The Emory Transplant Immunology Research Program at Emory is working to achieve complete immune tolerance for transplanted organs and to free patients from the need for continuous drug therapy. Current projects are exploring less toxic medications for kidney, pancreas, liver, lung, bone marrow, composite tissue, and xenotransplantation (the transplantation of living cells, tissues, or organs from one species to another, such as from pigs to humans).
Emory transplant researchers are conducting active clinical trials involving tolerance induction regimens as well as observational studies intent on developing methods of tailoring immunosuppressant drug therapy to patients so that over- or under-immunosuppression is avoided. Basic science studies include investigations of the fundamental mechanisms of donor specific tolerance and alloantibody formation.
For up-to-date and detailed information on the program, please visit the transplant research and clinical trials section of the Emory Transplant Center website at Emory Healthcare.
Development of Belatacept
Belatacept is an anti-rejection medication that is considered a less toxic alternative to standard immunosuppressants. A research team led by Christian Larsen, MD, DPhil, former director of the Emory Transplant Center (ETC) from 2000-2012, former dean of the Emory University School of Medicine from January 2013-November 2016, current professor of surgery, and Thomas Pearson, MD, DPhil, executive director of the ETC, began searching for ways to promote immune tolerance of a transplanted organ in the 1990s, and they became instrumental to developing belatacept.
In 2006, Dr. Larsen and UCSF kidney transplant surgeon Flavio Vincenti, MD, began leading BENEFIT (Belatacept Evaluation of Nephroprotection and Efficacy as First-line Immunosuppression Trial), which sought to further confirm if belatacept could provide protection from organ rejection following kidney transplantation while avoiding some of the toxic effects of standard immunosuppressive medications. Based on the three-year results of BENEFIT, the medication received FDA approval in 2011 for kidney transplant recipients in the form of the drug Nulojix.
In 2016, the seven-year results of the study were published in the Jan. 28 issue of The New England Journal of Medicine, and conclusively showed that kidney transplant recipients taking belatacept experienced a rate of mortality and graft loss significantly lower than patients taking a CNI-based regime. The investigators stressed that the best uses of belatacept still need additional definition, and the drug continues to be tested in experimental clinical trials for kidney transplant, liver transplant, and pancreatic islet transplant.
The Emory Transplant Immunology Lab gratefully acknowledges the Carlos and Marguerite Mason Trust for its generous support of both basic and translational work during the development of belatacept.
Islet Transplant Research and Trials
The transplantation of donor pancreatic islet cells as a means to restore insulin production is a proposed treatment for patients with type 1 diabetes, though it is still in the research stage because recipients must take immunosuppressive drugs to prevent rejection. Emory transplant surgeon-scientists are striving to reduce the requirements for immunosuppressive drugs in islet transplants while increasing the supply of donated islets.
In 2003, Dr. Larsen and Dr. Pearson initiated an Emory islet transplantation clinical trial by successfully performing the first successful islet transplant in Georgia for a patient with type 1 diabetes. Nicole Turgeon, MD, took over direction of the islet transplantation program in 2009. As of 2013, the program is following 30 patients who have received islet transplants. Researchers are awaiting FDA approval of islet cell transplants so the surgery will no longer be experimental. At that point, surgeons will be able to perform these transplants on patients who meet criteria.
Emory Transplant Center Biorepository for Translational Science (ETC Biorepository)
The ETC Biorepository—established through the generous funding of the Georgia Research Alliance—is one of the only transplant-based biorepositories in the U.S. The biorepository collects, processes, and distributes biological samples from patients receiving transplant services throughout Emory. By making the samples available to Emory researchers to use in their basic, translational, and clinical research studies, the facility is an important tool in the pursuit of improving transplant outcomes.