Research conducted by faculty of Emory's division of transplantation is done under the auspices of the Transplant Immunology Lab. Many of the lab's efforts are multi-disciplinary and include such notable projects as Belatacept Development, Clinical Trials in Organ Transplantation in Children, Collaborative Network for Clinical Research on Immune Tolerance, JDRF Center for Islet Transplantation, Microsurgery and Composite Tissue Transplantation (CTA), and the Protective Immunity Project.

Overview: Transplant Immunology Lab

Co-directed by Dr. Christian Larsen and Dr. Thomas Pearson, the immunology lab studies the immunologic mechanisms of transplant rejection and immunologic tolerance with the hope of achieving true immune tolerance, primarily by developing an antirejection medicine that's gentler on the body than the standard medication yet equally vigilant in protecting transplanted organs. Grants from the NIH (including a Program Project Grant), The Mason Foundation, the National Science Foundation and private industry have funded the lab's projects, which have been reported in Nature, The Journal of Experimental Medicine, The Journal of Immunology, The Journal of Clinical Investigation and Transplantation.

Currently, Dr. Larsen and Dr. Pearson lead the transplantation faculty in investigating the basic biology of cell, tissue and organ acceptance and rejection and translating this work into promoting graft survival without the requirement for toxic immunosuppression. Active programs specific to kidney, pancreas, liver, lung, bone marrow, composite tissue and xenotransplantation are ongoing.

Belatacept Development

In 2005, Drs. Larsen and Pearson collaborated with colleagues at Bristol-Meyers Squibb on the Phase III investigation of Belatacept, an investigational medication that is proving effective in preserving transplanted kidney function while avoiding toxic side effects of such immunosuppressive drugs as cyclosporine, primarily by selectively blocking the second of two cellular signals the body needs to trigger an immune response. Begun in the 1990s, the success of pre-clinical research conducted with nonhuman primates at the Yerkes Research Center led to human clinical trials, with the immunology lab completing a Phase II clinical study that compared Belatacept with cyclosporine in human kidney transplant patients. The drug is currently in its third phase of human trials and will be reviewed by the FDA in the middle of 2009.

Clinical Trials in Organ Transplantation in Children

Funded by a five-year NIH grant totaling approximately $6 million that was awarded in March 2008, Emory and Children's Healthcare of Atlanta are partnering with UCLA's Mattel Children's Hospital in Los Angeles and Lucile Packard Children's Hospital at Stanford in Palo Alto for a study of kidney transplants in children. Directed by Dr. Allan Kirk, the study hopes to develop methods of tailoring immunosuppressant drug therapy to children so that they they don't become over-immunosuppressed.

Collaborative Network for Clinical Research on Immune Tolerance

In 1999, Emory's kidney transplantation program was selected by the NIH to participate in the Immune Tolerance Network, a nationwide alliance of transplant research centers conducting clinical trials designed to uncover the basic biological features of clinical tolerance. Dr. Kenneth Newell leads this effort for Emory.

JDRF Center for Islet Transplantation

The Juvenile Diabetes Research Foundation Center for Islet Transplantation at Emory is based in the immunology lab. The center was launched in 2002 with a $4.1 million grant from the Juvenile Diabetes Research Foundation (JDRF) for the purpose of reducing the requirements for immunosuppressive drugs in islet transplants while increasing the supply of donated islets. The center received additional five-year funding from the JDRF of nearly $8.5 million in 2006. In 2003, Dr. Larsen, who directs the center, and Dr. Pearson performed the first successful islet transplant in Georgia for a patient with Type 1 diabetes. As of August 2008, Emory transplant surgeons have performed 18 successful islet transplant procedures into 11 patients.

In March 2007, the JDRF awarded the Emory Transplant Center a $2.5 million grant over three years to develop pig islets as an alternative to human donor islets. The grant funds development of a non-human primate model at Yerkes National Primate Research Center, an effort that involves faculty of the Immunology Lab and the Emory JDRF Center. If successful, the research will proceed to clinical trials in humans.

Microsurgery and Composite Tissue Transplantation (CTA)

Dr. Linda Cendales is the director of the Emory Transplant Center's Laboratory of Microsurgery and Composite Tissue Transplantation (CTA). CTA is the re-transplantation of multiple tissues such as skin, muscle, bone, nerve, and tendon as a functional unit, such as a limb, and Dr. Cendales plans on training the next experts in the procedure and establishing a program that incorporates the entire care continuum, from the laboratory bench to the bedside. Her team is currently conducting the first clinical trial of CTA in hand transplantation.

Protective Immunity Project

In 2005, Dr. Larsen and Dr. Rafi Ahmed received a biodefense contract to study protective immunity in transplant recipients. The five-year, $10.1 million contract consists of three projects: (1) characterization of the impact of immunosuppression on immune memory, (2) exploring the impact of immunosuppression on the immune response to influenza vaccination, and (3) characterization of the immune response to vaccination challenge in immunosuppressed non-human primates.

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