UVA Health System Blog

Mary Laughlin, MD, first became interested in using stem cells to treat diseases when she was in medical school in the 1980s.

A few decades and countless hours of research and trial work later, that idea is healing hundreds of people at UVA.

And, according to Laughlin, just getting started in terms of the possibilities.

The initial cases at UVA are treating patients with disorders such as leukemia and non-Hodgkin lymphoma, but trials are under way to use stem cells from umbilical cord blood for patients recovering from stroke and those with cardiovascular disease and even diabetes, to name just a few.

Cord Blood Cells

First, the obligatory disclaimer in any discussion about stem cells: The cells used for procedures at UVA are not derived from the controversial embryonic stem cells.

They instead come from the umbilical cords of healthy newborns, and would probably be discarded if not donated for research or medical purposes.

“There are no ethical concerns,” says Laughlin, noting the widespread acceptance of umbilical cord blood for medical research and therapy.

More importantly, the cord cells being used at UVA appear more effective than the alternatives: Adult stem cells and embryonic stem cells.

The problem with embryonic stem cells is that they are more likely to form a tumor, Laughlin says. “That is the major limitation for regulatory agencies like the FDA.”

Even without the thorny ethical issues involving embryonic cells, cord blood cells represent the most effective therapy, according to Laughlin.

Stem cells have the ability to become other cell types in your body, and can be used to produce red bood cells, white blood cells or platelets.

Stem Cell Transplants: Safety

Although it may seem like new therapy, Laughlin takes pains to note the years of research behind the procedures currently being carried out at UVA, pointing out that 24,000 humans have received transplanted cord blood throughout the world at this point.

The reason cord blood therapies now seem to be moving so fast, Laughlin says, is because researchers have identified roughly 600,000 specific cord blood cell lines. This means that a doctor at UVA can use a search engine to match a patient with the lines of cord blood cells available, and usually come up with a suitable  match.

The Numbers

When the UVA stem cell transplant program kicked off in early 2012, officials predicted the new group would perform about 15 transplant procedures in the first year.

Instead, the group expects to do about 120 in 2012 and is getting patient referrals from across Virginia.

“This is a unique, differentiating program that serves an unmet need in the Commonwealth of Virginia,” Laughlin says.

One major step on the near-term horizon may be accreditation from the Foundation for the Accreditation of Cellular Therapy, or FACT.

The Stem Cell Patient Experience

When a patient does come to UVA for stem cell therapy, the process is not an easy one.

Stem cell transplants are intensive procedures that can take a serious mental and physical toll on a patient.

Patients can typically count on being in the hospital for four weeks, and must commit to being in Charlottesville for 100 days with a caretaker to assist them.

Still, Laughlin says the patients who have undergone the procedure have become the program’s biggest advocates, as many have almost literally been given new life.

Stem Cells Building the Future at UVA

Laughlin says UVA is now well positioned to be at the forefront of the rapidly emerging world of stem cell therapy.

“My work is one small piece, but there is a robust knowledge base here,” Laughlin says, including in UVA’s labs and its surgery department.

Laughlin says the collaborative nature of UVA makes it well suited to be a leader in the field.

While the focus now is blood diseases, Laughlin says she expects UVA could eventually be among the institutions using stem cells to repair all of the organs of the body, including the brain, heart and pancreas.

“I think the near horizon for cord blood stem cell therapies is brain injury, spinal cord injury, type-1 diabetes and cardiovascular disease,” says Laughlin.

To move forward to such things will call on the combined talents of a lot of specialists.

“I’m just the face. It takes a village,” Laughlin says. “At any one time, our patients are cared for by 30 people. To coordinate all of that is just a pleasure.”

Learn more about the Stem Cell Transplant Program.

Mike Miller was a healthy 23-year-old. He never got sick. But that all changed suddenly when what he thought was a routine illness put him on a decade-long journey that ended with a kidney transplant at UVA.

Goodpasture’s Syndrome

Miller thought he had a cold. But when he started coughing up blood, he saw a doctor. He was diagnosed with a rare autoimmune disease called Goodpasture’s syndrome, which affects the lung and kidneys.

