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New Discovery May End Transplant Rejection
mmmscience writes with this excerpt from the Examiner:
"Big news in the medical world: scientists in Australia have found a way to stop the body from attacking organ transplants, greatly decreasing the possibility of organ rejection. ... When a new tissue is introduced, one's immune system kicks into overdrive, sending out cells known as killer T cells to attack and destroy the unknown tissue. ... Professor Jonathan Sprent and Dr. Kylie Webster from Sydney's Garvan Institute of Medical Research focused on a different type of T cells — known as regulatory T cells (Treg) — in this study. Tregs are capable of quieting the immune system, stopping the killer T cells from seeking out and attacking foreign objects."
Okay, what does that do for fighting off infection then?
It's not like there's a magical component to this that identifies the transplanted material as "good" and infectious agents as "bad".
Chas - The one, the only.
THANK GOD!!!
This will make organlegging possible. If you can just grab any kidney off the street and use it to replace a failing one, people will.
All ideas^H^H^H^H^Hprocesses in this post are Patent Pending. (as well as the process of patenting all postings)
As someone about to donate a kidney this summer, I really hope they work on this research more. Donor matching is incredibly difficult, and the risk of rejection poses issues not only with the health of the recipient (though that's obviously the major issue), but also with the psychological health of the donor. A failed donation can make you feel like crap.
In the end, yes.
simon
Temporary.
Now i can just keep smoking knowing my new lungs will fit in no problem! /s
Well, you can, but that would be like having a Core2Duo for just reading emails...
simon
But it only is needed for 2-3 weeks, according to the article. Just long enough for the body to accept the new cells, after that they let things go back to normal, which would allow the body to attach infectious agents.
by providing some sort of prevention, could this research help with autoimmune diseases like type 1 diabeties?
The idea (as I understand it) is this:
1) Immunosuppressants not only lower your defenses but are also toxic (as with many drugs).
2) I assume the treatment is either non-toxic, or at least not as bad for you.
3) Not sure about this: I think that people need to take immunosuppressants for a LONG time after the transplant, thus pumping in toxins AND keeping the defenses low, where as this idea is a one time thing you do before the transplant and are then done with.
The wording also makes it sound like the rejection rate is lower than usual, I am unsure if this is true or not.
So yes, you still have the lowered defenses, but with out the toxins, and possibly for a shorter time.
Do Or Do Not, There Is No Spoon, There Is Only Zuul. Everything in the above post is probably opinion.
TFA and TF summary are missing the "if"s.
Yes this could be a big deal, someday, if the finding holds up for other mammals (a big one), if it works for different kinds of transplants, if it's repeatable, if there are no other major consequences, if human trials are successful, if if if.
Failure to include the "if"s is misleading at best and irresponsible at worst, for giving possibly false hope to those dealing with transplant rejection.
If only there was a linked article that addressed these questions!
Absolute power corrupts absolutely. indymedia
My father died of aggressive cancer a year after a kidney transplant. If they found a way to stop immune suppression after a short period, that would be wonderful.
Except for ending slavery, the Nazis, communism, & securing American independence, war has never solved anything.
I assume you were goign to say "we might know how to reverse it".
The answer is fairly simple:
We are giving (and have been for a long time) people something like AIDS, not AIDS itself as that is a condition directly linked to HIV (even though the name makes it sound like it would be any time when you acquire a immune deficiency). It isn't AIDS we need a treatment for, it is HIV.
Do Or Do Not, There Is No Spoon, There Is Only Zuul. Everything in the above post is probably opinion.
The T cells go into over drive when a new organ is transplanted. The moderating T cells stop that overdrive, keeping things "Normal".
Is it sad that I am more likely to recognize you and your posts by your sig than your name or UID?
Sounds interesting: "The numbers of T regulatory cells dropped over time, and the immune systems returned to normal in about two weeks. By that time 80% of the mice had accepted the grafts of insulin producing cells as their own."
One thing this does show, though, is that this could easily cure type one diabetics. So even if it only works in this scenario they have discovered something. I am hoping it gets somewhere since I would love to no longer have insulin dependent diabetes.
I'm glad that joke didn't swing the other way.
I have been having problems with my hyperalloy combat chassis rejecting the external skin tissue overlays. I am making kill^H^H^H^H pet robots and this is just the trick I needed,
I wonder if this could help in regards to allergies? I.e. stop the immune system from "reacting" too much?
Looks like someone is getting a free trip to Sweden in the future...
There is more to science than physics!
www.iomalfunction.blogspot.com
Basically life is a terminal condition, resulting in death in every verifyable recorded sample.
I guess it's a matter of magnitude. I.e. whether you die now or then.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
Further, from what I'm gathering they're talking about adding cells. Adding cells is far different from an active virus. A virus will continue to inject its genetic material into every cell it can so long as it exists. In the case of HIV, that's pretty much indefinite. Cells on the other hand will have an active period, and eventually perish. So I'm guessing after being given a dose there will be a halflife and the effects will taper off accordingly. It is like a mini-infection of HIV though, very interesting work. Maybe we'll luck out and get some insight into how situations that are analogous to an HIV infection behave to gain some better insight into the real thing?
