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Medicine Science

New Discovery May End Transplant Rejection 201

Posted by Soulskill
from the time-to-get-that-extra-liver-you've-always-wanted dept.
mmmscience writes with this excerpt from the Examiner: "Big news in the medical world: scientists in Australia have found a way to stop the body from attacking organ transplants, greatly decreasing the possibility of organ rejection. ... When a new tissue is introduced, one's immune system kicks into overdrive, sending out cells known as killer T cells to attack and destroy the unknown tissue. ... Professor Jonathan Sprent and Dr. Kylie Webster from Sydney's Garvan Institute of Medical Research focused on a different type of T cells — known as regulatory T cells (Treg) — in this study. Tregs are capable of quieting the immune system, stopping the killer T cells from seeking out and attacking foreign objects."
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New Discovery May End Transplant Rejection

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  • by Chas (5144) on Wednesday April 08, 2009 @09:42AM (#27502483) Homepage Journal

    Okay, what does that do for fighting off infection then?

    It's not like there's a magical component to this that identifies the transplanted material as "good" and infectious agents as "bad".

    • by Anonymous Coward on Wednesday April 08, 2009 @09:53AM (#27502681)

      But it only is needed for 2-3 weeks, according to the article. Just long enough for the body to accept the new cells, after that they let things go back to normal, which would allow the body to attach infectious agents.

      • by furby076 (1461805) on Wednesday April 08, 2009 @10:23AM (#27503119) Homepage
        And in those 2-3 weeks they keep the person in a steril room devoid of any potential bacteria/virus' that could harm the person.

        Hopefully they will be able to run positive clinical trials in the future. So far this is only effective on mice on relatively simple procedures (skin grafts, and pancreatic transfers). Kidneys, hearts, lungs are huge deals. I'm assuming if this hurdle is passed the doner would only need to have a blood-type match? That would be awesome and would make the waiting list that much simpler.
        • by interkin3tic (1469267) on Wednesday April 08, 2009 @11:34AM (#27504211)

          And in those 2-3 weeks they keep the person in a steril room devoid of any potential bacteria/virus' that could harm the person.

          Depending on the transplant, you're probably not going to want to do anything other than lie in a bed during that time anyway.

          • Re: (Score:3, Insightful)

            by afidel (530433)
            Yes, but a complete isolation environment is MUCH more expensive than a normal ICU which is MUCH more expensive than a recovery room which is MUCH more expensive than outpatient followup visits. Basically the cost for two weeks in isolation is probably in the mid 6 figure range vs high 5 to low 6 figures for the procedures.
            • Yes, but a complete isolation environment is MUCH more expensive than a normal ICU which is MUCH more expensive than a recovery room which is MUCH more expensive than outpatient followup visits.

              ... but is still preferable in some cases than not getting a transplant and dying. More expensive, yes...

              • by Firethorn (177587)

                My thought is that, sure, it's more expensive, and it's pretty expensive right now, but if this treatment gains hold, would the costs of maintaining a sterile environment drop? I'd tend to think that a relatively large area could be set up for not much more than a small one. Go full bore with positive pressure and UV sterilization for incoming air, wash sheets/clothing with the nasty chemicals, etc...

                • by interkin3tic (1469267) on Wednesday April 08, 2009 @02:39PM (#27507091)

                  I'm guessing the problem isn't that sterilizing a place is so expensive. There would be the increased cost of doing buisness in a sterile place (autoclaving absolutely everything, scrubbing and suiting up if you're entering), but the two biggest costs by far I would assume to be verifying the cleanliness and (even bigger) liability and insurance for failure to maintain sterility.

                  I worked at a large phamecutical plant on a microbiology team ensuring that their clean room facilities were actually clean. Extremely boring work, but the worst part was that if and when you messed up (even in a trivial way like not using fresh batteries on the fans to sample the air for bacterial growth every single time) there was a mountain of paperwork to be filled out, explaining why you failed, how you're going to ensure you don't fail again, and assesing whether or not it was going to compromise anything important. An absurd amount of red tape. The actual monitoring of the sterility was extremely easy.

                  So that's a gigantic cost right there. I know nothing about the liability side to it other than I'm sure there are thousands of lawyers who would salivate at the thought of a patient dying after a transplant because of an infection during the 2 week sterile cycle.

