solez stem cell and future of transplantation
DESCRIPTION
Dr. Kim Solez discusses "Confronting the Question of Stem Cells and the Future of Transplantation" for the Alberta Transplant Institute Fellows Lecture Series on September 2nd, 2014 at the University of Alberta in Edmonton, Canada.TRANSCRIPT
Confronting the Question of Stem Cells and the Future
of Transplantation Kim Solez, MD
Who Am I?
Who Am I?
Twenty-three years ago Kim Solez and Lorraine Racusen presided over a unique Meeting in Banff Canada.
Banff Classification of Kidney Transplant Pathology
Histologic criteria for the diagnosis of rejection and other conditions in the transplanted kidney, began 1991, updated and expanded every two years in consensus meeting.
1991 First Conference 1993 First Kidney International publication 1995 Integration with CADI 1997 Integration with CCTT classification 1999 Second KI paper. Clinical practice guidelines. Implantation biopsies. 2001 Classification of antibody-mediated rejection: Regulatory agencies
participating 2003 Genomics focus, ptc cell accumulation scoring 2005 Gene chip analysis. Elimination of CAN, identification of chronic
antibody-mediated rejection. 2007 First meeting far from a town called “Banff” – La Coruna, Spain. 2009 Working groups. Meeting in Banff, Alberta, Canada 2013 Establishment of Banff Foundation for Allograft Pathology
BANFF Classification - Milestones
Significance of ‘Banff papers’• 4244 citations of the 9 Banff meeting reports• 790 Banff / Transplantation papers in PubMed• Banff 2003 meeting report (ABMR criteria) = most cited AJT
paper• 3 Banff meeting reports are among the top 4 cited AJT articles
Organizational structure of the Banff Foundation For Allograft Pathology
Board of Trustees: K. Solez (Chair), L. Racusen, D. Glotz, J. Demetris, M. Mengel, M. Mihatsch, D. Seron, N.
Schmidt
2015 Local Conference chair: Michael Mengel
Organ Steering committee Chairs: Composite tissues: Linda CendalesHeart : Rene RodriguezKidney: Mark HaasLiver: Jake DemetrisLung: William Wallace and Carol FarverPancreas: Cinthia Drachenberg
Banff Working Group (BWG) Leads: Molecular transplantation pathology: Michael Mengel, Banu SisIsolated v-lesions: Banu Sis, Ed KrausQuality assurance in transplantation diagnostics: Michael Mengel and Parmjeet RandhawaC4d-negative ABMR: Mark Haas, Banu Sis, Alexandre LoupyFibrosis scoring: Robert Colvin, Brad Farris, Michael MengelDigital Pathology in Transplantation: Jake Demetris
2015 Scientific program committee: Alex Loupy (Chair)Mark Haas, Banu Sis, Kathryn Tinkham, Candice Rofousse, Chris Bellamy, Lynn Cornell, Carmen LeFaucheurComposite tissues: Linda CendalesHeart : Rene RodriguezLiver: Jake DemetrisLung: William Wallace and Carol FarverPancreas/Islets: Cinthia Drachenberg and John Papadimitriou
Secretary/Treasurer: Michael Mengel
funding
collaboration
reports to
reports to
collaboration
collaboration
reports to
collaborationprogress reports to Budged
proposal and accountability for meeting costs
support
BANFF Conferences On Allograft Pathology 1991-Forever?
Target Audience for the 2015 joint CST/Banff meeting: total ~600 expected delegates Basic Scientists Pathologists Immunogeneticists and HLA experts Transplant Physicians: Internal Medicine, Surgery,
Infectious Diseases, Critical Care Allied Health Care Students, Trainees, Fellows
The Banff ProcessConsensus communication in renal transplantation
a
The Banff lesions
g, i, t, v - score
The Banff communityPathologistsNephrologistsTx-SurgeonsLab-Medicine
established by
consensus in 1991
The Banff classificationCurrent consensus for diagnostics
moderatedBanff meetings
thesis-antithesis-synthesis
tentative
thresholds
participate
refinementBanff Working Groups
Feedback concerning weaknesses and strengths by results from independent research
New membersBiostaticiansMolecular Biologists“Omics”-specialists
Off-springsLiverPancreasLung, HeartCTA
The Banff Allograft Pathology Meetings Are Sometimes Said to be the “Best Meetings In Transplantation”. How Can This Possibly Be So?
