F-149B Emory University Hospital
Atlanta, GA 30322
404 712 7317 Phone
HLA and Transplantation
Winship Cancer Center, The Emory Clinic
Co-Director, Histocompatibility & Molecular Immunogetics Laboratory, Emory University Hospital
B.S. (Microbiology), Indiana University, Bloomington, IN, - 1977
Ph.D. (Immunology), Indiana University School of Medicine, Indianapolis, IN, - 1985
- Overview -
The thrust of my research has been almost exclusively applied. Since my training and clinical responsibilities encompass two quite distinct entities, my research has also moved in several directions. However, an underlying theme has been the application of "State-of-the-Art" technology, specifically Flow Cytometry, to advances in diagnostic testing. In the area of transplantation, my projects have focused on the flow cytometric crossmatch and flow cytometric detection of alloantibody in patients awaiting transplantation. Our research efforts have essentially helped "set the standard of practice" for flow cytometric crossmatching and antibody identification in the United States. Additionally, we were one of the first laboratories to pioneer the area of microbead technology and its applications in clinical histocompatibility testing. Work that has been published from this laboratory has not only changed laboratory practice, but has been the foundation for changes in government (CLIA) and society (ASHI and UNOS) standards which regulate histocompatibility testing laboratories. In the area of clinical diagnostic flow cytometry, we have focused on cutting-edge applied projects. Our work has been primarily aimed at the utility of cytometry in the detection and classification of hematopoietic disease. To this end, our laboratory has been one of the leaders in flow cytometric analysis, an interpretation of leukemia/ lymphoma immunophenotyping. Of special interest have been our efforts at detecting minimal/residual hematopoietic disease. As a result of our efforts, we have also been able to help set the "standard of practice" in diagnostic flow cytometry. Our work contributed to a "consensus" document which has laid the foundation for standardized data analysis and interpretation in diagnostic cytometry (Borowitz M, Bray RA, Gascone R, etal: Cytometry 30:236-244, 1997). In summary, although almost exclusively "applied and translational" in nature, our projects have had a significant impact on the practice of laboratory medicine and patient care. This has not only benefited patients here at Emory, but through the field of Transplantation and Hematopathology. As a result, Emory has gained a reputation for excellence in these areas. This is evidenced by numerous requests from outside laboratories and Pathologists, desiring to learn our methods and to visit our laboratory for specific training.
I co-direct, along with Dr. Howard Gebel, the busy HLA laboratory at Emory University Hospital, which provides histocompatibility testing to support transplantation services at Emory Healthcare and beyond.
1994 Diplomate - American Board of Histocompatibility & Immunogenetics (ABHI)
1995 ABB - Certified American Board of Bioanalysis, High Complexity Clinical Laboratory Director (HCLD),
Bray RA, Hurley CK, Kamani NR, Woolfrey A, M¿ller C, Spellman S, Setterholm M, Confer DL. National Marrow Donor Program HLA Matching Guidelines for Unrelated Adult Donor Hematopoietic Cell Transplants. Biology of Blood and Marrow Transplantation. Vol. 14, (9):45-53, 2008.
Saw CL, Bray RA, Gebel HM. Cytotoxicity and antibody binding by flow cytometry: A single assay to simultaneously assess two parameters. Clinical Cytometry 74B:287-294, 2008.
Spellman S, Setterholm M, Maiers M, Noreen H, Oudshoorn M, Fernandez-Vi¿a M , Petersdorf E, Bray R, Hartzman R, Ng J, Hurley CK. Advances in the Selection of HLA- Compatible Donors: Refinements in HLA Typing and Matching over the First 20 Years of the National Marrow Donor Program Registry. Biology of Blood and Marrow Transplantation Vol. 14 (9): 37-44, 2008.
Kamani N, Spellman S, Hurley CK, Barker JN, Smith FO, Oudshoorn M, Bray RA, Smith AJ, Williams T, Logan B, Eapen M, Anasetti C, Setterholm M, Confer DL. State of the Art Review: HLA Matching and Outcome of Unrelated Donor Umbilical Cord Blood Transplants. Biology of Blood and Marrow Transplantation Vol. 14(1):1-6), 2008.
Gebel HM and Bray RA.. Laboratory Assessment of HLA antibodies circa 2006. Making Sense of Sensitivity. Transplantation Reviews 20:189-194, 2006.
Adamkiewicz TV. Boyer MW. Bray RA. Haight A. Yeager AM. Identification of unrelated cord blood units for hematopoietic stem cell transplantation in children with sickle cell disease. Journal of Pediatric Hematology/Oncology. 28(1):29-32, 2006.
