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Disclosure
- Consult for a start-up developing a monoclonal CD2
Tolerance in transplantation David Berglund, MD/PhD Docent of - - PowerPoint PPT Presentation
Tolerance in transplantation David Berglund, MD/PhD Docent of - - PowerPoint PPT Presentation
Tolerance in transplantation David Berglund, MD/PhD Docent of Immunology Disclosure Consult for a start-up developing a monoclonal CD2 antibody for use in transplantation. Transplant tolerance History Present knowledge
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Transplant tolerance
- History
- Present knowledge
- Future directions
- The treatment of today is not good enough.
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How good are the results?
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The clinical problem
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Lack of improvement long-term
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Effective at preventing acute rejection
Cancer Infections Diabetes…
Tacrolimus Mycophenolate Corticosteroids
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Transplant tolerance – what is it?
- Stable graft function in the absence of immuno-
suppressive drugs, with no clinically significant detrimental immune responses or immune deficits.
- “Accept the transplant as self.”
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History
>3,000 citations
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Tolerance to foreign tissues – chimerism
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Natures own experiment – pregnancy
Vascular anastomosis
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Mechanisms
- “There are three fundamental principles for the
induction of durable transplant tolerance:”
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Unfortunately,…
- … we don’t know any of them.
- How to search for mechanisms?
Central vs peripheral tolerance
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Looking for mechanisms – collecting rare patients
- 31-year old man with uremia
- Received kidney transplant from live donor
- Uncomplicated postoperative course
- Basiliximab-induction, CyA, corticosteroids
- Vacation
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Collecting rare patients
First year after tx
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Collecting rare patients
The last 11 years First year after tx
?
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Exceedingly rare (hard to find)
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What have we learned?
>1,000 citations
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Looking through a small keyhole
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