Medical Bulletin 21/ October/ 2024

An explanation of how an NYU Langone Health surgical team performed the world’s first combined face and whole-eye transplantation will be presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California. Their achievement demonstrates the feasibility of transplanting an entire eye alongside a face transplant.

This operation, performed in 2023, showcases the potential for future eye transplant procedures and marks a significant advancement in vascularized composite allotransplantation (VCA). This type of transplantation is particularly challenging since, unlike organ transplants that involve just one type of tissue, like a kidney or heart, vascularized composite allotransplantation involves transplanting a complex combination of different tissues — skin, muscle, blood vessels, nerves, and sometimes bone — all in one piece.

Led by Eduardo D. Rodriguez, MD, FACS, director of the face transplant program at NYU Langone Health, the surgery involved a multidisciplinary team of more than 140 medical professionals. The transplant was performed on Aaron James, a 46-year-old military veteran from Arkansas, who suffered extensive facial and eye injuries from a high-voltage electrical accident.

According to the researchers, the primary goal was to ensure the transplanted eye remained viable, and the innovative techniques used were critical to achieving that outcome. The team focused on optimizing blood flow, a key factor for the long-term success of such a complex transplant.

The team developed a microvascular bypass technique to maintain blood flow to the transplanted eye. This bypass used nearby blood vessels, specifically the superficial temporal artery and vein, which were rotated to connect to the transplanted eye’s ophthalmic artery and vein. This innovative approach minimized retinal ischemia (loss of blood flow) and simultaneously restored blood flow to the face and eye, addressing a major challenge in eye transplantation.

Key Surgical Achievements

Reduced Ischemia: The bypass technique shortened the time without blood flow, protecting the transplanted eye.

Enhanced Blood Flow: Post-surgery tests confirmed strong blood flow to the retina and other critical areas.

Surgical Precision: Customized cutting guides ensured precise alignment and preserved the intricate structures of the eye and surrounding tissue.

Reference: Chinta S, et al. Revolutionizing Vascularized Composite Allotransplantation: Surgical Underpinnings of the World’s First Combined Face and Whole-Eye Transplantation, Scientific Forum, American College of Surgeons (ACS) Clinical Congress 2024.

A multi-state study, published in The Lancet, is one of the first real world data analyses of the effectiveness of the respiratory syncytial virus vaccine. VISION Network researchers report that across the board these vaccines were highly effective in older adults, even those with immunocompromising conditions, during the 2023-24 respiratory disease season, the first season after respiratory syncytial virus vaccine approval in the U.S.

respiratory syncytial virus vaccination provided approximately 80 percent protection against severe disease and hospitalization, Intensive Care Unit admission and death due to a respiratory infection as well as similar protection against less severe disease in adults who visited an emergency department but did not require hospitalization, ages 60 and older. Of this population, those ages 75 and older -- were at highest risk of severe disease and were the most likely to be hospitalized.

The study was a collaboration among the Centers for Disease Control and Prevention (CDC) and geographically diverse U.S. healthcare systems and research centers with integrated medical, laboratory and vaccination records – all members of the CDC’s VISION Network.

“Unlike this data study, clinical trials for the respiratory syncytial virus vaccine were underpowered to access the effectiveness of the vaccines against severe disease requiring hospitalization. Addressing this gap in evidence, we were able to use the power of big data to determine respiratory syncytial virus vaccine effectiveness, information needed to inform vaccine policy,” said study co-author Shaun Grannis, M.D., M.S. “As a data scientist and a family practice physician, I encourage older adults to follow CDC guidance and get vaccinated for respiratory syncytial virus as we enter this year’s and every year’s respiratory disease season.” Dr. Grannis is vice president for data and analytics at Regenstrief Institute and a professor of family medicine at the Indiana University School of Medicine.