Being able to put something into a system does not mean you're able to take it out of the system again. A good example would probably be rabbits in Australia.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
Can't we do both? You know, eggs and baskets and all that.
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And in those 2-3 weeks they keep the person in a steril room devoid of any potential bacteria/virus' that could harm the person.
Hopefully they will be able to run positive clinical trials in the future. So far this is only effective on mice on relatively simple procedures (skin grafts, and pancreatic transfers). Kidneys, hearts, lungs are huge deals. I'm assuming if this hurdle is passed the doner would only need to have a blood-type match? That would be awesome and would make the waiting list that much simpler.
I do not support "The Man". I also do not support your irrational stupidity
Yeah... or buying a SUV to get your groceries. Oh, wait...
My 0.02 cents
More realistically*, you could have an intermediate state---we won't take you apart, but we won't give you any transplants, either---better add 'or let you vote' for first-order stability.
(Both systems actually suffer from the fact that people killed in this way may have friends and families...although people who die for lack of a transplant have them two, but one is much more direct and complaint-genic than the other.)
* ...which is not the same as 'realistically'
Is that, if it wasn't for the big pile of explosives money they put on the table, nobody would give a shit.
This is my sig.
"3) Not sure about this: I think that people need to take immunosuppressants for a LONG time after the transplant"
AFAIK ('tho there're bound to be exceptions maybe?) - you take them for as long as you don't want your immune system to attack the new organ, which'll basically be, for the rest of your life.
The revolution will not be televised... but it will have a page on Wikipedia
Is caused by the immune system not recognizing a foreign invader, the organ being transplanted.
No?
Then this guy wants to turn off that ability in the body?
Yes?
Historically speaking, whenever doctors have taken that approach it results in massive infection, and usually heart and lung problems.
You would think after so many complications from transplants, they would stop pursuing that direction.
Adult stem cell research seems to be the best approach to me. Same tissue so no rejection, and they do not have all of the problems fetal cells have. (i.e. Fetal stem cells have a nasty habit of becoming tumors.)
Somehow, Adult stem cells "know" what to do and when to stop growing appropriately much better than fetal stem cells when considering tissue regeneration in heart attack patients for example.
Not that doctors understand any of this process, but why they continue to invest so much money in transplant research is baffling. The quality of life for people financially and medically sucks for current transplant recipients.
-Hack
Got Geometrodynamics? Awe, too hard to figure out? Too bad.
Could they not kick the immune system into overdrive a day before the actual transplant and when the immune system is not looking once it's tired out they could stick a new heart in there.
Full Disclosure: I am a funded option 2 member of the Cryonics Institute.
Do politicians?
We should ignore a solution that can be brought about in the relative near term because a different solution, if it is ever proven to work, might eventually turn out to be better?
Tell that to the families of those who die in the mean time while we're figuring out whether a "grow-your-own" approach is even workable.
Wow, this seems like it would be a good way for some miscreant to start passing around some diseases that we would normally fight off, and start some epidemics, by nullifying our body's means of defense. It's like reverse War of the Worlds. I guess it'd be one way to allow for symbiotic partnerships with parasites too... mmm...
For starters "killer T-cells" are usually referred to as NK-cells and they are NOT thought to be part of the normal rejection process (they do not require activation and thus would no be stopped by immunosuppresion). There are three types of rejection hyperacute (pre-formed antibodies attack the organ in minutes - the organ literally dies as soon as it is transplanted - this is avoided by the "matching" process), acute (where T-cells [not NK-cells] attack the organ since it is not "self" and therefore "bad" - this is where immunosuppresion helps) and chronic (the body slowly rejects by allowing fibrosis of the vessels leading to the organ).
Actual survival statics for all kidney allografts exceeds 95% today. 80% is quite a drop!
Grafts are not assumed to "take" after 100 days allowing us to stop immunosuppresion! Immunosuppression is currently LIFELONG. There are a few instances where people have tolerated a non-identical twin transplant without medications, but this is _very_ rare. There is active research into finding the key to allow "tolerance" whereby we can drop the medications, but this is still early.
IL-2 suppression is the _mainstay_ of current immunosuppressants both blocking its production via calcineurin ihibitors (cyclosporin and tacrolimus), inhibiting the response (sirolimus/rapamune), or by blocking the receptor with antibodies (basiliximab/daclizumab). (Please understand this is only about half of the therapies that are in use for immunosuppresion, I'm just focusing on the Il-2 aspect).
Just followed the second link and it is _much better_. Still, I strongly disagree with their assertions of 100 days, just doesn't happen in humans. Apparently this study is using IL-2 STIMULATION with a complex that attempts to increase the regulatory T-cells...To me this means that this treatment will not co-exist with the current immunopupression dogma... this means that they will have to have a "complete" replacement for immunosuppresion they won't be able to add this to the current regiment and that means this treatment protocol will be quite sometime in the pipeline. And (fortunately) the authors acknowledge that they are optimistic, but aren't rushing off to collect their Nobel yet:
I am also aware that effective approaches in mice do not necessarily give good results in humans because of subtle differences in the immune systems of mouse and man.