Bray RA, JD L Nolen, C Larsen, T Pearson, KA Newell , K Kokko , A Guasch , P Tso, J.B. Mendel and HM Gebel. Transplanting the Highly Sensitized Patient: The Emory Algorithm. Am. J. Transplantation (6):2307-2315, 2006.
Young HE. Duplaa C. Romero-Ramos M. Chesselet MF. Vourc'h P. Yost MJ. Ericson K. Terracio L. Asahara T. Masuda H. Tamura-Ninomiya S. Detmer K. Bray RA. Steele TA. Hixson D. el-Kalay M. Tobin BW. Russ RD. Horst MN. Floyd JA. Henson NL. Hawkins KC. Groom J. Parikh A. Blake L. Bland LJ. Thompson AJ. Kirincich A. Moreau C. Hudson J. Bowyer FP 3rd. Lin TJ. Black AC Jr. Adult reserve stem cells and their potential for tissue engineering. Cell Biochemistry & Biophysics. 40(1):1-80, 2004.
Gloor JM, DeGoey S, Ploeger N, Gebel HM, Bray RA, Moore SB, Dean PG, and Stegall MD. Persistence of Low Levels of Alloantibody after Desensitization in Crossmatch Positive Living Donor Kidney Transplantation. Transplantation 78(2):221-7, 2004 .
Bray RA, Nickerson P, Kerman R and Gebel, HM. Evolution of HLA antibody Detection: Technology Emulating Biology. Immunologic Research, 29:41-53. 2004.
Bray RA, Harris, SB, Josephson CD, Hillyer CD, and Gebel HM. Unappreciated risk factors for transplant patients: HLA antibodies in blood components. Hu. Immunol. 65, 240-244, 2004.
Bearden CM. Agarwal A. Book BK. Sidner RA. Gebel HM. Bray RA. Pescovitz MD. Pronase treatment facilitates alloantibody flow cytometric and cytotoxic crossmatching in the presence of rituximab. Human Immunology. 65(8):803-9, 2004.
Gebel HM, Bray RA and Nickerson P. Pre-transplant Assessment of Donor Reactive HLA Specific Antibodies in Renal Transplantation: Contraindication vs Risk. Am. J. Transplantation 3:1488-1500, 2003.
Pearson TC. Trambley J. Odom K. Anderson DC. Cowan S. Bray RA. Lin A. Hollenbaugh D. Aruffo A. Siadak AW. Strobert E. Hennigar R. Larsen CP. Anti-CD40 therapy extends renal allograft survival in rhesus macaques. Transplantation. 74(7):933-40, 2002.
Gebel HM. Harris SB. Zibari G. Bray RA. Conundrums with FlowPRA beads. Clinical Transplantation. 16 Suppl 7:24-9, 2002.
Hader SL, Hodge TW, Buchacz KA, Bray RA, Padian NS. Rausa A. Slaviniski SA. Holmberg SD. Discordance at human leukocyte antigen-DRB3 and protection from human immunodeficiency virus type 1 transmission. Journal of Infectious Diseases. 185(12):1729-35, 2002.
Chen, X, Laur, O, Kambayashi SL, Bray RA, Weber DA, Karlsson L and Jensen, P. Regulated expression of human histocompatibility leukocyte antigen (HLA)-DO antigen-dependent and antigen-independent phases of B cell development. J. Exp. Med. 8:1053-1062, 2002.
Vaidya S, Cooper T, Avandsalehi J, Titus B, Brooks K, Hymel P, Noor M, Sellers R, Thomas A, Stewart D, Daller J, Fish JC, Gugliuzza KK, and Bray RA. 2001. Improved flow cytometric detection of HLA alloantibodies using pronase: Potential clinical impact. Transplantation 71:422-428: 2001.
Gebel H, Bray RA, Ruth JA, Zibari GB, McDonald JC, Kahan BD, and Kerman RH. Flow PRA to detect clinically relevant HLA antibodies. Trans. Proc. 33:477 2001.
Bray RA, and Gebel HM. . Is low resolution Class II typing adequate for solid organ transplantation. Trans. Proc. 33:1, 2001
Tambur AR, Bray RA, Takemoto SK, Mancini M, Costanzo MR, Kobashigawa JA, D'Amico CL, Kanter KR, Berg A, Vega JD, Smith AL, Roggero AL, Ortegel JW, Wilmoth-Hosey, L, Cecka JM and Howard M Gebel. Flow Cytometric Detection of Class I and Class II Antibodies Is a Predictor of Heart Allograft Rejection. Transplantation 70(7):1055-1059, 2000.
Gebel HM and Bray RA. Sensitivity and Sensitization: Defining the unsensitized patient. Transplantation 69:1370-1374, 2000.