                  And keep in mind that hospitals charge you about 10 dollars for an asprin...

            • by sjames (1099)

              But you have to balance that against a lifetime of outrageously expensive immunosuppressant drugs and additional medical care due to the toxic side effects. On top of that, the primary effect will make the patient more vulnerable to getting sick and each such illness will require aggressive medical care while a person not on immunosuppressants just needs to sit at home for a day or two.

              All of that added up with a reduced life expectancy on top will way exceed the six figure cost of spending 2 weeks in isola

            • So if you were going to die without a transplant, and were told that a donor had been lined up - your first response would be "How much is this going to cost? Is there a way we can do it cheaper? My life is only worth X amount of money to me."
              I am pretty sure in life-threatening situations, the patients main concern is hardly the costs involved.
              • by afidel (530433)
                It has more to do with how many people will be ABLE to get a transplant, a large reason so many people don't have health insurance in the US is because it's freaking expensive. In countries with socialized healthcare it's likely that such costly measures will be rejected or have such significant wait times that attrition will reduce costs. The fact is building, maintaining, and staffing such facilities is exceedingly expensive and so it might not turn out to be the most cost effective (efficient) solution.
                • Which is why socialized medicine is great for minor and/or common problems, but not so good with rare/expensive problems. It is also why the rich from countries with socialized health care usually end up coming to the USA for expensive specialized treatments. It also does happen on a smaller scale in the USA for those that belong to HMOs. It is hard to run the medical industry like a typical business - turning a profit isn't always the most desirable outcome, let alone a possible one.
                • by initdeep (1073290)

                  you do realize that most peopel die still waiting for a suitable transplant don't you?

                  my father is on the transplant list for a heart and has been in the second highest risk category for about a year now.

                  he's been called in twice.

                  there is more to it than just matching some blood types.

                  and for certain other types of transplant, like the bone marrow transplant a friends 13 year old son is going through, they already have to put them into basically a clean room environment now. because they have to KILL OFF th

                  • by afidel (530433)
                    I never said don't do it, I just said that it may not turn out to be cost effective. I'm all for progress and research to advance the human condition but just because we can do something doesn't mean we should or will.
        • by Chas (5144)

          Not quite sure where you got the notion that a hospital is a sterile environment. Far from it. Sure, tools and things can be sterilized. Most hospitals can be, at best, "clean" environments.

          Do a bit of research on nosocomial infection [wikipedia.org].

    • by Thansal (999464) on Wednesday April 08, 2009 @09:55AM (#27502699)

      The idea (as I understand it) is this:

      1) Immunosuppressants not only lower your defenses but are also toxic (as with many drugs).

      2) I assume the treatment is either non-toxic, or at least not as bad for you.

      3) Not sure about this: I think that people need to take immunosuppressants for a LONG time after the transplant, thus pumping in toxins AND keeping the defenses low, where as this idea is a one time thing you do before the transplant and are then done with.

      The wording also makes it sound like the rejection rate is lower than usual, I am unsure if this is true or not.

      So yes, you still have the lowered defenses, but with out the toxins, and possibly for a shorter time.

      • by x2A (858210) on Wednesday April 08, 2009 @10:32AM (#27503235)

        "3) Not sure about this: I think that people need to take immunosuppressants for a LONG time after the transplant"

        AFAIK ('tho there're bound to be exceptions maybe?) - you take them for as long as you don't want your immune system to attack the new organ, which'll basically be, for the rest of your life.

        • Re: (Score:3, Interesting)

          by hedwards (940851)

          That's not true, immunotherapies have historically not required permanent treatment. This isn't that much different from allergy shots or immunizations.

          Eventually the body adapts to having the pathogens there and realizes they aren't harmful. The big concern with rejection is that the body will kill off the cells before that happens.

          It depends upon the technique, but for many of the therapies it only takes 3-5 years, which even at double that is greatly superior to how we handle it now.

      • Re: (Score:3, Interesting)

        by tjonnyc999 (1423763)
        1.) Correct.
        2.) Also correct.
        Immunosuppressant drugs, besides increasing the risk of infection and cancer, also screw with the kidneys, liver, and pancreas. So besides the fun 1-2 punch of increased risk of infection post-surgery and having a weaker immune system to fight it with, you can also have a delightful bouquet of metabolic issues to go with it. This treatment seems to take the "traffic control" route, instead of mass-nuking the entire T-cell population.
        3.) If the rejection is hyperacute (immedia
      • Re: (Score:3, Interesting)

        by Anonymous Coward

        3) Not sure about this: I think that people need to take immunosuppressants for a LONG time after the transplant, thus pumping in toxins AND keeping the defenses low, where as this idea is a one time thing you do before the transplant and are then done with.

