Discovering ATG

The Aplastic Anaemia Trust turns 40 this year, and we have made a special treat for you to celebrate. We invited Professor Ted Gordon Smith to Kings Hospital to meet with Dr Austin Kulasekararaj and discuss treatment for aplastic anaemia and how it has improved.

In this second video, Professor Gordon Smith shares what he thinks of ATG! And we learn the name of the first ATG horse...

Dr Austin Kulasekararaj

is a consultant haematologist at King’s College Hospital, London and leads King's PNH Centre. He specialises in bone marrow failures, myeloid malignancies and allogeneic bone marrow transplantation. Dr Austin is a member of The AAT's RCAP and a regular star of AAT webinars, giving up his time to help us support patients.

Professor Ted Gordon Smith

was not only instrumental in founding our charity - he was part of the team who helped discover aplastic anaemia. When he was treating patients - his team were conducting some of the very first transplants, and he remembers the discovery of treatments including ATG (then called ALG) and ciclosporin. Professor Gordon Smith was an AAT Trustee for many years and is now our charity's Patron.

Video transcript

Dr Austin: You’ve talked about how  Bruce Camitta and how the Camitta criteria is still used and it has stood the test of time.  Oxymetholone is still used, Danazol is used but not as much as it was used before. Expanding from that, how did other treatments come into play, like Ciclosporin, ALG (or ATG, as we say it now)?  

Prof Ted: The story of Antilymphocyte globulin, ALG, is fascinating. In France a chap called Geroge Mathé had been sent patients from Yugoslavia who had been exposed to high doses of radiation (this was almost like a pilot study for what would happen later in Chernobyl). He had used ALG as a conditioning for transplant – and this is in the late 1960s. He showed clearly that there was a temporary transplant – donor red blood cells appeared in the patients who had transplants, he’d used a very small amount of marrow, and the patients recovered their own bone marrow afterwards. He postulated that perhaps the ALG was instrumental in improving their own bone marrow function. His PHD student at the time was a chap called Bruno Speck who worked in Basel, Bruno took up the idea that ALG was a good form of treatment for aplastic anaemia and it indicated that perhaps aplastic anaemia had an autoimmune basis. That was the first time that had been suggested.  

And in order to get ALG, which of course is a serum from a horse that has been exposed to human lymphocytes, he had found in the Swiss Red Cross a horse called Volcano. Volcano was able to provide all the antilymphocyte serum for the treatment of patients with aplastic anaemia, certainly throughout Europe for a period. A very big horse! Who actually died only 2 or 3 years ago.  

So that was another interesting new line of treatment – there were the anabolic steroids to stimulate the  marrow, and the antilymphocyte globulin perhaps to inhibit the immune destruction. But that was all we had.  

Dr Austin: And when did ciclosporin come in? 

Prof Ted: Well once transplantation became possible, new problems arose as a result of the transplantation. There was donor rejection, and of course Graft Vs Host Disease. And we had very limited forms of immunosuppression at that time other than the ALG and prednisone.  

Also the support was awful – there was no antivirals, there was no antifungal treatment, limited bacterial treatment and so on. Ciclosporin which was discovered, another fascinating story, by scientists in Sandoz in Basel . It was perhaps the first really successful, strong, general immunosuppressant treatment other than steroids. So gradually things improved – support improved with antibiotics and so on and the management of the complications of transplantation – everything. So that’s sort of a background 

Dr Austin: Would we ever do away with horse ATG? Maybe 40 years down the line?  

Prof Ted: Well we bloody well should do, it’s ridiculous – it's like black magic! Take the blood of a horse and a yam from Mexico and you give it to your patients – and they get better! There must be something better than that.  

Dr Austin: Sometimes if it works, you don’t question it!  

Prof Ted: Exactly.    

What is the Camitta criteria?

Watch next…

In the next video, we learn about why The AAT started, who started it,  and what that had to do with tents.

WATCH NEXT VIDEO

ATG for treating aplastic anaemia

You can find more information about how ATG is used to treat aplastic anaemia and what you can expect if you receive this treatment here:

Treatment involving ATG