The Banff Schema was first developed at a meeting of pathologists, clinicians and surgeons in Banff, Alberta, Canada, August 2-4, 1991 and has become the worldwide standard for the interpretation of transplant biopsies.
What People Mean is that They Like the Size, Atmosphere, Spirit, and Productivity of the Banff Meetings. These Attributes Must be Maintained.
The Banff Schema was first developed at a meeting of pathologists, clinicians and surgeons in Banff, Alberta, Canada, August 2-4, 1991 and has become the worldwide standard for the interpretation of transplant biopsies.
Dunbar’s Number of 150 People You Can Have Significant Empathetic Friendships With. Need to Maintain This Intimate Feeling in A Larger Meeting of 600.
Future ConceptsMoore’s Law&Eroom’s Law , the
technological Singularity and exponential change, exponential decline in # new drugs per billion dollars R&D expenditure.
The Technological Singularity
The Banff Foundation for Allograft Pathology Must Remain Youthful and Relevant for the Future – Must Adapt, Plan for Changes
As the field changes and stem-cell-grown organs replace transplantation, the organization must change with it
Transplantation may be loosing its luster but luster of the Banff Foundation for Allograft Pathology can remain strong.
As an exercise in alternative realities I asked participants to consider the very different life of David Crippen, my counterpart in critical care medicine. We need to consider changes that large!
The spectacular dynamics influencing the pace of stem generation of organs replacing transplantation in the future.
There were YouTube videos (now removed) suggesting that stem cell generation of complex organs in humans would be routine by 2020. Problems of clotting, endothelial loss, and cell type selection errors not mentioned.
The dramatic slowdown of new drug approvals (Eroom’s Law) by the FDA suggests that the FDA is ripe for disruptive innovation. Has happened.
However stem cell therapies may be the last area the FDA will relax regulation in, as unproven bogus stem cell therapies are causing widespread suffering and protection of the general public is needed.
Many problems with stem cell generate organs not being discussed. Do not exclude yourself from the action in this area!
Many problems with stem cell generate organs not being discussed. Need to get those conversations to happen.
The recellularized organ clots like crazy, impossible to regenerate more than 80% of endothelial surface. Artificial heparized surface not fenestrated. Cell traffic abnormal.
Hard to get right types of cells to right places. Podocytes seems to be terminally differentiated cells,
when attempt to culture them they turn into different type of cell.
Kidney progenitor stem cell difficult to identify, kidney work has lagged behind.
Easy to make stem cell generated kidneys that lack loop of Henle. Could produce lethal polyuria. What is “function”?
Many old fashioned questions of physiology about how the stem cell generated organ works, not just true for kidney, true for every organ.
Banff Foundation for Allograft Pathology and Banff Meetings Must Adapt to Future Changes in Field of Transplantation
Transplant pathologists will also become tissue engineering pathologists, pathologists who analyse organs grown from stem cells. This is not something beyond us, we can adapt to a work life that includes stem cells.. Someone needs to cross the disciplines,
It is OK to Allow the Natural Resistance to Change and Nostalgia for the Past to Motivate You!
Many of the questions that need to be posed about stem cell generated organs are old fashioned questions, intact nephron hypothesis, cell regeneration, stunned myocardium, contraction band necrosis etc. Use your nostalgia! Stimulate conversations between stem cell researchers and transplant physicians.
Turtles All
the Way
Down abstrusegoose.com/155
Animal Analogies
Limited.Need Human
Alter Egos
CCM-L Characters Off-Topic
DiscussionsNEPHROL
No CharactersNo Off-Topic Discussions
Many Military Awards, Karate
Black BeltNo Civilian AwardsNever Served in
MilitaryMany Civilian
Awards
Rock BandMotorcycles
Colorful History in 60’s and 70’s
No Band orMotorcycle
Boring Young Person
Crippen A Myth?
Proves the Metaphor
Works!
In our original location we had mule deer poking their heads
into the meeting rooms!We’ve come a long way!