        My father had a lung transplant about 5 years ago. You have to take the immunosuppressants forever with any inner body transplant (like heart, kidney, lung, etc). The immunosuppressants are quite good, but their side effects are significant and effect the life of a person. My father had to take significant amounts of pills daily at very specific times for everything to work properly. The pills also place quite a strain on the kidneys.

        Bizarrely enough, that's what eventually killed him. The doctors (who, BTW

        • by HAKdragon (193605)

          As somebody who had a kidney transplant a little more than 12 years ago, I can to pretty much everything that you've said. The point of the cost of the drugs is definitely one of the larger factors - my main two immunosuppressant drugs cost me $80 for a month's supply. That doesn't include other medications that offset what the immunosuppressants are doing.

          • Re: (Score:3, Interesting)

            by Firethorn (177587)

            $80/month is less than what I spend on gas to get to work. Heck, annualize my computer purchases and I'd likely spend more on computer stuff than that. My telephone/internet costs more (cell phone, landline+DSL).

            I assume you're talking about your copays?

            That's the thing about insurance - when you're looking at costs to society, you need to include the whole cost, not just deductibles/copays. You generally end up paying the money eventually.

      • by compro01 (777531)

        IANAMD, but I'm fairly sure the immunosuppressants are needed for the rest of the recipient's life.

      • by element-o.p. (939033) on Wednesday April 08, 2009 @11:44AM (#27504413) Homepage
        3) Not just a LONG time -- for as long as you have the transplant.

        I got a kidney transplant in 1995, and I will be on anti-rejection drugs until either 1) I die, 2) something better comes along that doesn't require anti-rejection meds anymore (<crosses fingers>), 3) or I reject the kidney and it is removed.
    • by blueg3 (192743) on Wednesday April 08, 2009 @09:57AM (#27502737)

      If only there was a linked article that addressed these questions!

  • Organlegging (Score:5, Interesting)

    by Maximum Prophet (716608) on Wednesday April 08, 2009 @09:44AM (#27502519)
    This will make organlegging possible. If you can just grab any kidney off the street and use it to replace a failing one, people will.
    • Re: (Score:3, Funny)

      by Idiomatick (976696)
      People selling organs could already do that. It just makes the storage space needed smaller.
    • This will make organlegging possible. If you can just grab any kidney off the street and use it to replace a failing one, people will.

      Or it might make xenografts (transplanting animal organs into humans) possible, I couldn't tell from the article. Which I guess PETA and other nutjobs would argue is still organlegging...

      Anyway, you're right to point out that every new technology has benefits but also downsides. However, keep in mind that now if you wake up in a bath of ice and a note saying "thanks for your kidneys," all you'll have to do is steal someone else's, you won't have to steal it back from the person who stole it from you.

    • by hedwards (940851)

      Not really, there are other very serious reasons why I wouldn't allow such an organ into me. Even if you ignore that and the obvious moral problems, there's still a good chance of getting HIV or hepatitis in that fashion, not to mention whatever else might be in their organ.

      And to top it all off the quality of the organ is likely to suffer greatly since it probably hasn't been handled in an appropriate fashion to maximize viability.

    • by Blakey Rat (99501)

      Or "The Brain That Wouldn't Die"!!

      Next thing you know, some doctor's going to cut off his girlfriend's head and keep it alive in a pan while he goes to strip clubs. Meanwhile, his assistant will get his arms pulled off by a telepathically controlled monster in the closet.

      Once again science fiction flawlessly predicts science fact!