Sounds like a biological warfare weapon designer's wet dream.
Yeah, people always think hearts, kidneys and livers when you start talking about transplants, but insulin producing cells would be HUGE. Type 1 is the most common childhood chronic illness, and types 1&2 is affect nearly 3% of the population.
in which the body attacks itself? I'm thinking rheumatoid arthritis, lupus -- any chances those who suffer from these types of maladies should take hope at this news?
I am not left-handed, either!
we can stop having unkempt slobs in dark alleys offering us x-ray eyes when in reality they are the two better z-ray eyes. No more will we be be indecisive about replacing our lungs with gills so we can more easily breathe underwater.
All we need do is lie on the table and let the nice nurse with big hands hold us down while we feel a small pain.
We will bankrupt ourselves in the vain search for absolute security. -- Dwight D. Eisenhower
1.) Correct.
:D
2.) Also correct.
Immunosuppressant drugs, besides increasing the risk of infection and cancer, also screw with the kidneys, liver, and pancreas. So besides the fun 1-2 punch of increased risk of infection post-surgery and having a weaker immune system to fight it with, you can also have a delightful bouquet of metabolic issues to go with it. This treatment seems to take the "traffic control" route, instead of mass-nuking the entire T-cell population.
3.) If the rejection is hyperacute (immediate) or acute (several days to weeks after transplant), it's treatable. Chronic rejection, though, is irreversible and requires a lifetime of immunosuppressants. Exception: if bone marrow can also be transplanted, this effectively replaces the recipient's immune system with the donor's, so there is no rejection.
Overall, this looks pretty damn promising. If they could also figure out what happened with Demi-Lee Brennan, we'd be well on our way to Bioshock-style instant upgrades
Except those rabbits would have a pre-programmed internal self-destruct timer. Other than that, great analogy. Hint: apoptosis.
No, not even close--well over 5% of all people who have ever lived have never died. There's no sound basis on which to claim that life is terminal.
3) Not sure about this: I think that people need to take immunosuppressants for a LONG time after the transplant, thus pumping in toxins AND keeping the defenses low, where as this idea is a one time thing you do before the transplant and are then done with.
My father had a lung transplant about 5 years ago. You have to take the immunosuppressants forever with any inner body transplant (like heart, kidney, lung, etc). The immunosuppressants are quite good, but their side effects are significant and effect the life of a person. My father had to take significant amounts of pills daily at very specific times for everything to work properly. The pills also place quite a strain on the kidneys.
Bizarrely enough, that's what eventually killed him. The doctors (who, BTW, were outstanding) switched him to an immunosuppressant that was less stressful on his kidneys. The new drug had one very rare side effect that would eventually cause death. Dumb father didn't tell them he was having problems with new drug until it was too late and his body rejected the lung killing him. But Dad got 5 extra years that we wouldn't have had otherwise.
And the article is wrong about one point. The biggest problem for transplant recipients is not the drugs themselves. I.E. the effects on the body. That's bad. What's worse is the cost of the drugs and all the associated aftercare. The costs of the drugs are so great that unless one has a quite good insurance policy or a small fortune, your going to lose just about one's entire worth to pay for drugs. To me that's the second great advantage to this finding.
BTW, if anyone out there is looking for an outstanding lung transplant program, the program at Cedar Sinai Medical Center in Los Angeles is fantastic. The doctors are great, the support staff is first rate, and the care they give you is outstanding.
Maybe I am misreading part of this article, but it says that "80% of the mice had accepted the grafts of insulin producing cells as their own". As a type 1 diabetic, I am looking at this as a possible cure for diabetes. I understand there are uses for this in organ transplants as well, but as a possible cure for diabetes this is huge.
IANAMD, but I'm fairly sure the immunosuppressants are needed for the rest of the recipient's life.
upon the advice of my lawyer, i have no sig at this time
And in those 2-3 weeks they keep the person in a steril room devoid of any potential bacteria/virus' that could harm the person.
Depending on the transplant, you're probably not going to want to do anything other than lie in a bed during that time anyway.
I still like, don't get it..
Yes, but a complete isolation environment is MUCH more expensive than a normal ICU which is MUCH more expensive than a recovery room which is MUCH more expensive than outpatient followup visits. Basically the cost for two weeks in isolation is probably in the mid 6 figure range vs high 5 to low 6 figures for the procedures.
There are 4 boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order. Starting now.
Mentioned in the original article, a problematic, potentially fatal time-lag for transplants involving any but living donors:
"We took normal, healthy mice, injected them for three consecutive days with the complex, then transplanted insulin-producing cells on the fourth day..."