Reference: Respiratory syncytial virus (RSV) vaccine effectiveness against RSV-associated hospitalisations and emergency department encounters among adults aged 60 years and older in the USA, October, 2023, to March, 2024: a test-negative design analysis, Payne, Amanda B et al.The Lancet, Volume 404, Issue 10462, 1547 - 1559

A National Institutes of Health (NIH)-funded clinical trial of an mpox vaccine in adolescents found it was safe and generated an antibody response equivalent to that seen in adults, according to a planned interim analysis of study data. Adolescents are among the population groups affected by mpox in the current Clade I mpox outbreak. The interim results of this trial were presented at the IDWeek2024 conference in Los Angeles.

People with compromised immune systems, children, and those who are pregnant are especially vulnerable to severe mpox regardless of the virus clade. A large proportion of people affected in the current Clade I outbreak in the DRC and other African countries are adolescents and children. The modified vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine is approved in several countries for the prevention of mpox and smallpox in adults, but insufficient data are available to support licensure for people younger than 18 years.

NIH’s National Institute of Allergy and Infectious Diseases (NIAID) is sponsoring a mid-stage study in the United States to evaluate the safety and immune response generated by two doses of MVA-BN in adolescents aged 12-17 years, comparing outcomes to those in adults aged 18-50 years. In a planned interim analysis, study investigators measured antibody levels two weeks after the second dose (study day 43) and monitored safety through 180 days after the second dose (study day 210). The analysis showed that the MVA-BN vaccine generated antibody levels in adolescents equivalent to those observed in adults at day 43 and found that the vaccine was well tolerated through study day 210. The overall frequency of adverse events was comparable between the study groups. Reports of dizziness were more common in adolescents than adults, but similar to the frequency of dizziness reported when other vaccines are administered in adolescents.

According to the study team, the interim data support the safety and quality of the immune response generated by the MVA-BN vaccine in adolescents, findings relevant to the United States and other areas where mpox cases have occurred. The authors underscored the need to evaluate the MVA-BN vaccine in younger children to extend the evidence base to all people affected by mpox.

Reference: CM Healy et al. Safety and Immunogenicity of Mpox Vaccination in Adolescents. IDWeek2024. Saturday, October 19, 2024.

Researchers from Tampere University, Finland, and Izmir Institute of Technology, Turkey, have developed an in vitro cancer model to investigate why breast cancer spreads to bone. Their findings hold promise for advancing the development of preclinical tools to predict breast cancer bone metastasis.

Approximately 80% of patients with primary breast cancer can be treated effectively, if they are diagnosed and treated promptly.

However, in many cases, the cancer has already spread to other parts of the body, or metastasized, at the time of diagnosis.

Metastatic cancer is incurable and accounts for more than 90% of cancer-related deaths.

Currently, there are no reliable in vitro models to study how breast cancer spreads to secondary organs such as bone, lung, liver or brain.

Now, researchers from the Precision Nanomaterials Group at Tampere University and the Cancer Molecular Biology Lab at Izmir Institute of Technology have used lab-on-a-chip platforms to create a physiologically relevant metastasis model to study the factors controlling breast cancer bone metastasis.

"Breast cancer most frequently spreads to bone, with an estimated rate of 53%, resulting in severe symptoms such as pain, pathological bone fractures, and spinal cord compressions. Our research provides a laboratory model that estimates the likelihood and mechanism of bone metastasis occurring within a living organism. This advances the understanding of molecular mechanisms in breast cancer bone metastasis and provides the groundwork for developing preclinical tools for predicting bone metastasis risk," says Burcu Firatligil-Yildirir, postdoctoral researcher at Tampere University and the first author of the paper.

According to Nonappa, Associate Professor and leader of the Precision Nanomaterials Group at Tampere University, developing sustainable in vitro models that mimic the complexity of the native breast and bone microenvironment is a multidisciplinary challenge.

"Our work shows that physiologically relevant in vitro models can be generated by combining cancer biology, microfluidics and soft materials. The results open new possibilities for developing predictive disease, diagnostic and treatment models," he says.