    • On an unrelated note, I've finally solved for ? in the following:

      1. Buy 2 lb. of ice and a scalpel.
      2. Abduct a hobo.
      3. ?
      4. Profit!
  • About to donate... (Score:5, Interesting)

    by jdpars (1480913) on Wednesday April 08, 2009 @09:47AM (#27502565)
    As someone about to donate a kidney this summer, I really hope they work on this research more. Donor matching is incredibly difficult, and the risk of rejection poses issues not only with the health of the recipient (though that's obviously the major issue), but also with the psychological health of the donor. A failed donation can make you feel like crap.
  • Great News! (Score:4, Funny)

    by cybrthng (22291) on Wednesday April 08, 2009 @09:50AM (#27502627) Journal

    Now i can just keep smoking knowing my new lungs will fit in no problem! /s

    • Re: (Score:2, Funny)

      by immakiku (777365)
      Bad news: your would-be donor started chain smoking, thinking he'd easily get a lung replacement, and developed cancer even faster than you did.
  • Autoimmune Diseases (Score:2, Interesting)

    by Twide (1142927)
    by providing some sort of prevention, could this research help with autoimmune diseases like type 1 diabeties?
  • ...if... (Score:4, Insightful)

    by hehman (448117) on Wednesday April 08, 2009 @09:55AM (#27502709) Homepage Journal
    TFA and TF summary are missing the "if"s.

    Yes this could be a big deal, someday, if the finding holds up for other mammals (a big one), if it works for different kinds of transplants, if it's repeatable, if there are no other major consequences, if human trials are successful, if if if.

    Failure to include the "if"s is misleading at best and irresponsible at worst, for giving possibly false hope to those dealing with transplant rejection.
  • This (Score:3, Informative)

    by esocid (946821) on Wednesday April 08, 2009 @10:03AM (#27502845) Journal
    is just a different method of immunosuppression. Under the use of cyclosporin it actually reduces the functionality of the immune system, which I think is more dangerous than what this new method describes. This one will more or less silence the immune system, but leave it intact. This seems better since you can always turn it back on if it is necessary, at least that's what I got from TFA. But of course:

    "We have yet to determine exactly how the complex works. Once we do, I believe a clinical trial of this very non-toxic agent would be worthwhile."

    • by Abcd1234 (188840)

      is just a different method of immunosuppression.

      Yes, but with one *vital* difference: when the immune system comes back online, it doesn't attack the transplanted tissue. Last I checked, cyclosporin didn't work that way. So this is more than just a little "better" than your average immunosuppressant. It could be a potential revolution in the area of tissue transplantation.

    • You missed a couple things:
        - It only shuts down one PART of the immune system - the part that kills and eats large stuff.
        - It only shuts it down for a couple weeks - actually, teaches it that anything present during those two weeks is "friendly" - after which it turns back on again (including its memory of all the OTHER enemies it's seen before and is ready to pounce on that AREN'T present right now).

  • by moteyalpha (1228680) on Wednesday April 08, 2009 @10:12AM (#27502975) Homepage Journal
    I have been having problems with my hyperalloy combat chassis rejecting the external skin tissue overlays. I am making kill^H^H^H^H pet robots and this is just the trick I needed,
  • Allergies? (Score:5, Interesting)

    by MBoDot (1392501) on Wednesday April 08, 2009 @10:12AM (#27502977)
    I wonder if this could help in regards to allergies? I.e. stop the immune system from "reacting" too much?
    • allergy as far as I remember are linked to basophil , a type of leucocyte.
    • IANAD but I believe allergies involve a different immune response mechanism involving mast cells and histamines. But you do raise a good point, would this approach be useful in treating other autoimmune diseases like lupus or MS?

  • Looks like someone is getting a free trip to Sweden in the future...
    • Is that, if it wasn't for the big pile of explosives money they put on the table, nobody would give a shit.

      • by afidel (530433)
        Nah, most of the people receiving the Nobel are top of their field and hence well compensated, the money is nice but it's not what motivates most of the recipients.
  • Tissue Rejection (Score:2, Interesting)

    by hackus (159037)

    Is caused by the immune system not recognizing a foreign invader, the organ being transplanted.

    No?

    Then this guy wants to turn off that ability in the body?

    Yes?

    Historically speaking, whenever doctors have taken that approach it results in massive infection, and usually heart and lung problems.

    You would think after so many complications from transplants, they would stop pursuing that direction.

    Adult stem cell research seems to be the best approach to me. Same tissue so no rejection, and they do not have all

    • We are a long way off from full organ replacement in the form of Adult Stem Cells. In the meantime, we have to make due with transplants. Understanding how our immune system works (and can be controlled) is still important research.

