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EDITORIAL
NUMBER 3-4 YEAR 2009
Research at European Level: Pius Branzeu Center Receives Top 10 Research Rating at the 14th Congress of the European Society for Organ Transplantation in Paris, France
1 Department for Transplantation Immunology and Cell Therapies, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery,
Victor Babes University of Medicine and Pharmacy, Timisoara

Correspondence to:
Lucian P. Jiga, MD, PhD, Senior Director of Research, Department for Transplantation Immunology and Cell Therapies, Pius Branzeu Center for Laparoscopic Surgery and Microsurgery,
Victor Babes University of Medicine and Pharmacy,
Timisoara, Tel/Fax: +40-256-216510.
Email: ljiga@umft.roin
This year, during August 30 – September 2, Paris hosted the 14th Congress of the European Society for Organ Transplantation. The meeting was held under the chairs of Prof. Bernard Charpentier and Prof. Yvon Lebranchu, two of the foremost European personalities in the field of organ transplantation.

Being one of the most important meetings worldwide in the field of solid organ transplantation, this meeting has reunited more than 1500 participants from over 30 countries all over the world.

The congress was inaugurated by awarding two of the pioneers in the field of transplantation, the ESOT Honorary Membership titles. The nominates were Sir Peter Morris, Nuffield Professor of Surgery and Director of the Oxford Transplant Center, Oxford University, UK and Christian Cabrol, Honorary Professor, Department for Cardio-Thoracic Surgery, Hospital de la Pitie, Paris, France.
In 1978, Sir Peter Morris was the first to demonstrate the major role of HLA-DR matching in kidney transplantation and made seminal contributions roin understanding the cellular mechanisms of acute rejection, defining donor-derived dendritic cells as key initiators of immune activation post-transplantation.

Christian Cabrol has pioneered heart transplantation, performing for the first time in Europe this procedure in 1968. Almost two decades later, he performed the first heart-lung transplantation in Europe (1982) and the first implantation of a total artificial heart in France (1986).

The scientifical content of the congress was on the highest level. The program consisted of a well-balanced mixture of top transplantation research and latest trends in regard with clinical organ donation and transplantation, gathered in more than 1500 abstracts of which 342 were oral presentations.

From the basic science field, there was a strong “translational” feeling throughout the congress, with presentations focused on results obtained in the first-line clinical research rather than pure fundamental studies. In the results presented from the first clinical trials in UK, stem cell therapies are taken “from bench to bedside” as alternatives or bridge to liver transplantation. There is hope also for future in-vivo use of bioartificial livers engineered from decelullarized liver matrix and hepatic cells. Innovative research in transplant immunobiology reveals new, emerging roles of memory T cells and of T cell subpopulations such as Th17 in inducing functional FoxP3+ T regulatory cells. Known target molecules, expressed on dendritic cells, with potential tolerogenic properties, such as IDO (indoleamine 2,3-dioxygenase) and their effect on the innate immune were exhaustively discussed in direct regard with future clinical applications.

Fadi Lakkis (Scientific Director of the Thomas Starzl Transplantation Institute, Pittsburg, USA) presented a highly interesting review about evolution of innate immunity, in which he demonstrates that basal marine invertebrates, which lack adaptive immune response (e.g. Hydractinia), can very accurately control allorecognition through specific genetic loci. These animals fail to become tolerant even if exposed, during early development, to cells from a histoincompatible individuals. Studying such organisms can provide clues to the innate mechanisms by which higher animals (e.g. humans) respond to organ allografts.

