Noninvasive graft rejection test
A blood test will be able to determine the rejection of a transplanted heart without a biopsy
In addition, this method allows you to determine rejection for several weeks, or even months earlier than by analyzing a tissue biopsy. The proposed analysis, called a cell-free DNA test, surpassed the standard test widely used in practice in terms of the effectiveness of detecting rejection. Such an analysis is possible, because during rejection, the DNA of the heart cells attacked by the immune system and dead will enter the blood. Article by Iwijn De Vlaminck et al. Circulating Cell-Free DNA Enables Noninvasive Diagnosis of Heart Transplant Rejection published in the journal Science Translational Medicine.
In 2011, scientists conducted a small pilot study, the results of which were confirmed by the results of this work. This time, 65 patients (21 children and 44 adults) were involved, who were monitored starting from the period of preparation for surgery and during the postoperative period. Both biopsy samples and blood were analyzed in patients. Using a DNA test, scientists were able to accurately identify two main types of rejection (antibody-mediated and acute cellular) in 24 patients. Moreover, signs of rejection were detected up to 5 months earlier than the first alarming data appeared in the analysis of biopsies.
Professor Stephen Quake described the new method as safer, cheaper and more accurate than traditional heart biopsy. And Associate Professor Kiran Kash (Kiran Khush) stressed that the use of a DNA test will allow to determine rejection much earlier, thereby avoiding irreversible destruction of the transplanted organ. This test can be revolutionary in the organization of care for patients with transplanted organs. In addition, the use of a DNA blood test allows you to expand the range of studies. For example, it is possible to check the infectious status of the patient and some other indicators that may be significant during transplantation.
The cell-free DNA test was first developed in 2008 for non-invasive diagnostics during pregnancy. There is such a phenomenon as the circulation of individual fetal cells in the maternal bloodstream. Using single nucleotide polymorphism (SNPs) analysis, maternal and fetal DNA can be separated for molecular analysis. The same principle is the basis of the described method, since DNA of donor origin can be detected in the human bloodstream after organ transplantation.
Stanford University has filed a patent application for this diagnostic method. Work is underway to maximize the adaptation of the method to the conditions of routine clinical use.
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