Vital organs like hearts are 'harvested' from the dying, often people who are terminally brain-injured in motor vehicle accidents. Medical policies and procedures involving keeping such traumatically injured people 'alive' on 'life support' for four days hold complex layers of ethical issues for doctors and excruciatingly painful emotional issues for families of those donors fatally injured.
That isn't a 'nay' to improving pancreatic islet transplantation (which, in my understanding, does not generally kill the donor), but rather an urgent 'caution' and plea to biomedical researchers: proceed honestly, transparently, and with as much public awareness as humanly possible of unintended consequences.
Seems to me that, in general, re-envisioning our lifestyles, diets, and relationships with our planet, seeking healthier ways of being, is a far more viable long-term cure for many degenerative diseases, than heroic and often inaccessibly expensive treatments.
3) Not just a LONG time -- for as long as you have the transplant.
I got a kidney transplant in 1995, and I will be on anti-rejection drugs until either 1) I die, 2) something better comes along that doesn't require anti-rejection meds anymore (<crosses fingers>), 3) or I reject the kidney and it is removed.
MCSE? No, sir...I don't do Windows. Yes, I am an idealist. What's your point?
Fetal stem cells have a nasty habit of becoming tumors.
I'm on my second kid and already I'm losing my hair and feel tired all the time. Unfortunately every time I ask my wife for some adult stem cell action, she turns me down.
That's not true, immunotherapies have historically not required permanent treatment. This isn't that much different from allergy shots or immunizations.
Eventually the body adapts to having the pathogens there and realizes they aren't harmful. The big concern with rejection is that the body will kill off the cells before that happens.
It depends upon the technique, but for many of the therapies it only takes 3-5 years, which even at double that is greatly superior to how we handle it now.
This reminds me of several Niven books. He did a pretty good job of exploring were society would go if we developed this tech. Basically you'd have the criminal element murdering folks to extend others lives. That's actually not the bad part. We've got existing laws dealing with kidnapping and murder.
What's the really bad news? Having about a hundred years or so of just about every crime having the death penalty so those that need/want organs can get them from criminals. Worse case, you get caught by those speeding or red light cameras and then you've got to report to become parts for some richer/more law abiding citizen.
Those that complain that the death penalty is immoral would be singing a different tune if they could double or triple their own lifespan by using spare parts obtained from criminals. That's basically what would drive having the death penalty for every little crime under the sun. The demand for parts will mean that something like that would happen. Imagine all those in prison now for various drug or sex offenses were all used for spare parts. I could easily see that slipped in.
I'm not really afraid of the evil bad guys kidnapping me and killing me. I'm afraid of the government being forced to make most laws have the death penalty by their own citizens and there being little to nothing that you can do to get out of being declared some else's spare parts.
This is better news than they even let on. A means to control rejection is the same as a means to control autoimmune disorders. Recent evidence supporting this is at http://www.ncbi.nlm.nih.gov/pubmed/19199937 There's a partial list of such disorders at http://en.wikipedia.org/wiki/Autoimmune_disease
Knowing the mechanism for increasing Treg leads to understanding the mechanism for controlling, thus including suppressing Treg. That would boost the body's immune response. It could control (though not cure) AIDS, and lead to treatments of such as hepatitis B or C without requiring the very side effect laden pegylated alfa interferon 2 + ribavirin treatment. Inducing autoimmnune disease has already been suggested as a cancer treatment http://www.pnas.org/content/96/10/5340.full
As explained in http://en.wikipedia.org/wiki/Immune_system an immune system is a very complex system with many components that interact. The more of these we can manipulate the closer we get to the kind of treatments suggested above.
"I may be synthetic, but I'm not stupid." -- Bishop 341-B
Exception: if bone marrow can also be transplanted, this effectively replaces the recipient's immune system with the donor's, so there is no rejection.
But wouldn't this cause the oppposite problem? In this case, isn't there the possibility of the 'new' immune system attacking the rest of the recipients body, rather than the recipients immune system attacking the donated tissue? Or am I missing something?
I really hope this doesn't work out too soon. Shocked? Let me explain: if the prevention of transplant rejection becomes possible before organ regeneration from stem cells becomes possible then every individual becomes a potential organ donor. Think war zones and third-world children with poor families.
Potential for abuse is a really stupid reason to hope that millions of people won't get the cure they need. This is still an intense procedure, requiring you to be immunosupressed for 2-3 weeks, you're not going to fly to a shady back alley Thai doctor to do this from the black market, since you would die of an infection.
Yes, but a complete isolation environment is MUCH more expensive than a normal ICU which is MUCH more expensive than a recovery room which is MUCH more expensive than outpatient followup visits.
... but is still preferable in some cases than not getting a transplant and dying. More expensive, yes...
How MUCH more expensive than years of taking immunosupressants? A year of immunosupressants can cost as much as $25,000 (source[pdf]) and immunosupressants need to be taken for at least 3 years (sometimes a lifetime).
