Immune System Trained to Kill Cancer ? Teperdexrian

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A year ago, when?chemotherapy?stopped working against his leukemia, William Ludwig signed up to be the first patient treated in a bold experiment at the University of Pennsylvania. Mr. Ludwig, then 65, a retired corrections officer from Bridgeton, N.J., felt his life draining away and thought he had nothing to lose.

Doctors removed a billion of his T-cells ? a type of white blood cell that fights viruses andtumors?? and gave them new genes that would program the cells to attack his?cancer. Then the altered cells were dripped back into Mr. Ludwig?s veins.

At first, nothing happened. But after 10 days, hell broke loose in his hospital room. He began shaking with chills. His temperature shot up. Hisblood pressure?shot down. He became so ill that doctors moved him into intensive care and warned that he might die. His family gathered at the hospital, fearing the worst.

A few weeks later, the fevers were gone. And so was the leukemia.

There was no trace of it anywhere ? no leukemic cells in his blood or bone marrow, no more bulging lymph nodes on his?CT scan. His doctors calculated that the treatment had killed off two pounds of cancer cells.

A year later, Mr. Ludwig is still in complete remission. Before, there were days when he could barely get out of bed; now, he plays golf and does yard work.

?I have my life back,? he said.

Mr. Ludwig?s doctors have not claimed that he is cured ? it is too soon to tell ? nor have they declared victory over leukemia on the basis of this experiment, which involved only three patients. The research, they say, has far to go; the treatment is still experimental, not available outside of studies.

But scientists say the treatment that helped Mr. Ludwig, described recently in?The New England Journal of Medicine?and?Science Translational Medicine, may signify a turning point in the long struggle to develop effective gene therapies against cancer. And not just for leukemia patients: other cancers may also be vulnerable to this novel approach ? which employs a disabled form of?H.I.V.-1, the virus that causes AIDS, to carry cancer-fighting genes into the patients? T-cells. In essence, the team is using gene therapy to accomplish something that researchers have hoped to do for decades: train a person?s own immune system to kill cancer cells.

Two other patients have undergone the experimental treatment. One had a partial remission: his disease lessened but did not go away completely. Another had a complete remission. All three had had advanced?chronic lymphocytic leukemia?and had run out of chemotherapy options. Usually, the only hope for a remission in such cases is a bone-marrow transplant, but these patients were not candidates for it.

Dr. Carl June, who led the research and directs translational medicine in the?Abramson Cancer Center at the University of Pennsylvania, said that the results stunned even him and his colleagues, Dr. David L. Porter, Bruce Levine and Michael Kalos. They had hoped to see some benefit but had not dared dream of complete, prolonged remissions. Indeed, when Mr. Ludwig began running fevers, the doctors did not realize at first that it was a sign that his T-cells were engaged in a furious battle with his cancer.

Other experts in the field said the results were a major advance.

?It?s great work,? said?Dr. Walter J. Urba?of the Providence Cancer Center and Earle A. Chiles Research Institute in Portland, Ore. He called the patients? recoveries remarkable, exciting and significant. ?I feel very positive about this new technology. Conceptually, it?s very, very big.?

Dr. Urba said he thought the approach would ultimately be used against other types of cancer as well as leukemia and lymphoma. But he cautioned, ?For patients today, we?re not there yet.? And he added the usual scientific caveat: To be considered valid, the results must be repeated in more patients, and by other research teams.

Dr. June called the techniques ?a harvest of the information from the molecular biology revolution over the past two decades.?

Hitting a Genetic Jackpot

To make T-cells search out and destroy cancer, researchers must equip them to do several tasks: recognize the cancer, attack it, multiply, and live on inside the patient. A number of research groups have been trying to do this, but the T-cells they engineered could not accomplish all the tasks. As a result, the cells? ability to fight tumors has generally been temporary.

The University of Pennsylvania team seems to have hit all the targets at once. Inside the patients, the T-cells modified by the researchers multiplied to 1,000 to 10,000 times the number infused, wiped out the cancer and then gradually diminished, leaving a population of ?memory? cells that can quickly proliferate again if needed.

The researchers said they were not sure which parts of their strategy made it work ? special cell-culturing techniques, the use of H.I.V.-1 to carry new genes into the T-cells, or the particular pieces of DNA that they selected to reprogram the T-cells.

The concept of doctoring T-cells genetically was first developed in the 1980s by?Dr. Zelig Eshhar?at the Weizmann Institute of Science in Rehovot, Israel. It involves adding gene sequences from different sources to enable the T-cells to produce what researchers call chimeric antigen receptors, or CARs ? protein complexes that transform the cells into, in Dr. June?s words, ?serial killers.?

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