Biomedical sciences, surgery collaboration comes to fruition

A translational research study has opened door to new treatments that could improve outcomes for heart surgery and transfusion patients.

An international study on cardiac surgery and transfusion medicine published in JACC: Basic to Translational Science is the result of a collaboration among physicians, surgeons, scientists and physician-scientists from across the School of Biomedical Sciences and Melbourne Medical School.

The collaboration is the result of an initiative launched in 2018 by Inaugural Head of School Professor Fabienne Mackay, now Director and CEO of QIMR Berghofer Medical Research Institute, to foster interactions between the schools that comprise the Faculty of Medical Health and Dental Science.

Following cardiac surgery, 20 per cent of patients develop Acute Kidney Injury (AKI), which is associated with increased mortality. Patients receiving a blood transfusion during surgery are at increased risk of developing this complication.

To study the underlying causes, Professor Jose Villadangos from the Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, and the Department of Biochemistry and Pharmacology at the Bio21 Institute, teamed up with Associate Professor Joseph Ischia of the Department of Surgery and Professor Karim Asehnoune of Nantes University. They hypothesized  that packed red blood cells (PRBC) used for transfusion contain inflammatory proteins that could be responsible for cardiac surgery–associated AKI.

The results, published in the paper Transfusion-Related Renal Dysfunction After Cardiac Surgery, found that the protein myeloid-related protein_14 (MRP14) induces accumulation of a type of immune cell, called neutrophil, in the kidneys. Neutrophils contribute to cause inflammation and normally protect against bacterial infection, but they can also accidentally cause damage of healthy tissues.

The researchers found that during AKI neutrophils damage the kidneys by trogocytosis, a process where a cell rips the outer membrane from other cells and has been likened to “cannibalism”. The researchers concluded that monitoring the levels of MRP14 in blood before transfusion, or reducing its amount or activity, may prevent cardiac surgery-associated AKI.

The research was accompanied by editor comment from Rajesh Gupta, MD, who wrote: “The work by Vourc’h et al has opened the door to many future investigations, and hopefully, to new treatments that can improve outcomes in cardiac surgery and transfusion medicine”.

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