Closing Session Highlights 'What's Hot, What's New'
The session, "What's Hot, What's New," will bring ATC 2009 to a summarizing, informative conclusion by presenting the latest updates in transplantation from manipulating the immune system to prevent graft rejection to addressing the causes of ischemia reperfusion injury. The session will be from 12:15 – 1:15 pm Wednesday in the Auditorium of Hynes Convention Center.
For the session, Sandy Feng, MD, PhD, Associate Professor of the Department of Surgery at the University of California, San Francisco, and John Iacomini, PhD, Associate Professor of Medicine at Harvard Medical School, Boston, Mass., will identify the top-scoring abstracts submitted to ATC 2009. Dr. Feng will discuss Clinical Science abstracts, while Dr. Iacomini will cover Basic Science abstracts.
"Developments in immunosuppression are always hot," Dr. Feng said. "There is a tremendous interest in minimizing or even altogether avoiding calcineurin inhibitors in kidney and/or liver transplantation in the interest of improving renal function. Several drugs are being assessed, including belatacept, a selective blocker of T cell activation."
One of the best-scoring basic science abstracts looks at TH17 cells in the process of allograft rejection, Dr. Iacomini said. TH17 cells have been identified in inflammation, particularly in the context of autoimmunity.
"Under certain circumstances, TH17 cells appear to be able to mediate allograft rejection and also appear to be resistant to tolerance induction so they are resistant to regimens normally used to allow for organ survival," he said.
Promising research is underway on the impact of antibodies, both allo- and auto-antibodies, on short and long-term transplant outcomes, particularly in kidney transplant and also in lung, heart and islet transplantation.
"New drugs with novel mechanisms of action are being tested to better control the production of antibodies," Dr. Feng said. "This is exemplified by bortezomib, a proteasome inhibitor, that is quite new to organ transplantation."
Ischemia reperfusion injury is another hot topic, Dr. Iacomini said.
"There are abstracts identifying the injury and evolving around what actually drives ischemia profusion injury. Is it an immunological issue or not? Are there ways to prevent it using some ways of identifying molecules that can play a role in modulating their expression to try to overcome that?" he asked.
Exciting abstracts have also been presented in islet transplantation to treat Type I diabetes.
"One of the best-scoring abstracts is from a group that has manipulated embryonic stem cells," Dr. Iacomini said. "Their abstract shows that these cells can be induced to become insulin producers and upon transplantation into a host seem to be able to regulate blood glucose levels."
Organ allocation policy is a hot topic of discussion at ATC 2009, Dr. Feng said.
"One abstract reports that broader geographic sharing of hearts has decreased waitlist mortality for the candidates listed as Status 1A and 1B, the sickest, without an increase in one year post-transplant mortality," she said. "In the liver arena, there are abstracts examining the most equitable way to order people. A larger discussion occupying the liver transplant community as to whether allocation should remain based on disease severity or whether it should shift to be based on the benefit of transplantation, as it is with lung allocation."
Both Drs. Feng and Iacomini praised the top abstracts submitted to ATC 2009. "They should get clinicians and researchers interested in at least considering these new pathways to prevent rejection," Dr. Iacomini said. "Within the next year or so, we'll see follow-ups to these studies and more clinically relevant models."