How do others identify you? The simplest answer may reside in what others use to recognize you, your face. In fact, people may use your face to get a putative synopsis of you and make judgments accordingly (Rifkin et al., 2018). So much for the old saying of not judging a book by its cover.

What would happen if you somehow lost your face to injury or disease? Would you lose your identity? No, you would still be “you,” at least as you know yourself. But how others perceive you would likely change, usually in a negative direction. Rude or uncomfortable stares are inevitable and this unwanted attention can be a source of great duress.

Truly a feat of modern medicine, face transplants offer a new hope to individuals who experience tragic events that robbed them of their own face. In a recent publication from a face-transplant team, the authors stated that as many as 40 of these miraculous surgeries have been performed (Kollar et al., 2018). They also highlighted that unlike typical organ transplants with about a 10-20% rejection rate, face transplants have an 80% rejection rate in the first year (Kollar et al., 2018). Early detection of rejection could be vital in helping a transplant recipient save their new face. Although biopsies of the transplanted tissue could provide such early detection, the side effects of scarring, infection or even initiating rejection are too risky.

Instead, the researchers decided to test proteomics’ potential to deliver a “liquid biopsy” blood test for early signs of rejection (Kollar et al., 2018). Using six patients (a small number when considered in its own right, but a huge fraction of actual face transplant recipients), the researchers harnessed SomaLogic® technology to look at serum samples that had been collected at different times, including before and after a tissue rejection was detected. In their analysis, the researchers found changes in five blood proteins that tracked well with severe rejection versus nonsevere or no rejection: Specifically, the proteins matrix metalloproteinase 3 (MMP3), aminoacylase-1 (ACY1), interleukin-1 receptor type 2 (IL1R2), kallistatin (SERPINA4) and carboxypeptidase B2 (CPB2). The identification of the proteins also offered a glimpse into the molecular processes of the body’s rejection of the new face.

From the five proteins identified, the researchers homed in on MMP3, which was the most elevated in severe rejection events. They surmised that the elevated levels of that protein may be indicative of continuous damage and repair of the tissue, which might alter the tissue’s configuration (Kollar et al., 2018). More work, however, is necessary to confirm this idea.

Although many ideas from this work still require validation, one cannot deny the potential impact of the work. From a small study that represents a significant proportion of the number of face transplant recipients, proteomics may have begun to uncover a means to provide early warning of a severe rejection event, free of subjective observations. The early detection could result in earlier intervention, which could potentially help the patients save both their face and their ability to navigate the social world without additional duress.

 

References

Kollar, B., Shubin, A., Borges, T. J., Tasigiorgos, S., Win, T. S., Lian, C. G., . . . Riella, L. V. (2018). Increased levels of circulating MMP3 correlate with severe rejection in face transplantation. Sci Rep, 8(1), 14915. doi:10.1038/s41598-018-33272-7

Rifkin, W. J., Kantar, R. S., Ali-Khan, S., Plana, N. M., Diaz-Siso, J. R., Tsakiris, M., & Rodriguez, E. D. (2018). Facial Disfigurement and Identity: A Review of the Literature and Implications for Facial Transplantation. AMA J Ethics, 20(4), 309-323. doi:10.1001/journalofethics.2018.20.4.peer1-1804