Three-Way "Domino" Kidney Transplant Includes a First

Surgeons at Johns Hopkins performed what is believed to be the world's first "domino" three-way kidney transplant involving an altruistic, non-directed living donor. Prior to the surgeries, transplant specialists searched their wait list of recipients for the best possible "matches" for kidney donors and discovered that a domino-effect could be achieved by including an altruistic donor who was willing to give his kidney to anyone who needed it.

"The shortage of donor kidneys for patients who need kidney transplantation is a national public health problem," says Robert A. Montgomery, M.D., Ph.D., lead surgeon on the case and director of Comprehensive Transplant Center at Johns Hopkins. "In this case, an altruistic donor's gift allowed three transplants to take place. All three transplanted kidneys are working well and the six donors and recipients are recovering quickly," added Montgomery.

The Hopkins team performed its first "triple swap" kidney exchange on July 28, 2003, building on the success of the paired kidney exchange program that it began in 2001. In a paired kidney exchange, incompatible donors agree to give a kidney to a stranger in order for their loved one to receive a kidney.

More than 60,000 people await kidney donation and are listed on the United Network of Organ Sharing (UNOS) recipient registry, and nearly one-third of patients with willing donors are excluded from kidney transplantation because of blood-type and other incompatibilities.

For more information visit our website for Incompatible Kidney Transplant Programs


AIDS Expert Says Strategy Needed to Combat "Feminization" of HIV/AIDS

In the June 10 issue of Science online, Thomas C. Quinn, M.D., professor of infectious diseases at Hopkins and a senior investigator at the National Institute of Allergy and Infectious Disease, reports that women have in the last 20 years moved from those least affected by HIV to those in whom the disease is spreading fastest.

"Women make up nearly half of the 40 million people worldwide currently infected with HIV, and in some developing countries, women represent the vast majority of those living with HIV/AIDS," Quinn says. 'They deserve a separate strategy because of the increasing and disproportionate numbers becoming infected, and the consequences of so many young mothers dying and leaving behind children who may also be infected as well as orphaned."

In sub-Saharan Africa, 60 percent of people living with HIV are female, and in South Africa, Zambia and Zimbabwe, young women ages 15 to 24 are three to six times more likely to be infected than men.

Excessive biological vulnerability to HIV among young women is believed to be due to an immature genital whose mucosal lining is easier for the virus to penetrate; to hormonal factors, such as the use of birth control pills; and to a high incidence of sexually transmitted diseases, which inflame the female genital area and provide additional target cells for the virus to infect.

Also needed are cultural programs for reshaping gender roles, such as educating more women about safe-sex practices, use of condoms, lessons on negotiating safe sex, and awareness campaigns about where to seek testing and treatment.

"Women are different when it comes to HIV infection," says Quinn. "If medical progress is to continue on how best to prevent and treat the disease, then developing specific strategies that empower women will be key to its success."

New Test for Early Detection of Prostate Cancer Shows Promise

In the first clinical study of a new blood protein associated with prostate cancer, researchers have found that the marker, called EPCA or early prostate cancer antigen, can successfully detect prostate cancer in its earliest stages.

Study results appeared in the May 15, 2005, issue of Cancer Research. The lead author is Robert H. Getzenberg, Ph.D., professor of urology and director of research at the James Buchanan Brady Urological Institute at Johns Hopkins.

The traditional two-step approach of PSA testing and digital rectal examination has helped doctors identify prostate tumors early, but PSA testing, like many disease-screening procedures, misses some cases of cancer and in other cases erroneously highlights noncancerous conditions.

"This new blood test, when coupled with PSA screening, may help reduce the number of both unnecessary biopsies and undetected prostate tumors," said Getzenberg,

The study suggests that the new test was correct 94 percent of the time. For comparison, only one-quarter of patients who undergo biopsies because they have elevated PSA values are actually positive for prostate cancer, while as many as 15 percent of those with low PSA values were found to have prostate cancer as detected by biopsy, according to Getzenberg. Larger clinical trials are under way to verify its usefulness for detecting prostate cancer in a larger sample of patients.