The problem is that developing organ replacement is going to be a long, long road. We're not going to have hearts, livers, kidneys, lungs, pancreases, eyeballs, skin, etc. all at once. Until then, immunosuppressant will still be pretty vital. And even then, immunosuppressants are useful for a lot of things outside the whole tissue transplant area. The better we are able to manually control our immune systems, the more options that gives us in medicine.
I'm sure glad they didn't follow his advice ten years ago. If this new method works, it will help people far more than ten years of only spending money on organ replacement probably would have.
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But you have to balance that against a lifetime of outrageously expensive immunosuppressant drugs and additional medical care due to the toxic side effects. On top of that, the primary effect will make the patient more vulnerable to getting sick and each such illness will require aggressive medical care while a person not on immunosuppressants just needs to sit at home for a day or two.
All of that added up with a reduced life expectancy on top will way exceed the six figure cost of spending 2 weeks in isolation.
So if you were going to die without a transplant, and were told that a donor had been lined up - your first response would be "How much is this going to cost? Is there a way we can do it cheaper? My life is only worth X amount of money to me."
I am pretty sure in life-threatening situations, the patients main concern is hardly the costs involved.
"But this one goes to 11!"
Well, IANAD, but as far as I understand it, not only does the new bone marrow generate T-cells (among other blood cells), its "offspring" take up residence in organs, so basically it's a complete reboot of the immune system, including bloodstream and organ tissues. As a matter of fact, it's such a "clean slate" that recipients lose their acquired immunity, and all the vaccinations (polio, measles, etc.) have to be done again.
It has more to do with how many people will be ABLE to get a transplant, a large reason so many people don't have health insurance in the US is because it's freaking expensive. In countries with socialized healthcare it's likely that such costly measures will be rejected or have such significant wait times that attrition will reduce costs. The fact is building, maintaining, and staffing such facilities is exceedingly expensive and so it might not turn out to be the most cost effective (efficient) solution. Actuaries put a cost on human life every day and wishing for universal state of the art health coverage isn't going to make it happen.
There are 4 boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order. Starting now.
As somebody who had a kidney transplant a little more than 12 years ago, I can to pretty much everything that you've said. The point of the cost of the drugs is definitely one of the larger factors - my main two immunosuppressant drugs cost me $80 for a month's supply. That doesn't include other medications that offset what the immunosuppressants are doing.
"Our opponent is an alien starship packed with atomic bombs. We have a protractor."
Could this be used to teach one's body to stop with the allergies already?
Delivery, how are you going to introduce suppressor T cells through a weaponized agent? There are plenty of things more dangerous than your typical bio-agent, they just can't be easily weaponized.
There are 4 boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order. Starting now.
Which is why socialized medicine is great for minor and/or common problems, but not so good with rare/expensive problems. It is also why the rich from countries with socialized health care usually end up coming to the USA for expensive specialized treatments. It also does happen on a smaller scale in the USA for those that belong to HMOs. It is hard to run the medical industry like a typical business - turning a profit isn't always the most desirable outcome, let alone a possible one.
"But this one goes to 11!"
Basically life is a terminal condition, resulting in death in every verifyable recorded sample.
Not mine. :)
you do realize that most peopel die still waiting for a suitable transplant don't you?
my father is on the transplant list for a heart and has been in the second highest risk category for about a year now.
he's been called in twice.
there is more to it than just matching some blood types.
and for certain other types of transplant, like the bone marrow transplant a friends 13 year old son is going through, they already have to put them into basically a clean room environment now. because they have to KILL OFF the immune system before they give them the transplant just to have a small hope of success.
if they could instead use something like this for 2-3 weeks, and use the same sterile environment procedures they already are, but for a lot less time (his was about 9 weeks all told before and after the transplant, and he had to have two so far), then they would actually SAVE money *gasp* by using a procedure like this.
oh my god, again, a slashtard with no knowledge making guesses and suppositions.... who would have guessed it......
I thought they were going to announce that they discovered Rafia anime reference
Exactly! That's not done currently only because the required anti-rejection treatment is worse than the insulin injections (and certainly much worse than dietary restriction). If that is no longer true, it opens the door to treat a lot more conditions.
I would dearly love to know if this technique would be suitable for helping people with autoimmune diseases. I have close friends with lupus, scleroderma, myasthenia gravis, and bipolar disorder. This could potentially be a godsend to them.
(unless maybe Score 5: Funny)
I'm a practicing transplant surgeon.
1. This story is not news at all - many methods of transplant tolerance have been successful in mice since the 1960s.
2. Transplants are complicated and require lots of people with specialized skills. A doctor could become a criminal, of course, but you would need a criminal transplant surgeon, criminal anesthesiologist, nurses, etc. as well as lots of specialized equipment and medicines that are only available to licensed practitioners (think audit trail) - not exactly the sort of thing that lends itself to black market activity. I can imagine this being done by rogue governments, though.
3. Rejection rarely causes graft loss these days anyway - less than 2% of organs fail from rejection in the first year.
This is not news. It has been possible to produce indefinite allograft survival in mice and rats since at least the 1960s.