      It isn't just tissue rejection. Lots of issues are caused by over-reaction by the immune system. Allergies are a good example. In fact, the gauze I have wrapped on my hand right now indicates that I would love a bit of reduction in my immune systems response.

      But, there are m

    • Fetal stem cells have a nasty habit of becoming tumors.

      I'm on my second kid and already I'm losing my hair and feel tired all the time. Unfortunately every time I ask my wife for some adult stem cell action, she turns me down.

    • Re: (Score:3, Insightful)

      by quantumghost (1052586)

      Is caused by the immune system not recognizing a foreign invader, the organ being transplanted.

      No?

      No. Rejection is the appropriate response by the body. With immunsuppresion, we modulate that response.

      Then this guy wants to turn off that ability in the body?

      Yes?

      No, not quite. Their proposal is to stimulate the immune system, but to add this "complex" that says "It's ok...don't attack"

      Historically speaking, whenever doctors have taken that approach it results in massive infection, and usually heart and lung problems.

      Well, if that were the case, most of the transplant pt's would be dead. Obviously you have taken this a little to far (reduce ad absurdum). First, keep in mind there are two major (humoral aka antibody mediated and c-mediated) and several minor arms to the immunesystem. The

    • You would think after so many complications from transplants, they would stop pursuing that direction... Adult stem cell research seems to be the best approach to me... Not that doctors understand any of this process, but why they continue to invest so much money in transplant research is baffling.

      What's baffling to me is that people advocate abandoning everything other than adult stem cells when no technology currently is capable of delivering what we want. Until adult stem cells actually do all the things we want them to and reveal themselves to be completely perfect, it would be foolish to give up on everything else. From my perspective, adult stem cells are less impressive than induced pluripotent stem cells. Adult stem cells produce fewer tumors, but getting them to make the cell type you wan

    • by sjames (1099)

      Historically speaking, whenever doctors have taken that approach it results in massive infection, and usually heart and lung problems.

      That's why this would be revolutionary if successful. It would briefly knock the immune system down and then cause it to accept the transplanted tissue as native while operating normally. That, in turn, would eliminate the problem of massive infection and the complications from rejection.

      Yes, adult stem cells might be even better one day, but we don't know how to make that work yet. We may or may not know how a decade from now. Meanwhile, THIS method can make life better (and possible) for many people.

  • Horrible Article (Score:5, Informative)

    by quantumghost (1052586) on Wednesday April 08, 2009 @11:04AM (#27503723) Journal
    While I am not a transplant surgeon I have worked on a surgical transplant service as part of my training. From my experience that first article has so many flaws in its description that it is not worth reading. I hope it does not reflect the original article.

    For starters "killer T-cells" are usually referred to as NK-cells and they are NOT thought to be part of the normal rejection process (they do not require activation and thus would no be stopped by immunosuppresion). There are three types of rejection hyperacute (pre-formed antibodies attack the organ in minutes - the organ literally dies as soon as it is transplanted - this is avoided by the "matching" process), acute (where T-cells [not NK-cells] attack the organ since it is not "self" and therefore "bad" - this is where immunosuppresion helps) and chronic (the body slowly rejects by allowing fibrosis of the vessels leading to the organ).

    Actual survival statics for all kidney allografts exceeds 95% today. 80% is quite a drop!

    Grafts are not assumed to "take" after 100 days allowing us to stop immunosuppresion! Immunosuppression is currently LIFELONG. There are a few instances where people have tolerated a non-identical twin transplant without medications, but this is _very_ rare. There is active research into finding the key to allow "tolerance" whereby we can drop the medications, but this is still early.

    IL-2 suppression is the _mainstay_ of current immunosuppressants both blocking its production via calcineurin ihibitors (cyclosporin and tacrolimus), inhibiting the response (sirolimus/rapamune), or by blocking the receptor with antibodies (basiliximab/daclizumab). (Please understand this is only about half of the therapies that are in use for immunosuppresion, I'm just focusing on the Il-2 aspect).

    Just followed the second link and it is _much better_. Still, I strongly disagree with their assertions of 100 days, just doesn't happen in humans. Apparently this study is using IL-2 STIMULATION with a complex that attempts to increase the regulatory T-cells...To me this means that this treatment will not co-exist with the current immunopupression dogma... this means that they will have to have a "complete" replacement for immunosuppresion they won't be able to add this to the current regiment and that means this treatment protocol will be quite sometime in the pipeline. And (fortunately) the authors acknowledge that they are optimistic, but aren't rushing off to collect their Nobel yet:

    I am also aware that effective approaches in mice do not necessarily give good results in humans because of subtle differences in the immune systems of mouse and man.