One of top subjects that benefited from utmost audience was composite tissue and xenotransplantation.
Extensive research on xenotransplant models has shown new insights (e.g. immune-induced thrombocytopenia) of the mechanisms involved in xenograft rejection of livers taken from A1,3-GTKO (galactosyltransferase knock-out) pigs, in a pig-to-baboon model. Further results documented multiple gene involvement, in xenotransplant rejection, other that A1,3-GT, which still need characterization and control. Although, the future use of A1,3-GTKO pigs as organ source in clinical transplantation still remains elusive, a certain amount of optimism is arising from research on pancreas islet xenografting, where transplantation of hCD46 (hCD 46 - human complement regulatory protein) transgenic porcine islets into diabetic non-human primates, results in long-term (more than 390 days) normoglycemia under limited immunosuppression, thus making xenopancreatic islet transplantation a realistic option for future clinical applications.

Along with these results, a captivating presentation, delivered by the group of Jean Michele Dubernard and Palomina Patuzzo, presented the three-year follow-up of the first face transplantation. The patient received in 2005 a full allogeneic nose-lip-chin complex, for definitive reconstruction of a mutilating injury after a dog-bite. Although facing two rejection episodes, transient immunosuppression-induced renal failure and major lipid metabolism alterations, these problems were accurately corrected. At three years, the patient enjoys normal social life with full recovery of the motor and sensory functions of the graft, enabling normal phonation, and drinking-eating habits.

The first clinical transplantation on an ex-vivo engineered allogeneic tracheal allograft was presented by a group from Barcelona, Spain. This implant, after being harvested from a deceased donor, was denaturized in-vitro and then, using bioreactor technology, was re-enriched with epithelial and mesenchimal-stemcell-derived chondrocytes cultivated from the recipient. The emerging graft was successfully used to replace the diseased left main bronchus of a 30-yo patient, which now has normal lung function without any form of immunosuppression. These results show that, under certain conditions, patients could benefit in the future from organ parts than could be “constructed” in-vitro, to have the same properties of the target organ but lacking any form of immunogenicity.

In the context of an ever-expanding pool of waiting donors, the lack of sufficient organ grafts for transplantation, still represents a major unresolved challenge. The non-heart beating donor, represents a new and valid source for solid organ allografts and this topic was intensively discussed from the procurement, allocation, safety and best practice point of views.

Posttransplant infections with particular emphasis on viral involvement in chronic allograft rejection and posttransplant cancer development; ways to improve immunosuppressive regimens and novel protocols of humoral monitoring of rejection such as 2D-DIGE analysis of urine proteome, were other hot topics presented.

Romania was present at the ESOT Congress with 14 accepted presentations, from Fundeni Institute, Bucharest (Prof. Irinel Popescu, Clinic for General Surgery and Liver Transplantation; Prof. Ionel Sinescu, Center for Urological Surgery, Dialysis and Renal Transplantation), Cluj Napoca (Prof. Mihai Lucan – Center for Urology and Renal Transplantation) and Timisoara (Assoc. Prof. Lucian Jiga, Department for Transplantation Immunology and Cell Therapies, Victor Babes University of Medicine and Pharmacy). The main subjects presented by the Romanian groups consisted of both experimental immunobiology and clinical transplantation with an overall scientifical relevance leveling the importance of this meeting. A complementary proof in this direction was the selection of the work from the group in Timisoara, based on a scoring evaluation, as top 10% most relevant of basic research – transplant immunobiology category.

If it were to define the scientifical content of this congress through a key word, “translational” would be the most accurate. There is a high tendency, from the most relevant groups within the organ transplant community, to develop key areas (e.g. biomarkers for rejection, immune-monitoring, the non-heart beating donor, genetically engineered allografts) with high potential for clinical applications and this conjoined effort could lead to much expected discoveries in the most relevant fields of organ transplantation such as expanding organ donation pool, operational tolerance, chronic rejection, etc.

To conclude, this was a highly interesting meeting, which provided not only updates on cutting-edge research and clinical transplantation, but also setting new trend lines in the further development of this field, towards its improvement in the ultimate benefit of the patients.

ACKNOWLEDGEMENT

The authors’ presence to this meeting was financed by the grant LYMPHOTERA Nr. 41-027/2007. This project was awarded by the Romanian Ministry of Education and Research.


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