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But in the future, those drugs may not be needed. A new study suggests that patients receiving an organ that's less than a perfect match can be protected against rejection by a second transplant — this time of the organ donor's imperfectly matched stem cells.
Though preliminary, the new study is being hailed as a potential game-changer in the field of transplantation, a mystifying development that could offer hope to hundreds of thousands of patients who await or have received donor kidneys and depend on a harsh regimen of daily anti-rejection pills.
The small pilot study, reported Wednesday in the journal Science Translational Medicine, describes a novel regimen that combined old-fashioned cancer treatments with 21st century cell therapy to induce five patients' immune systems to accept donor kidneys as their own despite significant incompatibility.
If the technique proves successful in a larger group of people, future transplant patients may need to take anti-rejection drugs only briefly, and some who rely on them now could discontinue them safely. The recipients of kidneys as well as other organs, including heart, lung, liver and pancreas, might also benefit from access to a wider pool of organs.
The strategy could offer hope, too, for patients receiving bone marrow transplants to treat blood cancers, speeding the process of finding a donor by allowing physicians to use stem cells that today would be rejected as incompatible.
"Few transplant developments in the past half century have been more enticing," wrote pioneer transplant surgeons James F. Markmann and Tatsuo Kawai of Massachusetts General Hospital, in a commentary accompanying the study. If borne out, they wrote, the findings "may potentially have an enormous, paradigm-shifting impact on solid-organ transplantation."
In an interview, Markmann said that the greatest benefit of techniques described in the new research would be to greatly improve the lives of transplant patients by freeing them of a lifetime reliance on anti-rejection drugs.
But it might also ease the shortage of transplantable organs somewhat by reducing the number lost to rejection, he said. According to the National Kidney Foundation, 4,573 U.S. patients died in 2008 awaiting a kidney transplant due to a donor shortage.
Markmann added that the study could have "huge potential to open up the pool" of those who could donate stem cell transplants to patients fighting blood cancers. Currently, he said, many of the 6,000 patients yearly who have a stem cell transplant "have to look far and wide for a perfect match."
The research builds upon a handful of landmark studies that have begun to show how best to trick the human immune system into accepting and defending both a foreign organ and a patient's own tissues after a transplant, a quest that stretches back decades.
In the study, eight patients with kidney failure received kidneys that were less-than-perfect matches. All came from living donors, and in four cases, the donor was related to the recipient.
The extent to which the organs were incompatible varied from minimal to extreme; one patient's kidney matched on five out of six "human leukocyte antigens," or HLAs. The others were compatible on no more than three HLAs.
It's common for transplant recipients to get organs that are an imperfect match. But holding on to such an organ is a challenge that exacts a serious toll.
To prevent the immune system from mounting an all-out attack on tissue it sees as a foreign invader, patients must follow an arduous drug regimen for the rest of their lives. Without the medications, a transplanted kidney that's an incomplete match is likely to be rejected, and the patient faces the prospect of dialysis, a repeat transplant or death.
The anti-rejection drugs — typically 15 to 20 pills a day — make patients vulnerable to infection, diabetes, hypertension and cancers: they are so toxic, they often overwhelm transplanted kidneys. They have typically cost as much as $20,000 a year, and remain expensive despite the recent availability of generic versions.
And after all that, many patients reject their transplanted organs anyway.
In this case, for five of the study's eight participants — two women and three men from 35 to 46 years of age — that's not how it went. Despite receiving the least compatible kidneys among the study participants, these five were able to discontinue their use of immunosuppressants completely after a year.
They showed no signs of rejecting their organs during a follow-up ranging from six to 20 months after being weaned off anti-rejection drugs
Saturday, February 18, 2012
Stem cells can be used to heal scars after heart attacks, bringing regenerative treatments a step closer.
The study found the amount of permanent scarring on the heart was reduced by half compared to conventional treatment and led to the development of new muscle.
However, the treatment produced no significant change in "ejection fraction" - a measure of the heart's pumping capacity.
The Caduceus trial recruited a total of 25 patients with an average age of 53 who had all suffered a heart attack in the previous month.
