SYMPOSIUM PRESENTS CHALLENGES AND TRIUMPHS OFTRANSFUSION MEDICINECC Department <strong>of</strong> TransfusionMedicine Chief Dr. Harvey Klein(left) presented the 2010 RichardJ. Davey Award to Dr. WalterDzik <strong>of</strong> Massachusetts GeneralHospital for his dedication toresearch and education in transfusionmedicine.The <strong>Clinical</strong> <strong>Center</strong> Department <strong>of</strong> TransfusionMedicine hosted the 29th annual Immunohematology& Blood Transfusion Symposium, cosponsoredby the American Red Cross, in MasurAuditorium on September 16, 2010.The programprovides practical information about recentdevelopments, current practices, controversies, andlaboratory management issues relative to transfusionmedicine.The Richard J. Davey Award—given annuallyto an individual whose contributions havesignificantly advanced the field <strong>of</strong> transfusionmedicine—was presented to Dr.Walter Dzik,co-director <strong>of</strong> the Blood Transfusion Service atMassachusetts General Hospital and associatepr<strong>of</strong>essor <strong>of</strong> pathology at Harvard Medical School.He was a fellow in transfusion medicine herefrom 1981 to 1983.During the symposium, Dzik presented on cerebralmalaria and cytoadherence. Infected red bloodcells attach to blood vessels by binding proteinpfEMP-1 to the CD-36 antigen. CD-36 is foundon platelets, which bond to endothelium (layer <strong>of</strong>cells in blood vessels), and endothelium itself.The clusters <strong>of</strong> red blood cells, platelets, andendothelium make blood delivery difficult andan be lethal.Complicating the connection, CD-36is also present on monocytes, which swallow redblood cells thereby protecting from dangerousadhesions to endothelium.After a few unsuccessful attempts, Dzik’s groupfound a way to code for CD-36 on monocytesversus platelets to examine expression in relationto cerebral malaria and outpatient malaria.Theyare doing so in a clinical study in Uganda.”Thereare a lot <strong>of</strong> obstacles in trying to get to the heart<strong>of</strong> that matter,” Dzik said.“You just have to acceptthat and keep working toward your intent.”Dr. Susan Stramer, executive scientific <strong>of</strong>ficer atthe American Red Cross, presented “Plagues inthe Blood Supply? Emerging Infectious DiseaseAgents du Jour” and listed causes <strong>of</strong> infectiousdisease risk, including failure <strong>of</strong> donor selection,insensitive tests, mutant/variant organisms, andemerging/reemerging agents. Other presentationsduring the day-long symposium focused on infectiousdiseases, blood and drug evaluation, bloodusage and monitoring, and application <strong>of</strong> redblood cell molecular testing.physician draws acrowd in LipsettReflecting on the lessons learned andchallenges faced in the field with internationalmedical humanitarian organization DoctorsWithout Borders/Médecins Sans Frontieres(MSF), Dr. Jean-Herve Bradol spoke to apacked Lipsett Auditorium on April 16, 2010.Director <strong>of</strong> research at the MSF <strong>Center</strong> forReflection on Humanitarian Action & Knowledge,Bradol has extensive field experiencewith MSF including in refugee camps in Thailandand in Rwanda during the early 1990s.He also served as president <strong>of</strong> MSF-France foreight years and is a former board member <strong>of</strong>MSF-USA. Bradol discussed his experiencewith Burmese refugees in Thailand sufferingfrom advanced malaria. A patient told him thathe had resorted to smuggled drugs from Chinabecause the MSF drugs were not working. Bradol’steam obtained the other pharmaceuticalsand started investigating their safetyand efficacy.“But setting up trials in those environments isnot that easy,” Bradol said. The refugee communitywas not initially receptive to using aChinese drug not registered in their country,and ethical concerns were rampant in conductingresearch with such a patient population.“How can a refugee give consent when thequestion is asked by the very organization thatprovides their basic survival? The person isnot really in a position to say no,” Bradol said.He reported that with advance treatments andpreventive measures such as mosquito nets,malaria is no longer a major public health issuein that area.His lecture coincided with the release <strong>of</strong> theMSF collection Medical Innovation in HumanitarianSituations: The Work <strong>of</strong> Médecins SansFrontieres, which illustrates 10 examples <strong>of</strong> thecomplexities <strong>of</strong> introducing medical innovationsin the midst <strong>of</strong> difficult humanitarian crises.22 • ANNUAL REPORT <strong>2011</strong>
PHARMACEUTICAL DEVELOPMENT SECTION UPGRADES TONEW, TAILOR-MADE SPACEThe unique and groundbreaking work <strong>of</strong> the<strong>Clinical</strong> <strong>Center</strong> calls for clinical trial drugs notalways available from a study sponsor, so we makeour own.The CC Pharmacy Department PharmaceuticalDevelopment Section (PDS) was established in1956 and has operated in several areas over the lasthalf-century. Evolving good manufacturing practices,as mandated by the Food and Drug Administration,presented an opportunity to upgrade thePDS environment and equipment in a new spacecreated especially for the section.PDS formulates and analyzes vaccines and medicationsnot able to be purchased from manufacturers.These products account for one-third <strong>of</strong> the1,000 separate drugs (including placebos andvarying strengths) that the CC uses in its researchprotocols, said PDS Chief George Grimes, Jr.An example is a topical, sterile gel <strong>of</strong> resiniferatoxin,which PDS is developing for researchinto its utility as a pain treatment in an upcoming<strong>National</strong> Institute <strong>of</strong> Dental and Crani<strong>of</strong>acialResearch protocol from Dr. Mike Iadarola, chief<strong>of</strong> the NIDCR Integrative Neurobiology andNeuronal Gene Expression Unit, and Dr.AndrewMannes, staff clinician in the CC Department <strong>of</strong>Perioperative Medicine.The section also registers and packages all drugsobtained from outside pharmaceutical companiesfor use in CC clinical trials.“We handle all investigationaldrugs,” Grimes said.“In the double-blindstudies in particular, all the drugs look alike, so wehave to be really good about record-keeping andprocedures.”In the new facility, there’s a different room forseemingly every step <strong>of</strong> their process, allowing forbetter air and overall quality control, Grimes said.Where staffers work with HIV-infected blood inthe <strong>Clinical</strong> Pharmacokinetic Research Laboratory,for example, negative air flow (pulling more air inthan is pumped out) and the use <strong>of</strong> a biologicalsafety cabinet decreases the risk <strong>of</strong> contaminationoutside the confines <strong>of</strong> the laboratory.<strong>Clinical</strong> Pharmacokinetic Research Laboratorystaff characterize how drugs are excreted andmetabolized, another function <strong>of</strong> the PDS.Pharmaceutical DevelopmentSection Chief GeorgeGrimes, Jr., does the honorsat a ribbon-cutting onJanuary 8, 2010. With himare CC Director Dr. John I.Gallin (left) and PharmacyChief Robert DeChrist<strong>of</strong>oro.PDS staff (from left) KumiIshida, Scott Hotaling, andRam Agarwal adjust the newautomatic capsule machinein their section’s updatedarea.ANNUAL REPORT <strong>2011</strong>• 23