George William Burke, III, MD, FACS


I am a transplantsurgeon with a special interest in recurrence of disease after kidney or kidney-pancreas transplantation.
Along with Dr. Alberto Pugliese, I have been involved in studying recurrence of auto-immunity in those patients with type 1 diabetes (T1D) and end-stage renal disease who underwent kidney-pancreas transplantation in thepast. Our intention is to address the diagnosis and prediction of recurrent autoimmunity, a significant clinical problem, and to gain insight into the relationship between autoimmune humoral responses, cellular responses and disease progression in the transplanted allograft through biopsy. The pancreas transplant population provides a unique opportunity to conduct such studies, which are not feasible in patients with type 1 diabetes who do not have a transplant. Our ultimate goal is to contribute to the possible treatment and cure of type 1 diabetes through the application of therapy to T1DR.

Our other major interest is the treatment of children with focal segmental glomerulosclerosis (FSGS) and the problematic recurrence of proteinuria after kidney transplant. Ou group initiated a protocol utilizing one dose of rituximab in addition to the standard induction immunosuppression protocol for pediatric patients with FSGS in order to mitigate against the recurrence of proteinuria after kidney transplantation. Serum was collected before and after transplantation. Biopsies were performed pre and post reperfusion, looking for early changes consistent with podocyte foot process dysregulation. This led to our collaboration with Dr.Alessia Fornoni who demonstrated the favorable effect of rituximab clinically was associated with rituximab binding a novel target (SMPDL3B,a sphingomyelinase) on the podocyte membrane. This work has led to further collaborations with Dr. Peter Mundel in which we used abatacept as rescue therapy for patients with recurring proteinuria after kidney transplantation for FSGS in the context of podocyte B7-l expression.Our collaborative work has the potential to shed light on the function of the podocyte, including its role in innate immunity following transplantation, which perhaps may translate into the treatment of primary disease.

These two areas of research represent robust examples of “bedside to bench and back again’‘ translational research.