Margaret L. Pollack, MD, fellow in the Division of Allergy and Infectious Diseases at the University of Washington in Seattle, is this year’s recipient of the Astellas Postdoctoral Fellowship in Transplant Infectious Diseases. This award is intended to encourage young physicians interested in transplant infectious diseases.
Dr. Pollack received her medical degree in 2004 from Rush University in Chicago. She completed her residency and chief residency in internal medicine and pediatrics at Mount Sinai School of Medicine in New York. During her residency, Dr. Pollack developed an academic interest in transplant infectious diseases and virology. In 2008, she began her fellowship at the University of Washington in Seattle and is currently completing a master’s in public health in epidemiology.
Dr. Pollack’s aim is to investigate abortive cytomegalovirus (CMV) transmission from hematopoietic stem cell products to naïve CMV hosts. CMV infection in the setting of severe immune compromise, such as occurs after hematopoietic cell transplantation (HCT), remains associated with increased mortality and increased risk of bacterial and fungal infections despite advancements in early diagnosis and treatment. Hematopoietic cells have been shown to be a source of latent CMV that is capable of reactivation during HCT. Each stem cell product from a CMV seropositive donor (D+) contains tens of thousands infected cells, yet the observed transmission rate to seronegative recipients (R-) is only 15-20 percent. This is much lower than the transmission rates of 50-90 percent reported in solid organ transplantation.
Furthermore, while many D+/R- patients develop replicative CMV infection after transplantation, there is a distinct group of patients who demonstrate “abortive” infection characterized by low level CMV DNA-emia or antigenemia that does not progress to replicative infection or disease. This subset of patients demonstrates self-limited infection, which can provide critical insights into protective immunity.
To further characterize patients with abortive infection and the role of neutralizing antibodies, Dr. Pollack will retrospectively correlate CMV DNA-emia and neutralizing antibody titers in a cohort of patients (n=500) who were transplanted prior to the adoption of pp65 antigenemia/DNA based pre-emptive treatment strategy and who developed replicative CMV infection compared with those demonstrating selflimited DNA-emia.
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