Current immunosuppression is very effective - less than 2% of transplanted organs fail in the first year from rejection (some fail for other reasons).
One year kidney allograft survival is currently around 95% with an optimal graft (i.e. a living donor kidney).
Current immunosuppression does have some risks and side effects. They are not trivial but not as big a deal as the general population assumes. Transplant recipients are nowhere near as immunocompromised as patients receiving high-dose cytotoxic chemotherapy, for example.
David Bruce
Immunosuppression is obviously a complex beast, but two things that stand out:
1) Different organs have different immunogenecity which means one can 'get away' with different levels of immunosuppression.
For example, the mismatch (i.e. difference in HLA) between a donor and recipient for a liver can be much greater than for a pancreas (one of the most immunogenic organs). The liver is pretty good at mopping up circulating antibodies.
Consequently, the amount of immunosuppression needed varies. Whereas a recipient of a pancreas might be on an antimetabolite (azathioprine, mycophenalate), a glucorcitcoid (i.e. steroi, eg prednisolone), and a calcineurin-inhibitor (i.e. anti-T cell, e.g. tacrolimus, ciclosporin), recipients of a liver may end up getting by on just a glucocorticoid.
2) Side Effects of the Immunosuppression
In addition to the general effects (bone marrow suppression, increased infection risk, and malignancy), perhaps the most 'ironic' side effect is that of renal/graft-failure. The calcineurin inhibitors are notoriously nephrotoxic (bad for kidneys), and so it's not uncommon for a renal or liver transplant recipient to require renal transplantion as a result of renal failure due to immunosuppressants.
Not a member of the General Public
I never said don't do it, I just said that it may not turn out to be cost effective. I'm all for progress and research to advance the human condition but just because we can do something doesn't mean we should or will.
There are 4 boxes to use in the defense of liberty: soap, ballot, jury, ammo. Use in that order. Starting now.
That's pretty fascinating and I wish I could mod you informative. I want to read more about this.
"Congratulations on your new heart! You'll have about three months to enjoy it before your addled immune system completely overlooks the next podunk infection or trivial abnormal cell growth."
I will preface my post by saying that I had a living-donor renal transplant in September of 2005. This is very exciting news. Anything that can diminish the number of medicines and the frequency with which they need to be taken is great! Often, the side effects of the medication that you're taking can be very damaging to other aspects of your health. Infection is the number one cause of graft failure and patient morbidity in the first 24 months post transplant. Newer transplant drugs have brought about the diminish use of steroids and that has had a positive effect in both quality of life and graft survival. On the other hand, the cost of these medications is extremely high and it has increase the burden on insurance providers and patients.
If we can return the immune system to normal productivity the quality of life for the patient will be far greater and the burden on insurance companies and Medicare will diminish. This would be great news for the American taxpayer. Medicare shoulders the largest burden of transplantation costs. After 36 months, they no longer provide the patient with immunosuppressive coverage. This is a cost-saving move but at the same time the rates of graft rejection spike at 36 months because some patients are no longer able to afford medication.
In the United States, we have over 75,000 people awaiting a kidney transplant today. They are another 25,000 people awaiting various other organs. The burden to the US healthcare system and the Medicare system is incredible. We are very fortunate that we can keep people alive with dialysis but the cost of dialysis approaches $50,000 a year per patient. Medicare spends over $1 billion each year just for the drug EPO. A billion dollars!
I hope you will all join me in keeping up my fingers crossed and hoping that this is the breakthrough we've all been looking for!
My thought is that, sure, it's more expensive, and it's pretty expensive right now, but if this treatment gains hold, would the costs of maintaining a sterile environment drop? I'd tend to think that a relatively large area could be set up for not much more than a small one. Go full bore with positive pressure and UV sterilization for incoming air, wash sheets/clothing with the nasty chemicals, etc...
I don't read AC A human right
Sounds like the Treg cells are used to identify the transplant tissue and 'mostly harmless' so that the Killer T's leave off and go harass some other bit 'o flesh.
I drank what? -- Socrates
$80/month is less than what I spend on gas to get to work. Heck, annualize my computer purchases and I'd likely spend more on computer stuff than that. My telephone/internet costs more (cell phone, landline+DSL).
I assume you're talking about your copays?
That's the thing about insurance - when you're looking at costs to society, you need to include the whole cost, not just deductibles/copays. You generally end up paying the money eventually.
I don't read AC A human right
Just curious but since you seem to know what you are talking about perhaps you could say something about transplant rejection and eyes (cornea, retina, ?)? I seem to remember reading something many years ago about the eyes having a "magical" ability to suppress rejection of transplanted material in a way that didn't happen with any other part of the body? Or am I just having a really fuzzy memory?
The tyrant will always find a pretext for his tyranny - Aesop
I'm guessing the problem isn't that sterilizing a place is so expensive. There would be the increased cost of doing buisness in a sterile place (autoclaving absolutely everything, scrubbing and suiting up if you're entering), but the two biggest costs by far I would assume to be verifying the cleanliness and (even bigger) liability and insurance for failure to maintain sterility.