Boyer, MW, Waller EK, Bray RA, Unangst T, Johnson TS, Phillips C, Jurickova I, Winton, EF, and Yager, AM. Cytokine upregulation of the antigen presenting function of acute myeloid leukemia cells. Leukemia 14(3); 412-418, 2000.
Roback, JD, Bray RA, Hillyer CD. Longitudinal monitoring of leukocyte subsets in packed red blood cell units after filtration: Implications for transfusion transmitted infections. Transfusion 40:500-506, 2000.
Young HE, Steele, TA, Bray RA, Detmer K, Blake LW, Lucas PW and Black AC. Human pluripotent and progenitor cells display cell surface cluster differentiation markers CD10, CD13, CD56 and MHC Class I. Proc. Soc. Exp. Biol. Med. 221;63-71 1999.
Bucur SZ, Lackey DA, Adams JW, Lee ME, Buccolo LS, Trainor LD, Villinger F, Mayne A, Bray RA, Winton EF, Novembre F, Ansari AA, Hillyer CD. Studies on the effects of recombinant human (rh) and rhesus (rr) cytokinew on hematologic and virologic parameters in a cohort of SIVmac239 infected macaques. AIDS Res Hum Retroviruses 14:651-660, 1998.
Miraglia S, Godfrey W, Yin AH, Atkins K, Warnke R, Hholden JT, Bray RA, Waller EK and Buck DW. A novel five-transmembrane hematopoietic stem cell antigen: Isolation Characterization and Molecular cloning. Blood 90:5013-5021, 1997.
Borowitz MJ, Bray RA, Gascoyne ME, Melnick S, Parker JP, Picker L, Stetler-Stevenson M. U.S. - Canadian Consensus project in leukemia/lymphoma immunophenotyping: Data analysis and interpretation. Communications in Clinical Cytometry 30(5):236-244, 1997.
Geller RB and Bray RA. CD34 expression on acute myelocytic leukemia cells. Leukemia Research. 21(5):387-389, 1997.
Scornik JC, Bray RA, Pollack MS, Cook DJ, Marrari M, Duquesnoy R and Langley JW. Multicenter evaluation of the flow cytometry T cell crossmatch. Results from the ASHI-CAP proficiency testing program. Transplantation. 63:1440-1445, 1997.
Holden JT and Bray RA. Combined phenotypic and genotypic assessment for the detection of minimal residual disease in hematolymphoid malignancies. Clin. Immunology Newsletter. Vol 16(10/11):151-155, 1996.
Launder TM, Bray RA, Chenggis ML, Stempora LL, and Farhi DC. Lymphoid antigen expression in acute myeloid leukemia. American Journal of Clinical Pathology 106(2):185-91, 1996.
Wells SJ, Bray RA, Stempora L, and Farhi DC. CD117/CD34 Expression in Leukemic Blasts. American Journal of Clinical Pathology. 106(2):192-196, 1996.
Bray, RA. The Clinical Utility of Flow Cytometry in the Histocompatibility Laboratory. Clinical Immunology Newsletter. Vol 16(2); 10-14, 1996.
Holden J, Farhi D, Stempora L, Geller R, and Bray RA. 1995. Characterization of Thy-1 (CDw90) expression in CD34 positive acute leukemia. Blood 86:60-65, 1995.
Chrysschoos JT, Weber JW, Cohen C, Moore J, DeRose P, Hagler M, Bray RA, Stempora LL, Mainiero M, and McGarity WC. DNA Index (DI) and Ploidy Distinguish Normal Human Parathyroids from Parathyroid Adenoma and Primary Hyperplastic Parathyroids. Surgery 118:1041-50, 1995.
Hull RJ, Bray RA, Hillyer C and Swerlick RA. Transfusion -associated chronic cutaneous graft-versus-host disease. J. Am. Acac. Dermatology. 33:327-332 (Review), 1995.
Abou-Elella, AA, Camarillo TA, Allen MB, Barclay S, Pierce JA, Holland HK, Wingard JR, Bray RA, Rodey GE, and Hillyer CD. Low incidence of red cell and HLA antibody formation by bone marrow transplant patients. Transfusion 35: 931-935, 1995.
Rodey GE, Neylan JF, Whelchel JD, Revels KW, Bray RA. Epitope specificity of HLA Class I alloantibodies: I. Frequency analysis of antibodies to private versus public specificities in potential transplant recipients. Hu. Immunol. 39:272-280, 1994.
Bray RA. Flow cytometry in the transplant laboratory. Annl, N.Y. Acad. Sci. 677:138-151, 1993.
Hillyer CD, Lackey DA, Hart KK, Stempora LL, Bray RA, Donnenberg AD, Bender JG. CD34+ Progenitors and CFU-GM are recruited during large volume leukapheresis and concentrated by counterflow centrifugal elutriation. Transfusion 33(4):316-321, 1993.
