For especially vulnerable patients like premature babies or adults with leukemia, blood cell transfusions can involve the risk of infections and other complications. A five-year, $8 million National Institutes of Health grant to Emory University School of Medicine researchers will support efforts to reduce those risks.
The grant will fund a regional clinical trial examining the best ways to protect low birth weight infants from transfusion-related viral infections, and a study of new strategies for rebuilding the immune systems of bone marrow transplant recipients.
"The goal of these projects is to make transfusion and bone marrow transplant recipients safer," says Christopher Hillyer, MD, director of the Emory Center for Transfusion and Cellular Therapies. "Although they are distinct projects, each one builds on the knowledge generated by the other."
Doctors perform transfusions of blood cells in several situations: replacing what was lost during trauma or surgery, or restoring blood-forming capacity with transplanted bone marrow after radiation or chemotherapy is deliberately used to wipe out a leukemia.
In a clinical trial covering the greater Atlanta area, transfusion specialists at Emory are teaming up with doctors at Northside Hospital and Children's Healthcare of Atlanta to screen for cytomegalovirus (CMV) in blood given to low birth weight infants.
A majority of adults have CMV in their bodies, but it doesn't make them sick. Low birth weight infants have incomplete immune systems and are vulnerable to CMV infection, which can lead to liver or lung damage, permanent disability or even death, says Hillyer, a professor of pathology and laboratory medicine at Emory.
The study will test whether a combination of screening blood by DNA and antibody methods and removing white blood cells before transfusion is enough to eliminate CMV infection.
CMV is also an example of a threat facing bone marrow transplant recipients: infections that take advantage of the patient's weakened immune system. Doctors have to balance strengthening the patient's new white blood cells against the cells' ability to attack their surroundings in "graft-versus-host" disease.
Two projects funded by the grant will address bone marrow transplants. One, led by John Roback, MD, PhD, Emory associate professor of pathology and laboratory medicine and co-director of the transfusion center, tests a new vaccine against CMV in animals, with an eye towards adapting the vaccine to protect against other opportunistic infections in people.
Another, led by Edmund Waller, MD, PhD, professor of hematology/oncology and director of Emory's Bone Marrow and Stem Cell Transplant Center, is a clinical trial where doctors will treat white blood cells with a suppressive drug before they are given to a patient post-transplant.
A fourth project, led by James Zimring, assistant professor of pathology and laboratory medicine, will advance an animal model for studying immune responses sometimes developed against red blood cells by repeat transfusion recipients.