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Teen Takes On Donor's Immune System
Leibel writes "The Australian ABC News is reporting that a 15-year-old Australian liver transplant patient has defied modern medicine by taking on her donor's immune system. Demi-Lee Brennan had a liver transplant. Nine months later, doctors at Sydney's Westmead Children's Hospital were amazed to find the teenager's blood group had changed to the donor's blood type. They were even more surprised when they found the girl's immune system had almost totally been replaced by that of the donor, meaning she no longer had to take anti-rejection drugs. 'Dr. Michael Stormon says his team is now trying to identify how the phenomenon happened and whether it can be replicated. "That's probably easier said than done... I think it's a long shot," he said. "I think it's a unique system of events whereby this happened. "We postulate there's a number of different issues - the type of liver failure that she had, some of the drugs that we use early on to suppress the immune system and also that she suffered an infection with a virus called CMV, or cytomegalovirus, which can also suppress the immune system."'"
kids these days.
must... stay... awake...
Kill her! Who knows what other powers she might have?
Sounds like carbosilicate amorph warfare to me...but then, who'dathunk that the Australians would go in for that schlock?
Actually, if memory serves, NPR had a short bit on a treatment for negating the need for anti-rejection drugs in kidney transplants--they not only transplanted the kidney, but also bone marrow from the donor, and 5 patients out of 6 were able to go off the anti-rejection drugs.
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So if she takes on her donor's immune system, how does that prevent her from rejecting her own body tissues?
Wouldn't her new immune system see the rest of her body apart from the liver as a foreign invader, and attack it?
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...and the two most interesting words in it were "...stem cells..."
If CMV was really the cause of this strange, but fortunate, occurence, that's a tough one.
CMV is no laughing matter. It's one of the opportunistic diseases that immuno-deficit people have to worry about. It can lead to blindness and a slew of other complications.
The best we can hope for (if CMV is to thank for this effect) is that they can isolate the mechanism and replicate it. You wouldn't want to use CMV in this way.
I'd rather have someone respond than be modded up.
The implications for immunology and organ transplants are amazing, but it goes even further than that. If you can induce stem cells to penetrate a patient's bone marrow, then you open the door to all kinds of innovations.
Imagine if they could take a sample of your DNA, correct inherited defects, and then re-implant you with stem cells carrying the corrected sequence. It would mean hope for victims of all kinds of diseases like Tay-Sachs or Kreuzfeld-Jacob.
At the very least, the promise of being able to transfer immunological memory on the marrow level potentially means that all we have to do is find the one person whose immune system wipes out HIV, say, and we can all receive that same immunity.
Do what you can, with what you have, where you are.
As someone who has received a renal Tx and who also has a degree in Anat.,Phys.&Biochem. I have 2 questions.
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New Medical Technique Frees Transplant Patients From Lifetime Anti-Rejection Drugs January 24, 2008 9:32 a.m. EST
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Yes, its called Graft Versus Host Disease (GVDH), and is a common complication of bone marrow transplantation. If it happens, it manifests as skin, liver, and gut problems mostly. Liver obviously isn't going to be a problem for her, and it sounds like from the original NEJM article I just read that she hasn't had any other manifestations of GVHD. If you are going to get bad GVHD its usually early on, so she's out of that woods, but there is always chronic GVHD manifestations that will show with time.
Though given a choice, I'd take the GVHD risk, lose the immunosuppressants, and never worry that my liver graft would fail. All in all she's a hella lucky kid.
This story actually coincides with an interesting story that ran on NPR yesterday about several experimental new transplant techniques that might help future transplant patients avoid having to take anti-rejection drugs, as well.
In particular, the article tells the story of one 28-year-old woman who received a kidney transplant from her mother, who was only a partial match. Prior to the kidney transplant, she also received a partial bone marrow transplant from her mother. The bone marrow transplant essentially caused the patient's immune system to become a "blend" of her own and her mother's, producing T-cells that would attack bacterial and viral antigens just like normal, but leave the transplanted kidney alone.
The results are pretty impressive. The patient originally had to take anti-rejection drugs after her first kidney transplant at age 13, and they caused a host of miserable side effects. After her more recent transplant, however, she's been off the drugs for five years and even ran 2 marathons last year (how's that for healthy?).
Unfortunately, the new technique only works for organs that you intentionally plan on transplanting ahead of time, since the bone marrow has to be transplanted first in a separate surgery. That means that organ donors who die and donate hearts, livers, etc. aren't really an option. But for a transplant from a living donor, this is a very promising new technique (some of the researchers even think that it could eventually make transplants from animals possible).
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Despite the best care, sometimes bad things happen and people die. And sometimes the best care isn't possible, and you do the best you can as the doctors did in this case. The ideal is a perfect blood type and HLA match, however failing to act because you don't have a perfect match would have resulted in this child's death. Perfect in this case is the enemy of good.
Unfortunately this sort of attitude creates no end to trouble and causes both inappropriately aggressive therapeutics and diagnostics in the US as opposed to elsewhere. There is a saying amongst OB/Gyns - you don't get sued for the C-Section that you do, you get sued for the C-Section you don't do. So surprise.... the US has a higher section rate for women. Similarly, in the US your child with belly pain is much more likely to get a CT scan to rule out appendicitis. Doing the CT doesn't get you sued, but failing to do it eventually will (because there is always going to be that very small number of kids with an appy that presented very atypically.) However, if you do 500 Abdominal CTs in kids less than 15, you will ultimately cause one excess cancer death in that group. But you won't get sued when the kid dies of renal cell cancer in his 40's. So kids with a very low risk of appendicitis instead of being observed (maybe even at home with responsible parents) will more often in the US get a trip to the donut and the resulting dose of radiation to their more vulnerable bodies.
While it might seem that holding physicians to unreasonable expectations is beneficial, in the long run you will get worse care due to the practice of defensive medicine.