I worked at a large phamecutical plant on a microbiology team ensuring that their clean room facilities were actually clean. Extremely boring work, but the worst part was that if and when you messed up (even in a trivial way like not using fresh batteries on the fans to sample the air for bacterial growth every single time) there was a mountain of paperwork to be filled out, explaining why you failed, how you're going to ensure you don't fail again, and assesing whether or not it was going to compromise anything important. An absurd amount of red tape. The actual monitoring of the sterility was extremely easy.
So that's a gigantic cost right there. I know nothing about the liability side to it other than I'm sure there are thousands of lawyers who would salivate at the thought of a patient dying after a transplant because of an infection during the 2 week sterile cycle.
And keep in mind that hospitals charge you about 10 dollars for an asprin...
allergy as far as I remember are linked to basophil , a type of leucocyte.
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On March 1st and have been battling against rejection. I just got the result of a heart biopsy performed Monday and finally, my new heart is rejection free. The side effects of the drugs that it took to get me there are significant, so if this works in humans it will be a tremendous breakthrough. Of course my hope is that this technique would also work post transplant so that they can fix me. The article doesn't mention anything about that though...
Don't donate to those suffering from adult onset diabetes. It is caused by poor diet. Those bastards get what they deserve.
etc.!
... or buying a SUV to get your groceries. Oh, wait...
Well the CAFE (Corporate Average Fuel Economy) standards killed the station wagon so the SUV became the smallest vehicle not part of the CAFE average pool available. (They're considered a "truck".)
Ban or restrict SUVs and watch people buy vans and pickups for shopping.
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
I'm currently being treated for a brain tumor with the chemotherapy drug Temodar. The cost of the initial course of the drug was about $12,000. This was for a low dose while undergoing radiation treatment after surgery. After the radiation treatments were over with, I have to take a 5 day course of the drug each month at a much higher dose. Each of these monthly courses runs about $5,000 to $7,000 and there are some pretty nasty side effects, but hopefully the drug will kill off, or at least keep any possible remnants of the tumor in check, but there are no guarantees.
I'm now able to get the drug for free through a program that the manufacturer offers, but I had to pay my 25 percent copay on prescriptions until I was accepted into the program. The copays alone ran nearly $500 a week, which was more than I was getting through my short-term disability insurance at work.
So is this basically just shutting the immune system off? Wouldn't that cause serious problems, unless you're a "boy in a bubble"?
You're shutting down one part of the immune system for a couple weeks - and teaching it that anything it currently sees is OK once it's turned back on.
So you have things like increased cancer risk (because a mini-cancer that's currently held at bay by this branch of the immune system becomes "OK" - and ditto with a pre-cancerous lesion which may also be attacked less effectively once it takes the next steps.) And some types of infection will not be fought as effectively - possibly making a minor infection become limb- or life-threatening.
So the recipient would have to keep very clean (but avoid harsh scrubbing), wear a filter mask, avoid scratches, etc. until things are back to approximately normal. (See all the stock treatments for immune-suppressed transplant recipients.) And he'll have to be watched more carefully and treated more aggressively infections now and cancers now and in the future.
But it's a heck of a lot better than turning off this AND OTHER parts of the immune system for YEARS or a LIFETIME.
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
... even then, immunosuppressants are useful for a lot of things outside the whole tissue transplant area.
Even for vat-grown tissue you may need immunosuppressants. Examples:
- The organ failed due to auto-immune disease.
- The new organ was needed because a genetic defect made the old one faulty - and the new one must be genetically and (especially) antigenically distinct to function properly.
Etc.
Heck: This therapy looks like it could also become a cure for auto-immune diseases. Two weeks wearing filter masks and hanging out at the clinic, then no more: ...
- Graves' syndrome
- Lupus
- MS
- Rheumatoid Arthritis
- Diabetes type I (WITHOUT a transplant if caught in time)
- Guillain-Barré syndrome
-
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
Will that also end the type1 diabetes autoimmune reaction?
Did not RTFA. But sounds like we get another meaning for AIDS acronym - Artificial ImmunoDificiency Syndrome.
No. Your genitalia will still be rejected.
"That which does not kill us makes us stranger." -Trevor Goodchild
it seems that they actually only charge that much if you have insurance. Making insurance much more expensive. So if we can eliminate the insurance industry we can get back to affordable health care. During this time of many other economic failures and cut backs it would seem to be a great time to put all those insurance workers out of work and let them find new careers. The opportunities are endless right now. Lets try to get us back to the country doctor who'd work for a chicken or two. If health care were affordable we could avoid all that nasty socialist stuff as well and pay for our own health care easing the burden on business and the taxpayer.
So who's with me?
We can work on the lawyers next. This could be great!
Why bother
what kind of world do you live in?
Depending on the transplant, you're probably not going to want to do anything other than lie in a bed during that time anyway.