    • by sjames (1099)

      Actual survival statics for all kidney allografts exceeds 95% today. 80% is quite a drop!

      Presumably, in practice if the new method fails, the current treatment is the fallback. That is, 80% face no rejection issues and need no meds once the treatment is complete and 95% of the remaining 20% survive through current immunosuppresion therapy. That is certainly an improvement if it pans out.

      Still, I strongly disagree with their assertions of 100 days

      The 100 day criterion only applies in a non-immunosuppressed subject. That is, it only comes up in research. No actual patient would be transplanted without immunosuppresion. Hypothetically, if a patient was tra

    • Just curious but since you seem to know what you are talking about perhaps you could say something about transplant rejection and eyes (cornea, retina, ?)? I seem to remember reading something many years ago about the eyes having a "magical" ability to suppress rejection of transplanted material in a way that didn't happen with any other part of the body? Or am I just having a really fuzzy memory?
  • in which the body attacks itself? I'm thinking rheumatoid arthritis, lupus -- any chances those who suffer from these types of maladies should take hope at this news?
  • we can stop having unkempt slobs in dark alleys offering us x-ray eyes when in reality they are the two better z-ray eyes. No more will we be be indecisive about replacing our lungs with gills so we can more easily breathe underwater.

    All we need do is lie on the table and let the nice nurse with big hands hold us down while we feel a small pain.

    • we can stop having unkempt slobs in dark alleys offering us x-ray eyes when in reality they are the two better z-ray eyes. No more will we be be indecisive about replacing our lungs with gills so we can more easily breathe underwater.

      A few things wrong with your post

      1. Where would they get the x-ray eyes
      2. Same thing about human gills
      3. If you REPLACE your lungs with gills, you're not going to breathe underwater BETTER, you're ONLY going to breathe underwater.

  • This reminds me of several Niven books. He did a pretty good job of exploring were society would go if we developed this tech. Basically you'd have the criminal element murdering folks to extend others lives. That's actually not the bad part. We've got existing laws dealing with kidnapping and murder.

    What's the really bad news? Having about a hundred years or so of just about every crime having the death penalty so those that need/want organs can get them from criminals. Worse case, you get caught by those

  • Autoimmune Disorders (Score:5, Informative)

    by DynaSoar (714234) on Wednesday April 08, 2009 @11:54AM (#27504581) Journal

    This is better news than they even let on. A means to control rejection is the same as a means to control autoimmune disorders. Recent evidence supporting this is at http://www.ncbi.nlm.nih.gov/pubmed/19199937 [nih.gov] There's a partial list of such disorders at http://en.wikipedia.org/wiki/Autoimmune_disease [wikipedia.org]

    Knowing the mechanism for increasing Treg leads to understanding the mechanism for controlling, thus including suppressing Treg. That would boost the body's immune response. It could control (though not cure) AIDS, and lead to treatments of such as hepatitis B or C without requiring the very side effect laden pegylated alfa interferon 2 + ribavirin treatment. Inducing autoimmnune disease has already been suggested as a cancer treatment http://www.pnas.org/content/96/10/5340.full [pnas.org]

    As explained in http://en.wikipedia.org/wiki/Immune_system [wikipedia.org] an immune system is a very complex system with many components that interact. The more of these we can manipulate the closer we get to the kind of treatments suggested above.

  • by bugi (8479)

    Could this be used to teach one's body to stop with the allergies already?

  • I would dearly love to know if this technique would be suitable for helping people with autoimmune diseases. I have close friends with lupus, scleroderma, myasthenia gravis, and bipolar disorder. This could potentially be a godsend to them.

  • On March 1st and have been battling against rejection. I just got the result of a heart biopsy performed Monday and finally, my new heart is rejection free. The side effects of the drugs that it took to get me there are significant, so if this works in humans it will be a tremendous breakthrough. Of course my hope is that this technique would also work post transplant so that they can fix me. The article doesn't mention anything about that though...
  • Hmm... wasn't there this other thing that disabled all T-cells and that wasn't all that good...?

    I think it was called... AIDS!

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