"Tricking" The Immune System By Giving Bone Marrow To Heart Transplant Patients

April 23, 1998

PHILADELPHIA -- Once a compatible organ is found and after it is successfully sewn into place and is beating rhythmically, a heart transplant patient still faces one big worry: rejection.

To ward off the acute form of rejection, which appears quickly and can be treated with immunosuppressive drugs, a patient must swallow up to 30 pills a day for the rest of his or her life.

Arteriopathy, or chronic rejection, is more insidious. It is a gradual thickening of the walls of vessels surrounding the transplanted heart, arising from the patient's own immune system reaction to the foreign organ.

Temple University School of Medicine is now in the second year of a four-year, $3 million study to investigate chronic rejection and to determine whether donor bone marrow can coax recipients' immune systems to coexist without rejection of the transplanted hearts. Funding for the study is provided by the National Institute of Allergy and Infectious Disease of the National Institutes of Health (NIH).

The trial will determine whether arteriopathy can be prevented by infusing donor bone marrow shortly after transplantation. Through a process known as microchimerism, white cells from the two immune systems blend in the recipient, inducing tolerance that protects the new organ from attack by the recipient's white blood cells.

Sooner or later, graft arteriopathy becomes a problem for every patient who receives a solid organ transplant. It affects approximately 40 percent of patients by the third year after transplantation and is the major cause of death after the first year.

"It gets everyone eventually," says Dr. Chris D. Platsoucas, chairman of Temple's Department of Microbiology and Immunology and principal investigator of the program project grant from the NIH.

Though studies have been done elsewhere on the effects of donor bone marrow in liver and kidney transplantation, Temple's study is significant because it is the first double-blind, randomized trial of bone marrow infusion in solid organ transplantation.

Any patient who meets the general criteria -- that this is their first heart transplant and they do not require any other organs -- is accepted. Neither the patients nor almost all of the Temple personnel involved in the study know who does or does not receive bone marrow with their hearts.

When the donor heart is harvested, six or seven pieces of the vertebral bone are removed as well. Within four to seven days after surgery, patients receive an intravenous solution of donor bone marrow or placebo; a second infusion is administered six days after the first.

If the Bone Marrow Infusion Trial proves that the failure of transplanted hearts can be prevented, "it will have an absolutely revolutionary effect," says Dr. Howard Eisen, medical director of Temple's Heart Transplantation Program and co-principal investigator of the study.

"If this works, it will become standard therapy for all solid organ transplants. It has a low risk and is easy to do. If we can prevent or reduce transplant arteriopathy it will mean longer survival, and much less immunosuppressive therapy."

It will also mean fewer re-transplantations. About five percent of the heart transplants performed at Temple each year are re-transplantations made necessary by arteriopathy. If those can be avoided, it will be "one of the most significant advances ever in heart transplantation," says Dr. Valluvan Jeevanandam, surgical director of Temple's Heart Transplantation Program and co-principal investigator of the study.
-end-


Temple University Health System

Related Infectious Disease Articles from Brightsurf:

Archaeology uncovers infectious disease spread - 4000 years ago
New bioarchaeology research from a University of Otago PhD candidate has shown how infectious diseases may have spread 4000 years ago, while highlighting the dangers of letting such diseases run rife.

Lack of continuous infectious disease pandemic research endangers responses
The coronavirus was also studied considerably less than blood borne viruses like Hepatitis B or C and H.I.V. and its research community has less prolific researchers than the other investigated diseases.

For patients with sepsis, an infectious disease expert may reduce the risk of death
When people with severe sepsis, an extreme overreaction by the body to a serious infection, come to the emergency room (ER), they require timely, expert care to prevent organ failure and even death.

Infectious disease in marine life linked to decades of ocean warming
New research shows that long-term changes in diseases in ocean species coincides with decades of widespread environmental change.

What makes some people more receptive to the idea of being vaccinated against infectious disease?
Fear, trust, and the likelihood of exposure are three leading factors that influence whether people are willing to be vaccinated against a virulent disease, according to a new study in the journal Heliyon, published by Elsevier.

Can we feed 11 billion people while preventing the spread of infectious disease?
A new article published in Nature Sustainability describes how the increase in population and the need to feed everyone will give rise to human infectious disease, a situation the authors of the paper consider 'two of the most formidable ecological and public health challenges of the 21st century.'

Climate change responsible for severe infectious disease in UK frogs
Climate change has already increased the spread and severity of a fatal disease caused by Ranavirus that infects common frogs (Rana temporaria) in the UK, according to research led by ZSL's Institute of Zoology, UCL and Queen Mary University of London published today in Global Change Biology.

New research framework may help better understand, predict infectious disease risks
University of South Florida-led research identifies individual hosts more or less likely to escalate outbreaks.

Researchers study bacterial immunity to understand infectious disease
Patients with cystic fibrosis are often infected by pseudomonas aeruginosa, a bacterium that infects the lungs and prevents breathing, often causing death.

National Academies target opioid abuse and infectious disease consequences
The National Academies of Sciences, Engineering, and Medicine today released proceedings of a March 12 workshop exploring the rise in infectious diseases accompanying opioid abuse, and possible strategies for reducing both epidemics.

Read More: Infectious Disease News and Infectious Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.