I have lived with a transplanted kidney now for 4 years. I was out of the hospital in 4 days after transplant. Any positive move forward in transplantation anti-rejection is great news for people like me.
Hmm... wasn't there this other thing that disabled all T-cells and that wasn't all that good...?
I think it was called... AIDS!
Any sufficiently advanced intelligence is indistinguishable from stupidity.
Not quite sure where you got the notion that a hospital is a sterile environment. Far from it. Sure, tools and things can be sterilized. Most hospitals can be, at best, "clean" environments.
Do a bit of research on nosocomial infection.
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Which is why socialized medicine is great for minor and/or common problems, but not so good with rare/expensive problems. It is also why the rich from countries with socialized health care usually end up coming to the USA for expensive specialized treatments.
Hit the nail on the head. The trick though, is that by treating minor/common problems well, there are a lot less people with expensive problems. I'm a Canadian, and as such, love to bitch about our health care; but if you look at it, we have about 2 year longer life expectancy than our southern neighbors, yet we spend roughly half as much on health care. Actually, the Canadian government spends less on health-care per person than the US does - yet I don't pay a penny to go to the hospital or doctor. Why?
Two answers I think
1. Because Canadians are much more likely to get all those little things taken care of sooner because they are free.
2. Although a bureaucracy is not a great way to run heath-insurance (public) it's better than private companies who's job it is to screw you - particularly if you develop something chronic.
Let me correct you slightly, it's not "sometimes" a lifetime, it's almost always a lifetime. Any solid organ transplant requires the recipient to take immunosuppressants for as long as the organ lives, which, by the way, is a fixed time, depending on the organ. Well-cared for kidneys are expected to last 20 to 30 years tops, because, and it's a bit ironic, ciclosporin is toxic to the kidney and to the liver.
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Yes, it would, it is called Graft-versus-host disease GVHD
www.meneguzzi.eu/felipe
I had a liver transplant almost a decade ago and haven't had a single problem with rejection. Strangely, I haven't had any infections and can't remember having any colds since my transplant. I stopped taking the prescribed steroids a few months after the transplant and have cut my anti-rejection drugs to a quarter the prescribed dose a couple times, for a couple weeks to see if I would have any reaction, after reading that 20% of liver transplant patients can survive without drugs. I can only guess that my body is able to fight infection or ignores the rhino virus and that the donor was a pretty close match (cadaver, unrelated to me). Both sides of my family have been in America for nearly 400 years, so I would guess I share genes with a large number of people and may have been lucky enough to find a donor that shares some of those genes. I would like to stop taking the anti-rejection drugs and truly believe the odds are better than 50% that I could just quit, because of the lack of problems I have experienced, but am not willing to take the chance that I may reject the organ. The anti-rejection drugs will eventually take my kidneys out, so the sooner they find a solution the better.
You also have to consider the cost over time. My father got a kidney transplant and is on anti-rejection drugs (as well as lots of other stuff). It's not cheap. And he's on them for life.
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Insurance is definitely part of the problem.
But a modern doctor didn't go through 4 years of college, 4 years of medical school, and another three or five years of grueling internships to get paid in chickens. If anyone in our society earns a six figure income, it would be them.
I'm still waiting for the results of the two brothers who reported that they could build new hearts, kidneys, etc. by growing cells on a soluble matrix the shape amd size of the organ needed by using "directed" stem cells! Now that would completely avoid transplant rejection,without drugs or cell manipulation affecting the recipient's imune system. This was in SCientific American a few years back. Still working on it, I guess?
Seems to me most of us endured quite an education. I do agree but, they can handle many patients and get more than just chickens, give me a break think about it. With their education they can help quite a few patients in a day and make a very good living. We could always go back to the old Chinese system of paying them a monthly stipend until you get sick, at which point you stop paying until you get better.
Why bother
I think health trumps everything else. So I don't mind if a physician earns $100,000 or even $200,000 or $250,000 per year. Most of the extra costs we pay at the doctor's office are covering liability insurance and overpriced medical equipment.
Our pediatricians schedule about 4 patient visits per hour. With insurance the cost per visit is $15. Without insurance, it's $200. I doubt my insurance company is paying $185 extra per visit, and even if it is the lack of Ferraris in the parking lot tells me the physician is not getting even 20% of the $800 per hour in gross income he brings to the facility.
But a modern doctor didn't go through 4 years of college, 4 years of medical school, and another three or five years of grueling internships to get paid in chickens. If anyone in our society earns a six figure income, it would be them.
Well nurse practitioners can charge chickens and doctors can charge cows.
Seriously, we shouldn't revert to chickens, being food is so cheap these days, but we can do things to make prices more affordable. I paid $15 dollars at Walmart for a license renewal eye exam. I could have gotten it for free at the DMV, but Walmart keeps better hours. For ~$50 I could have gotten a real eye exam, and for another ~$15 I could get my eye glass prescription.
Of course I bought some lead dust encrusted gum and pretzels from Walmart immediately after the eye exam adding another $7.00 to my bill.
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