A History of Transplantation Immunology. Leslie Brent. 482 pp. Academic Press, 1997. $54.95.
Students and scholars in all fields of immunology will find this thorough and critical review of the important literature associated with the science of transplantation immunology indispensable. And most fortunately, this high-quality text is moderately priced so that all can afford it. In view of current interest in solving immunological problems that will ultimately permit the successful use of animal organs for transplantation into human beings, this book may also be of interest beyond the field of immunology. It certainly provides useful background and references to bioethicists just entering the field of cross-species (xenogeneic) transplantation.
Leslie Brent has been intimately involved in the field of transplantation almost from the beginning of its modern history, and he is able to provide a very personal and informed perspective on its development. The text is quite thorough, and it includes over 3,000 references associated with its 11 chapters, which even taken alone make the book worth its purchase price to scientists who are actively working in the field. By including at the end of each chapter photographs and short biographies of major contributors to the literature, the author makes the point that the accomplishments reviewed did not just happen but were the product of exhaustive work and dedication by many specific individuals. It is refreshing to find a scientific review that includes this perspective on the scientists who have been involved in producing the work, as well as on the work itself, because it reminds the reader that the history of transplantation immunology is represented not solely in the journal articles referenced but also in the lives of the men and women who produced those publications. The book details the history of a science, but it is also a human history in which the reader is made aware that human pride, jealousy and bias very much affected what appeared in print.
A History of Transplantation Immunology's chapters first address what the author perceives to be the landmarks in the field, and then discuss the scientific basis for allograft rejection (why your sibling's kidney can't just be sewn into you without problems), blood groups and associated diseases of the neonate (Rh factor), and the genetics of histocompatibility. These chapters are followed by reviews of the current understanding of tolerance of transplanted tissues, the regulation of immune responsiveness and clinical approaches used to suppress graft rejection. The text ends with chapters on bone-marrow transplantation, xenotransplantation and reproductive immunology, focusing on the fetal-maternal relationship.
The author completes the book with something of an apologia in which he summarizes the importance of work in the field of transplantation immunology to our current understanding of broader immunological issues, as well as the importance of animal research to past and future discoveries. Finally he concludes with reference to ethical issues involved in organ transplantation, stating that discussion of this topic is beyond the scope of his book. Despite this disclaimer, Brent obviously hopes that his text will provide a springboard for discussion by ethicists on the science and clinical practice of transplantation and induce scholarly consideration of the ethical issues being created by the technological advances in this field.
In spite of the thoroughness of the text, some immunologists will invariably feel that their contribution was overlooked or not emphasized enough; an author of such a historical review can hardly avoid such perceived slights. Even so, Brent valiantly tries to give an honest and balanced presentation and is quite successful in its achievement. Some readers may feel that the work of Medawar, Billingham and Brent receives undo emphasis, which, if true, is a forgivable failing (although from my perspective, the contributions of Medawar and his associates cannot be overemphasized).
The book is so successful in addressing its objective that the author can hardly be faulted for failing to give an in-depth discussion of the role transplantation immunology played in the rather recent creation of legislation, rules, heightened concern and awareness of misconduct in science. But readers familiar with the "Summerlin case" will be disappointed by the author's terse review of the infamous work at the Sloan-Kettering Institute and Cancer Center in the 1970s, with the simple statement that Summerlin's findings "seem to have involved some fraudulent activity." The scandal, which involved a young physician in training attempting to demonstrate an astounding advance in allogeneic transplantation, broke when Dr. W. T. Summerlin admitted to using a black-ink marker to color the fur of white mice to fool his colleagues into believing the dyed fur was successfully transplanted skin from genetically unrelated mice. The accompanying photograph, which is prominently displayed on the book's cover, comes from the author's own laboratory. It shows a mouse with a successful skin transplant and represents a popular animal model used by transplantation immunologists 30 years ago. But it may remind older readers of the Summerlin incident, which was certainly a dark aspect of the history of transplantation.
It is understandable that the author did not want to expound on the Summerlin case. However, this embarrassment to immunologists has had as profound an effect on all of science as the advances in transplantation immunity have had on medicine. The event was key because it raised the consciousness of the professionals themselves about the possibility of fraud. Since that time careers have been damaged, studies of scientific misconduct on a broader scale initiated—a new office at the National Institutes of Health was established to investigate accusations of fraud (its staff has grown in size annually)—and journal editors sensitized to its possibility. In turn they have instituted safeguards for their publications. Social scientists have built careers on studies of fraud in scientific research, attorneys have established reputations in defending accused scientists, and Sigma Xi and other national and international scientific organizations have organized symposia and produced publications on scientific ethics.
Although this cautionary message should be heeded by all working scientists, the real tone of this book is one of hope.The author clearly wants his treatise to be a summary and overview of the many important discoveries in transplantation immunology this century and of their broader positive effect on science and medicine generally, and he accomplishes this goal admirably. After finishing the book, immunologists and others will be left with the feeling that the day will soon come when a person—whose heart, pancreas, liver or lungs have been destroyed by viral infection, cancer or by years of cystic fibrosis—can schedule surgery to receive a porcine organ instead of waiting a long time for a potential human donor to die even as the candidate's own health deteriorates.—Philip B. Carter, Microbiology and Immunology, College of Veterinary Medicine, North Carolina State University