Seventeen received coronary artery infusions of 12 to 25 million stem cells derived from healthy tissue taken from their own hearts.
The remaining eight underwent standard post-heart attack care.
A year later, the proportion of the heart left scarred in the stem cell-treated patients had been reduced from 24% to 12%. No change was seen in patients who did not receive the treatment.
Professor Eduardo Marban, director of the Cedars-Sinai Heart Institute in Los Angeles, who led the US team, said: "The effects are substantial, and surprisingly larger in humans than they were in animal tests.
"This discovery challenges the conventional wisdom that, once established, scar is permanent and that, once lost, healthy heart muscle cannot be restored."
Future work will need to see if stem cell treatment can bring any long-term improvement in patients who experience heart failure after a heart attack.
This occurs when a weakened heart is not strong enough to pump sufficient blood around the body, causing breathlessness and exhaustion.
Professor Jeremy Pearson, associate medical director at the British Heart Foundation (BHF), said: "It's early days, and this research will certainly need following up, but it could be great news for heart attack patients who face the debilitating symptoms of heart failure."
The BHF's Mending Broken Hearts appeal aims to raise £50 million for research into regenerative heart treatments.
Tuesday, February 14, 2012
A promising stem cell therapy approach could soon provide a way to regenerate heart muscle damaged by heart attacks.
Researchers at Cedars-Sinai Heart Institute and The Johns Hopkins University harvested stem cells from the hearts of 17 heart attack patients and after prepping the cells, infused them back into the patients' hearts. Their study is published in the current issue of The Lancet.
The patients received the stem cell infusions about three months after their heart attacks.
Researchers found that six months after treatment, patients had significantly less scarring of the heart muscle and also showed a considerable increase the amount of healthy heart muscle, compared to eight post-heart attack patients studied who did not receive the stem cell infusions. One year after, scar size was reduced by about 50 percent.
"The damaged tissue of the heart was replaced by what looks like healthy myocardium," said Dr. Peter Johnston, a study co-author and an assistant professor of medicine at The Johns Hopkins University School of Medicine. "It's functioning better than the damaged myocardium in the control subjects, and there's evidence it's starting to contract and generate electrical signals the way healthy heart tissue does."
"In the U.S., six million patients have heart failure, and the vast majority have it because of a prior heart attack," said Johnston.
While this research is an early study designed to demonstrate that this stem cell therapy is safe, cardiologists say it's an approach that could potentially benefit millions of people who have suffered heart attacks. Damage to the heart muscle is permanent and irreparable, and little can be done to compensate for loss of heart function.
The damaged scar tissue that results from a heart attack diminishes heart function, which can ultimately lead to enlargement of the heart.
At best, Johnston said, there are measures doctors can try to reduce or compensate for the damage, but in many cases, heart failure ultimately sets in, often requiring mechanical support or a transplant.
"This type of therapy can save people's lives and reduce the chances of developing heart failure," he said.
Cardiac Regeneration A Promising Field
Other researchers have also had positive early results in experiments with stem cell therapy using different types of cells, including bone marrow cells and a combination of bone marrow and heart cells.
"It's exciting that studies using a number of different cell types are yielding similar results," said Dr. Joshua Hare, professor of cardiology and director of the University of Miami Interdisciplinary Stem Cell Institute.
The next steps, he said, include determining what the optimal cell types are and how much of the cells are needed to regenerate damaged tissue.
"We also need to move to larger clinical trials and measure whether patients are improving clinically and exhibiting a better quality of life after the therapy."
In an accompanying comment, Drs. Chung-Wah Siu amd Hung-Fat Tse of the University of Hong Kong wrote that given the promising results of these studies, health care providers will hopefully recognize the benefits that cardiac regeneration can offer.
And Hare added that someday, this type of regeneration can possibly offer hope to others who suffered other types of organ damage.
"This stategy might work in other organs," he said. "Maybe this can work in the brain, perhaps for people who had strokes."
Amazing advances are being made using stem cells. This is such promising news for those who have suffered a heart attack.........MrCordBlood