell. “With a paired kidney transplant, one incompatible donor-pair is able to give a healthy kidney to a compatible recipient. In exchange, the second donor-recipient pair will give a compatible kidney to the first donor-recipient pair, making two compatible living donor transplants possible and increasing the potential number of available donor kidneys. This option can help those patients waiting for kidney transplants who have family members or friends willing to be donors and who are medically suitable, but who have an ABO blood type that is incompatible with the recipient’s blood type.”

Because of Pomenville’s donation, a 7-year-old boy named Zion was able to receive a lifesaving kidney from an unrelated donor because his dad, Mike, was able to donate. His surgery took place at Children’s Healthcare of Atlanta at Egleston.

And Gerald Smith of Five Points, Ala., would receive his life-saving kidney because his son, Matt, a recent University of Alabama graduate, would donate his to Zion. And finally, 20 year-old Edward Hill of Macon, a young man with a history of health challenges, would also receive his transplant at Children’s Healthcare of Atlanta – completing the six-person cycle, although the donor of Edward’s kidney is still unknown.

And Zion and Matt Smith will not only share a common bond and connection throughout life in the form of a kidney, but something even sweeter that that … blue Powerade.

“I’ve always really enjoyed drinking Powerade, particularly the blue flavor,” says Smith. Shortly after Zion awoke from his surgery, he inexplicably began requesting the blue-tinted soft drink too.

Other powerful kidney transplant stories out of Emory:

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Transplant nursing pioneer revisits Emory Transplant Center, 45 years later

Millie Elliott

Nearly 45 years after she cared for Georgia’s first organ transplant recipient, Millie Elliott, 84, visited the Emory Transplant Center outpatient transplant clinic to see how things have changed since her time at Emory. Elliott, who was Millie Burns at the time, worked at Emory University Hospital first as an obstetrics nurse, then as head nurse of an NIH-sponsored clinical research unit at Emory from 1961 to 1967. She served as a dialysis nurse on that unit and may have been the Southeast’s first renal transplant coordinator.

During her recent visit to Emory, this former Cadet Nurse Corps nurse and World War II veteran regaled the transplant center staff and kidney transplant program director Thomas Pearson, MD, PhD, with her stories about the first transplant at Emory. Elliott recalled spending a lot of time researching medical sources to prepare herself and her nurses for that remarkable day. The first transplant patient was a 16-year -old boy with renal failure who received a donor kidney from his father.

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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

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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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Health Care Heroes honored by Atlanta Business Chronicle

Emory faculty-physicians were honored May 20 at the annual Health Care Heroes Awards celebration sponsored by the Atlanta Business Chronicle. All three are featured in this week’s edition of the newspaper.

Sheryl Gabram-Mendola, MD

Sheryl Gabram-Mendola, MD, professor of surgery at Emory School of Medicine and the Winship Cancer Institute, was the Community Outreach winner. Gabram-Mendola is director of the Avon Foundation Comprehensive Breast Center at the Georgia Cancer Center for Excellence at Grady Memorial Hospital.

She was nominated by the Georgia Cancer Coalition and honored for her work in reducing breast cancer mortality by increasing breast cancer awareness and leading the effort to diagnose the disease earlier in a high-risk population of minority women.

Last September the Avon Foundation awarded $750,000 to the Winship Cancer Institute at Emory and the Avon Comprehensive Breast Center. The grant is being used to continue community outreach, education, clinical access, and four research studies that directly affect care for the underserved populations in Atlanta. Since 2000, the Avon Foundation has awarded nearly $11 million to Winship and Grady to support leading-edge breast cancer research projects and improve outcomes for underserved women diagnosed with breast cancer in Atlanta.

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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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