Heart And Lung Transplant Patients May No Longer Need Biopsies And Could Receive Personalized Care From Biomarkers

Personalized care is an integrative process of tailoring care to an individual patient's characteristics or preferences, based on each individual's unique biology, behavior and environment. At this year's meeting, researchers are presenting data from gene and protein based blood testing that may be helpful for reducing immunosuppression. Related data suggests gene analysis may allow for prediction of future occurrence of cardiac allograft rejection and its diagnosis.

Speaking in plenary sessions at the meeting, experts provided current perspectives on biomarkers in transplantation. In "Biomarkers: What Are They? How Might They Aid in Care of Allograft Recipients and Other Patients," Christopher J. O'Donnell, MD, MPH, from NIH National Heart, Lung and Blood Institute/Framingham Heart Study, Framingham, MA, presented data pertaining to personalized care, its benefits and future impact on heart and lung patients.

Dr. Christoph Borchers, Director of the Genome Canada Proteomics Platform at the University of Victoria, British Columbia, provided a look at the emerging strategies for plasma protein analysis in "New Tools, Technologies and Results for Probing Proteomic Biomarkers in Plasma of Transplant Patients."

Finally, Dr. Ralph Weissleder from Massachusetts General Hospital/Harvard discussed "Imaging Biomarkers: New Horizons and Opportunities in Transplantation," and shared the latest information on imaging biomarkers and how advanced imaging techniques may soon help in the management of transplant patients.

"In recent years, there has been an intensive focus on enhancing our ability to provide the most particular predictive, diagnostic, prognostic and therapeutic guidance for patients. This intent has been enabled by unbiased and targeted examination of genotypes and haplotypes that may convey risk or protection against certain disease processes like immune rejection, as well as by defining the molecular signatures of a disease process like rejection by measuring mRNA, proteins or metabolites in the blood or urine. Distillation of such data, along with clinical features, is intended to improve care, reduce costs, and make patients lives more enjoyable," said Bruce McManus, MD, PhD, University of British Columbia, one of the Co-Chairs for the biomarkers plenary session.

Until recently, heart muscle biopsy was the only method available to rule out heart transplant rejection and guide treatment with anti-rejection, or immunosuppressive, therapy. Aside from the invasive and painful nature of the procedure, a biopsy is only able to detect rejection after damage has already occurred to the heart tissue. Similar dilemmas exist in the monitoring of lung transplant recipients.

Alternatively, non-invasive molecular testing of a routine blood sample allows analysis of gene expression in white blood cells, proteins in the plasma, and metabolites in blood and urine. The latter biomarkers provide information on the immune, inflammatory and injury status of the transplanted heart before tissue damage occurs. The new and original information on biomarkers and personalized care in lectures given at ISHLT will offer a deeper knowledge of this innovative direction that is revolutionizing health care. The discussion will also raise awareness of alternatives to biopsy procedures that are on the horizon.