Toba K, Winton EF, and Bray RA. An improved flow cytofluorometric triple staining method for the simultaneous analysis of cell cycle and surface phenotype using bromodeoxyuridime, propidium iodide, and 7-amino-actinomycin-D. Cytometry 13:60- 67, 1992.
Bray RA, Pope RM, Landay AL. Identification of a population of large granular lymphocytes obtained from the rheumatoid joint coexpressing the CD3 and CD16 antigens. Clin Immunol Immunopathol 58:409-418, 1991.
Bray RA. The Flow Cytometric Crossmatch. Clin. Immunol. Newsletter 10:63-69,1990.
Gottschalk LR, Bray RA, Kaiser H and Gebel H. Two populations of CD16+/Leu-19+ cells in bone marrow transplant recipients. Bone Marrow Transplant 5:259-264, 1990.
Bray RA, Lebeck LL and Gebel HM. The flow cytometric crossmatch: Dual-color analysis of T cell and B cell reactivities. Transplantation 48:834-840, 1989.
Gebel HM,, Pollack MS and Bray RA. The HLA system. In; AABB Technical Manual, 16th Edition. Roback J, Combs M, Grossman B and Hillyer C, eds. Chapter 19, pps. 547-568; 2008.
Saw CL, Heaney DL, Gebel HM and Bray RA. Relevance of antibody screening in solid organ, hematopoietic stem cell transplantation and blood transfusion. In; Handbook of Human Immunology; 2nd Edition. O'Gorman M and Donnenberg A, eds: Chapter19; pps. 565-588; 2008.
Bray RA and Gebel HM. 2007. Clinical utility of flow cytometry in allogeneic transplantation. Ch. 14. pp.275-292. In: Clinical Flow Cytometry. ASCP Press, Chicago, IL., (Keren, D., ed.)..
Bray RA, Gebel HM, Ellis TM. Flow Cytometric Assessment of HLA Alloantibodies. In: Current protocols in Cytometry. John Wiley & Sons, Inc. (Robinson JP, ed.). Supplement 27, Chapter 6.16, pp.1-23, 2004.
Bray RA. Flow Cytometry in Histocompatibility Testing. In. Seminars in Hematology. Academic Press, New York, N.Y. (Fleisher T. ed.). Vol. 38;194-200, 2001.
Bray RA and Gebel HM. Clinical utility of flow cytometry in allogeneic transplantation. In: Clinical Flow Cytometry. ASCP Press, Chicago, IL., (Keren, D., ed.). pp. 505-534, 2001.
Bray, RA and Gebel, HM. Transplantation Immunophenotyping. In. Immunophenotyping: Cytometric and Cellular Analysis. Academic Press, NY. (Stewart and Nicholson, J. eds.) . pp.321- 332, 2000.
Bray, RA Flow Cytometric Crossmatching in Solid Organ Transplantation. In: Methods in Cell Biology: Flow Cytometry, Vol. 41, (Darzynkiewicz, Z, Crissman, H.Z, and Robinson, J.P., eds). Chapter 7, pp103-119, 1994.
Landay AL, George SK, Bray RA. Phenotyping Cells of the Immune System: Methods and Applications. In: Techniques in Diagnostic Pathology, No. 2, Diagnostic Flow Cytometry; JS Coon and RS Weinstein, eds. Williams & Wilkins, Inc. pp. 55-77, 1991.
Gebel HM and Bray RA. Transplant Applications of Flow Cytometry. In: Techniques in Diagnostic Pathology, No. 2, Diagnostic Flow Cytometry; JS Coon and RS Weinstein, eds. Williams & Wilkins, Inc. pp. 79-88, 1991.
Landay AL and Bray RA. Flow Cytometry of Urine. In: Clinics in Laboratory Medicine, Vol. 8., No. 3, pp.541-555, 1988.
Bray, RA and Stempora LL. Phenotyping by Immunofluorescence. In: ASHI Laboratory Manual. American Society for Histocompatibility and Immunogenetics, 1994.
Bray RA and Gebel HM. Principles of Isolation and Separation of Human Mononuclear Cells. In: ASHI Laboratory Manual. American Society for Histocompatibility and Immunogenetics, 1994.
Leffell MS and Bray RA. Principles of Immunofluorescence and Flow Cytometry. In: ASHI Laboratory Manual. American Society for Histocompatibility and Immunogenetics, 1994.
Bray RA and Gebel HM. Principles of Isolation and Separation of Human Mononuclear Cells. In: ASHI Laboratory Manual. American Society for Histocompatibility and Immunogenetics, 1990.