Checkpoint therapy coming to transplantation

John J. Fung, MD, PhD, FACS, FAASLD
John J. Fung, MD, PhD, FACS, FAASLD

Transplantation isn’t just surgery; it’s a combination of surgery and medicine, according to John J. Fung, MD, PhD, FACS, FAASLD, professor of surgery, chief of transplant surgery, and co-director of the Transplantation Institute at the University of Chicago Medicine, IL.

“Organ transplantation would not be successful without effective immunosuppression,” he said. “The next step in transplantation is the introduction of new immunosuppression protocols with less toxicity and more specificity.”

Dr. Fung will explore the latest advances in immunosuppression Monday during the I.S. Ravdin Lecture in the Basic and Surgical Sciences, Suppressing the Immune System: The Good, The Bad, and The Ugly. Dr. Fung has been involved in several critical advances in immunosuppression in the last 30 years.

“My particular research interest is trying to understand the immune system: What are the immune cells and what are the relationships between those cells and the transplanted organ?” Dr. Fung said. “We know that many animals and some patients who have had a liver transplant can develop tolerance and become totally free of immunosuppression. By understanding the relationship between the host immune system and the transplanted liver, we may be able to improve other transplant outcomes.”

One area of research is building on findings in cancer immunobiology. Cancers have the ability to mask themselves from the immune system. The tumor convinces the body to tolerate malignant tissue as it continues to grow and spread, eventually killing the host. In a similar manner, some transplanted organs have the ability to mask themselves from the immune system and induce the host to tolerate foreign tissue that would ordinarily be attacked.

“The next step in immunotherapy will be based on the concept of checkpoint inhibition,” Dr. Fung said. “Interactions between the immune system and tissue, sometimes referred to as peripheral tolerance, utilize checkpoints in the immune system that modulate the immune system. These checkpoints in the immune system can be inhibited in cancer immunotherapy to allow the body to attack the cancer. Those same checkpoints in the immune system can be activated to promote transplant tolerance.”

Dr. Fung brings a unique perspective to transplant surgery and research. He is part surgeon, part basic and translational researcher, and part clinical scientist. He’s an academician who is firmly enmeshed in clinical practice.

“Surgeons are not just surgeons anymore,” Dr. Fung said. “We don’t just cut and sew and end our care when we walk out of the operating room. Surgery today is about managing patients, optimizing them to the time of surgery, and caring for them in partnership with others after surgery. We combine the best of surgery and the best of medical care. And if you want to manage your patients for the best outcome, you have to know what your options are and where the field is heading.”

This annual lecture has been sponsored by the I.S. Ravdin Surgical Society since 1964 to honor Dr. Ravdin by promoting knowledge in basic sciences with application to surgery.