UVA employee Mike Miller, left, recently had a kidney transplant at UVA. His friend Paul Watson, right, donated the kidney.

“I had a complete body shutdown. I couldn’t function,” Miller says. He was admitted to UVA, where he was sedated in the MICU (medical intensive care unit) for five weeks. He had dialysis. A similar process called plasmapheresis removed the harmful antibodies from his body, and immunosuppressive drugs inhibited his immune system “so my body could stop fighting itself.”

There’s no known cause for Goodpasture’s, though exposure to chemicals and viral infections are possible causes, according to the National Institutes of Health.

After five weeks in a hospital bed, Miller had to relearn how to walk, hold a phone and do other everyday activities, so he spent three weeks at UVA HealthSouth for rehabilitation.

But that wasn’t the end of the journey.

A Cure But a Kidney Transplant Ahead

Miller’s Goodpasture’s disease was cured, but his kidneys were permanently damaged. He knew he’d need a kidney transplant some day.

That some day turned out to be 12 years later. Meanwhile, Miller, a project coordinator in the Health System’s Nursing Governance Office, was monitored by doctors at the UVA Kidney Center.

His kidney function decreased over time, causing hypertension and high cholesterol. He also developed glomerulonephritis, a disease in which the small blood vessels in the kidneys are inflamed and less able to filter fluid and waste. “It’s basically just a downward progression over time,” Miller says.

The Kidney Center team checked his blood every three months, looking at his kidney filtration rate and creatinine levels. Over time, the creatinine levels increased from 1.5 to 5.3 (a healthy level is .6 – 1.2 for adult males).

The decreased kidney function affected his energy level. Just going to work was all the activity he could handle for one day. “I had to save up my energy and time.” In December 2010, his Kidney Center team decided it was time for a transplant.

An Organ Donation from a Friend

In January 2011, Miller had his first appointment with UVA’s Transplant Clinic. His mother went with him to take notes and be a second set of ears (a good idea for anyone with a serious diagnosis).

Miller got his name on the waiting list for a kidney. The estimated wait time was seven years.

He told a select group of friends about his situation and his friend Paul Watson, a former UVA employee, volunteered right away. “He said, ‘I’m doing it and there’s not really a choice,’” recalls Miller.

The choice was a simple one, according to Watson: “I said, ‘I’m just going to do it. I’ve got an extra one, and I want you to have it,’ I’m a fixer and I could do this. It’s the easiest thing I’ve ever done, but the most important,” he says.

Miller and Watson were each assigned a separate transplant team with their own transplant coordinator. Watson went through a number of tests to make sure he could donate a kidney to Miller. At each step of his testing, UVA’s Transplant Board evaluated Watson’s results, and after 10 months, he was approved to donate.

Kidney Transplant and Recovery

Miller and Watson went to the hospital for their surgeries on September 22, 2011. Miller’s transplant surgery lasted about three hours and he was in the hospital for one week. He and Watson both were up and walking the next day, which helps with the recovery process and healing.

Miller wasn’t nervous, he said, because he was well prepared by the people of UVA. He took a class and read his transplant handbook. “There was nothing to be surprised about. I wasn’t scared.”

Watson wasn’t nervous, either. “I’ve been around this place my whole life,” he says. “I was convinced because of the care I’ve received here over all of my life. I was born here. I got all of my medical care here growing up. If you’re going to have a transplant, you’re going to have it here.”

Recovery wasn’t easy for Miller, though, and there were setbacks. “It took a whole lot more out of me than I thought it would,” Miller says. “I was living a fairly normal life, working mostly full-time, before the surgery.” But post-surgery, he found himself wondering when he would feel better. “It was a big shock,” he says.

But Miller did start feeling better — gradually. After two months, he realized it wasn’t as difficult to walk up the two flights of stairs to his apartment.

“Now I feel better than I did before my surgery and I’m starting to feel hopeful again,” he says.

Miller still goes in for blood work every week for a full report on how his body is doing. “It’s neat to be so connected, to know exactly what’s going on inside.” He hopes to reach the point where he only needs blood work once a month.

