MedStar Georgetown University Hospital

Research is a critical part of what we do at MedStar Georgetown University Hospital, as we are always searching for innovative ways to treat and manage advanced disease and transplantation surgery.

Research is conducted under the oversight of Dr. Thomas Fishbein, M.D. Executive Director of MedStar Georgetown Transplant Institute. Clinical Trials are led by highly skilled Surgeons and Clinicians as Primary Investigators (P.I.) who specialized in Transplant. We are committed to bringing basic research into medical and nursing practice to produce meaningful health outcomes to improve medicine.

All of our studies are presented at regional, national, and international meetings and are published in peer-reviewed scientific journals. We are committed to advancing the art and science of transplantation and to improving the quality of patients' lives through systematic investigation.

In 2013, the Center for Translational Transplant Medicine (CTTM) was jointly formed by the MedStar Georgetown Transplant Institute (MGTI) and Georgetown University Medical Center with the ultimate goal of transforming patient care. Toward that end, CTTM promotes the cross-fertilization of ideas by bringing together disease groups and specialties, laboratory scientists and transplant physicians to work together for innovative responses to current clinical problems.

Overarching areas of interest include immunity modulation, inflammation, cellular reprogramming, tolerance induction and other potential paths to improve graft survival and reduce infection and rejection, particularly for complex small bowel transplantations.

Since its debut, approximately 100 clinical trials have been launched under the CTTM umbrella, ranging from investigator-initiated basic studies to retrospective chart reviews to sponsored therapeutic drug and clinical device trials. By comparison, only 85 transplant-related trials were conducted altogether over the previous decade.

As a result of such activities, clinical research enrollment for phase I and phase II surgery trials is now double what it was before CTTM. Today, nearly all MGTI physicians are engaged in research to hasten the clinical adaptation of new and better protocols, treatment algorithms, immunosuppressive regimens, surgical techniques and other advancements.    

In 2015, CTTM expanded into a new 3,000-square-foot lab dedicated to transplant immunology and recruited Alexander Kroemer, MD, PhD, to the newly created position of Transplant Lab Chief, advancing the pace of research and development even further. 

Intestinal Immunology

Intestinal immunology is a prime example of how CTTM is contributing to the field. With so few intestinal transplant centers in the nation, MGTI fulfills a vital role by collecting, processing and storing intestinal biospecimens from its well-established center. The largest such repository in the world, MGTI currently houses 3,000 samples which it shares with other institutions conducting intestine-­related scientific investigations nationwide. Combined with MGTI’s own body of work, these collective studies are molding the future of overall gastrointestinal care.

MGTI’s intestinal research focuses on delineating the mechanisms that contribute to post-transplant infection and rejection of the small bowel. By identifying specific biomarkers, translational researchers hope to manipulate the body’s immune response for improved
graft survival.  

Center of Liver and Pancreas Sugery

Chronic pancreatitis is uncommon and difficult to diagnose, often eluding detection until its advanced stages. By then, unresolved disease may have consumed much of the organ’s insulin-producing islet cells, leaving some patients with few to isolate and transplant. 

That scenario reduces the number of patients who could benefit from the procedure, prompting the physician/scientists at MGTI to search for novel solutions on multiple fronts.

• Effect of Liver Histopathology on Islet Engraftment Post-Autologous Transplant. With support from the National Pancreas Foundation, MGTI studied how pre-existing degrees of fat and inflammation in the liver may affect the organ’s reaction to engraftment, possibly leading to new ways to optimize the liver’s acceptance of transplanted islet cells.
• Application of Human Bone Marrow-Derived Mesenchymal Stem Cells to Human Islet Transplantation. In this U.S. Department of Defense-funded study, collaborators from the MGTI islet cell transplant lab and MedStar Georgetown University Hospital’s Blood and Marrow Collection Program—the world’s largest—are examining the effect of transplanting mesenchymal stem cells (MSC) and islet cells simultaneously to improve islet cell engraftment, promote immunomodulation and convert MSC into insulin-producing cells. A similar MGTI-sponsored study substitutes human placenta-derived amniotic epithelial cells for MSC.
• Pseudo Islet Generation from Human Islet Cells. In this joint study with the biotechnology firm Propagenix, human islet cells are broken down into their component parts, stimulated to grow and then reassembled to create a pseudo islet cell. To date, MGTI’s researchers have proven that the pseudo cells produce insulin in vitro and are now testing how the pseudo cells perform in an animal model. 

Center for Intestinal Care and Transplant 

The Center for Intestinal Care and Transplant has an active lab and research program, along with one of the nation’s few intestinal tissue repositories which supports scientific investigation here and elsewhere.

A major current focus is determining how key immunologic factors affect long-term transplant outcomes in intestinal transplant recipients by:

• Advancing understanding of critical interactions between host innate and adaptive immune cells such as antigen presenting cells and T cells
• Investigating how recently discovered innate effector cells such as innate lymphoid cells (ILCs) critically determine allograft rejection or acceptance
• Studying the role of the microbiome and its therapeutic relevance in intestinal transplantation
• Examining the interactions between innate and adaptive immune responses and intestinal stem cells, and their respective roles in intestinal regeneration after small bowel transplantation
• Translating integrative knowledge into novel diagnostic and therapeutic strategies such as immunomonitoring and immunotherapies that will benefit intestinal transplant patients in the future

Transplant Center for Children

Current areas of inquiry include research into intravenous lipid therapy for TPN-associated liver disease, the use of a genetically engineered hormone (GLP-2) to improve intestinal rehabilitation and prevent the need for intestinal transplant in children, and understanding and reducing opportunistic infections.