Senior Investigator Richard H. Aster, MD, and his team are working to understand how genetics, medications and antibodies cause blood cell destruction.
Throughout his 50-year career at Versiti Blood Research Institute (BRI), research by Senior Investigator Richard H. Aster, MD, has advanced understanding of many blood disorders. Since 1970, he has held one of the longest-running grants from the National Institutes of Health (NIH), which supports his research in immune diseases of the blood and other issues concerning blood platelets, storage, transfusion, measurement of therapeutic effects, and more.
When Dr. Aster first came to Versiti in 1970, he was interested in the study of conditions in which antibodies attack blood cells. One noteworthy disorder, neonatal alloimmune thrombocytopenia (NAIT), occurs when a pregnant mother makes an antibody against her unborn baby’s platelets. As a result, the baby is born with a very low platelet count and may have severe bleeding. Most NAIT patients recover over time, but some babies are born with fatal intercranial hemorrhaging or nonfatal bleeding that can lead to disability.
When he was at the NIH in the early 1960s, Dr. Aster was involved in the original research that established NAIT as a distinct medical condition, occurring in about 1 in 3,000 births. Thanks in part to the creation of Versiti Diagnostic Labs’ Platelet and Neutrophil Immunology Lab (PNIL) in 1974, Dr. Aster and his colleagues were able to advance NAIT diagnostic testing so that it could detect and characterize NAIT antibodies in mothers and define which blood antigen in fetal platelets (inherited from the baby’s father) was the target of the antibody that caused platelet destruction.
During the 1980s and 1990s, Dr. Aster and his team continued to research and characterize NAIT antigens. “This is an area that we have gradually learned more about,” Dr. Aster said, “and we have published many papers over the years describing NAIT, how it should be treated, and how it can be prevented.” This groundbreaking work has provided support and guidance to both patients and physicians; has been helpful in treating infants with NAIT; and has helped reduce the odds of complications in a mother’s subsequent pregnancies, as the disease tends to worsen over time.
Dr. Aster credits much of the success of his program to the PNIL. “It’s fair to say that this lab is the premier lab of its kind in the world,” he said. “We’re able to provide better, more complete service in this field than any other laboratory. We’ve continued to be the major source in the United States to which these kinds of patients are referred.”
Dr. Aster’s research has also focused on drug-induced thrombocytopenia (DITP), which affects about 20 people per every million each year in the U.S. DITP occurs when a patient taking a medication develops an antibody to it and subsequently experiences a dramatic decrease in platelet count (thrombocytopenia). In some persons, red blood cells or white blood cells are affected. But when platelets are targeted, patients experience serious bleeding, anemia and, in worst cases, death. Any drug has the potential to induce an antibody and cause thrombocytopenia, so improving the methods for detecting these antibodies, identifying which drugs trigger them, and understanding how the antibody causes blood cell destruction is crucial for understanding, treating and preventing these conditions.
In the last year, Dr. Aster and his team have received recognition for their research of heparin-induced thrombocytopenia (HIT), a condition that affects at least 20,000 patients annually in the U.S. This research provides new insights into how heparin induces antibodies, how to best identify the ones that are dangerous, and how to best treat patients with HIT. “Recently, we developed a new and improved diagnostic technique that we believe is an important advance over what was available previously,” he said.
Richard H. Aster, MD, is a senior investigator at Versiti Blood Research Institute and a professor in the Departments of Medicine and Pathology at the Medical College of Wisconsin. In 2019, he was awarded the Wallace H. Coulter Award for Lifetime Achievement in Hematology from the American Society of Hematology.