Prostate cancer is the most common type of cancer found in American men. The American Cancer Society estimates that there will be approximately 232,090 new cases of prostate cancer in the United States in 2005, and 30,350 men will die of this disease.


Once Given "No Respect", Cells' Tiny RNAS Take Driver's Seat in Cancer Development

Ribonucleic acid, or RNA, has long been viewed as a mere translation service for getting DNA's blueprint to make the proteins that are cells' workhorses. But new evidence shows that tiny bits of RNA not used make proteins actually play central roles in normal biology and the development of cancer.

"Scientists have known for a few years that production of microRNAs is only supposed to happen at certain times and in certain tissues, but no one had been able to identify what controlled the timing," says Joshua Mendell, M.D., Ph.D., assistant professor in the McKusick-Nathans Institute of Genetic Medicine. "We've identified the first such controller, a well-studied protein called Myc.

The work from investigators at Johns Hopkins is one of three papers on microRNAs in the June 9 issue of Nature.

The Myc protein (pronounced "mick") is already known to regulate about 10 percent to 15 percent of the genes in the human genome, and it is known to be faulty and overactive in many human cancer cells. Humand cells tested revealed that Myc directly controls the gene for a set of six microRNAs in a region of chromosome 13 tied to the development of human lymphoma.

Accompanying the Hopkins paper are two reports looking specifically at microRNAs in cancer -- one in humans, one in mice. One report found that human cancers' microRNA "fingerprints" identify the tumors' tissue of origin much better than other tests. The other study shows that over-expression of chromosome 13 microRNAs dramatically increases risk of cancer in mice.

"Whether too much or too little of these or other microRNAs is a good thing or a bad thing -- whether it would contribute to or help prevent cancer -- depends on their targets in the cell," adds Myc specialist Chi V. Dang, M.D., Ph.D., the Johns Hopkins Family Professor in Oncology Research and a professor of medicine in the McKusick-Nathans

July 22, 2005
Hopkins Teamwork and Communication Training for Healthcare
Center for Innovation in Quality Patient Care
Johns Hopkins Medicine, Baltimore MD

CME COURSES

July 17-22, 2005
Eighth Annual Johns Hopkins Internal Medicine Board Review Course 2005
Sheraton Baltimore North Hotel, Baltimore, MD

July 23-27, 2005
Seventh Annual Update in Pulmonary and Critical Care Medicine
Eldorado Hotel, Santa Fe, NM

July 28, 2005
Course on Research Ethics (C.O.R.E.)

July 31 to August 7, 2005
MDCT at Sea: Advanced Topics in Multidetector CT Scanning: A Cruise to Alaska
Departs from Vancouver, BC, Canada


INSIDE NEWS

Famed Irish Tenor, Physician and Disabled Athlete to Receive Johns Hopkins President's Medal

Ronan Tynan, M.D., a champion disabled athlete, physician and celebrated tenor, will receive the Johns Hopkins University President's Medal in recognition of his distinguished career. Johns Hopkins University President William R. Brody, M.D., Ph.D., will present the medal to Tynan on June 8.

"Dr. Tynan's life is a testament to persistence in the face of obstacles and his triumphs in medicine, competition and music carry messages we all can learn from," said Edward D. Miller, M.D., dean of the medical faculty and CEO of Johns Hopkins Medicine.

A member of The Irish Tenors group since 1998, Tynan was born with a lower limb disability, and became a double leg amputee at age 20 due to complications from an automobile accident. Within a year, he was winning gold medals at the Paralympic Games and, between 1981 and 1984, amassed 18 gold medals and 14 world records in track and field and equestrian events.

Tynan was the first disabled person ever admitted to the National College of Physical Education and later become a physician specializing in orthopedics and sports injuries. In his musical career, Tynan won the John McCormack Cup for Tenor Voice, the BBC talent show Go For It, and the prestigious International Operatic Singing Competition in Marmande, France.

The JHU President's Medal is an honor extended by the university to individuals who have achieved unusual distinction and has been awarded to heads of state, members of Congress, a Supreme Court Justice, diplomats, literary figures, academics and other noteworthy individuals.