Babies receive the world’s first combination of heart and thymic tissue transplants

Infants who are believed to have first received a combination of heart transplantation and allogeneic treated thymic tissue transplantation may acquire immune function 6 months after surgery and reduce the need for rejection drugs. there is.

The two steps were performed at Duke University Hospital on August 6 under an FDA-approved extended access application. Researchers have called this procedure a milestone in heart transplantation.

infant, Easton cinnamon, It was 6 months when he received him Heart transplant.. Transplantation of cultured thymic tissue from his heart donor was performed 2 weeks after heart transplantation. Easton was born with severe single ventricle heart disease and unexplained thymic deficiency, and the infection recurred and could not be placed on the heart transplant list. Joseph W. Turek, MD, PhD, Chief of Pediatric Cardiac Surgery at Duke Health.

Successful procedures could lead to increased survival of transplanted organs in the future, Turek told Healio. Currently, the average lifespan of a transplanted heart is about 10 to 15 years, Turek said. Other options have long been sought because the toxicity of immunosuppressive drugs limits their durability.

Joseph W. Turek

“If you have a congenital athymic adenopathy transplant here at Duke, it will only be approved for patients under 9 months of age,” Turek told Healio. “Because he was six months old when he received the heart, he helped get FDA approval to do a thymus transplant in Easton. The lab is now able to do enough to do the transplant. We are investigating the age of the thymus of sex, which may increase the number of patients who can benefit from it. Procedures beyond infants — There may be donors aged 10, 20, and 30. “

Mind recognized as “self”

Duke’s researchers were licensed by the FDA for a research procedure after two key elements were lined up. Infants needed heart transplants and treated thymic tissue transplants independently of each other. He was a Duke patient. Transplantation of treated thymic tissue Only available.

“It was a coincidence in the sense that Easton needed a heart transplant, and he also had a very poor immune system,” Turek said. “We do each of these operations independently at Duke. We were the only ones in the Western Hemisphere to perform thymic culture transplants for patients with congenital thymic inflammation, so we had that expertise in-house. We also do a lot of heart transplants here, which allowed us to discuss and approve the FDA and try this groundbreaking task in his situation, with less risk than other methods. . “

In a media briefing, Turek called the combination of the two steps “very intriguing” and set forth the long-standing goal of Duke researchers who did similar work in animal experiments.

“If we had a thymus and heart transplant in Easton, we thought that if we took both from the same donor, the heart could be perceived as’self’,” Turek said. “This is a concept known as resistance, and resistance was the Holy Grail of Transplantation. If it works, it can be applied to all solid organs of the future.”

A successful combination of procedures could mean that the baby does not reject the heart, even if all immunosuppressive drugs are discontinued, Turek said.

Easton is now 13 months old and continues to take immunosuppressive drugs, Turek said. If he is successful, in a few months he will be able to gradually reduce the rejection suppressants.

Processed thymic tissue transplantation method pioneered by Duke Louise Markert, MD, In a press release, Duke states that he uses proprietary technology to culture and manage the treated thymic tissue (Enzyvant Therapeutics GmbH). The FDA approved allogeneic treated thymic tissue-agdc last fall. This indicates immune reconstitution in a pediatric patient with congenital athymic adenopathy.

Promote future research

During the briefing, Turek said tests show that the transplanted treated thymic tissue is functioning and building T cells. Duke’s Easton care team continues to monitor progress.

“We wanted to make sure his immune system was responsive, so we waited for this to be announced,” Turek said. “Sure enough, he’s developing his T cells. It’s exciting.”

Future studies will focus on how the two procedures work for patients with a competent immune system, Turek said.

“It’s a major obstacle to research and I feel that this is progressing in the use of this cultured thymic tissue,” says Turek. “Cultured tissue can be used to create a scaffolding so that the thymus is free of other cells. You can form a brand new immune system. This organ, be it the heart or the liver, whatever it is. , May grow and be recognized with its new thymus. “

Easton’s parents, Caitlyn cinnamon When Brandon Cinnamon, Said their son was placed in an extracorporeal membrane oxygenation early in his life as his heart began to weaken. They described the day they finally took him home from the hospital as “amazing.”

“He wanted to be here, so he decided to give us this transplant,” said Caitlin Cinnamon.