Fannie Utz, RN, is Miller’s post-transplant coordinator. “I’ve been here for almost 30 years, and I’ve taken care of a lot of employees. I treat all of my patients as if they were a family member or how I would want to be treated,” she says. “You develop a bond with them because they feel like they can call on you for anything.”

Support From Fellow UVA Employees

Miller was out of work for three months for the surgery and recovery. His manager, Holly Hintz, coordinated an effort by his coworkers to give him their unused vacation time (short-term disability benefits only paid a portion of his salary). “We have such a culture of doing this [donating vacation time] at UVA,” says Miller. “It’s different to be on the receiving end of it. It’s a big deal.”

Miller works with many UVA nurses as part of his job, and they are the reason he chose UVA, he says.

“It’s why I had my surgery here,” he says. “I trusted in the care I was going to get because I work with so many nurses, so it just made sense to come here. I was looking forward to seeing these people I work with do their job.”

More About Organ Donation: Find out more about organ donation and one man who gave a kidney to a stranger.

Eighteen people die each day because there aren’t enough organs available for those in need, according to the U.S. Department of Health and Human Services.

Laurie Miller of Harrisonburg donated a kidney to a stranger in need.

Eighteen.

And there are more than 100,000 people on the waiting list for organs nationwide, including 759 UVA patients. For many of those waiting, time is limited.

Organ Donation: What Can You Do?

Many people agree to donate their organs when they die. It’s called a deceased donation, and it’s as easy as checking a box when you apply for a driver’s license. Some even donate a kidney or a part of their liver to a friend or family member. That’s called a living donation.

Laurie Miller of Harrisonburg donated one of his kidneys as part of a living donation. But Miller donated to a stranger. It’s called an altruistic (or non-directed) donation and it’s fairly uncommon, according to Anita Sites, RN, who coordinates and manages care for patients in UVA’s Living Donor Program. There are about one or two altruistic donations a year at UVA, she says. (more…)

Leah Yetzer, 30, was 37 weeks pregnant with twin boys in 2009 when doctors discovered she’d developed HELLP syndrome, a rare but serious condition that occurs during pregnancy or just after delivery. HELLP reduces red blood cells and increases liver enzymes. Leah was airlifted to UVA, where she had a liver transplant that saved her life. Leah, who lives in Blacksburg, shared her story with us.

Leah Yetzer with her husband, Nate, and her twins, Nick and Jack

In May of 2009 I experienced a tragic sequence of events that led to my life almost ending at 27 years of age. I was 37 weeks pregnant with twin boys and I loved almost every week of it. But in my 36th week I felt incredible discomfort throughout my body, especially in the abdomen area, as well as headaches, swelling in my feet and fatigue. This was to be expected, I thought, given my condition and that I was carrying over 12 pounds of extra weight on my small 5-foot-2-inch frame.

I was never advised to be on bed rest and was told by my primary obstetrician in Blacksburg that non-stress tests, which monitored my contractions and their effect on my boys’ heart rates twice a week for 2 hours starting at 32 weeks, were a waste of my time. My husband and I trusted the OB’s knowledge and discontinued those tests (recommended by a previous OB seen at the same establishment) after one week. We then trusted his knowledge when we were sent back home on a Monday with a prescription for muscle relaxers, despite how I felt toward my 36th week — that it was time and my body could not handle anymore. We were told that an induction would not be possible with my doctor until at least two days later, a Wednesday, when I would be in my 37th week. (more…)

Tony was only 53. But he was often short of breath and too tired to play with his kids or enjoy golf. We often think heart failure only happens to older people, but younger adults like Tony with other (sometimes undiagnosed) heart conditions or other risk factors can also develop it. According to the American Heart Association, about 5.7 million Americans have heard failure, including 10 percent of people over 80. In some cases, you might not even know you have heart disease until you begin having heart failure symptoms.

Do you know the signs and symptoms of heart failure? You can learn more about heart failure at our community lecture Thursday, May 26, 6:00-7:30 p.m. at UVA Alumni Hall. Dr. James Bergin and nurse practitioners Carole Ballew and Nita Reigle will discuss the latest treatment options. We talked to them to get some more information before the event. (more…)