The Life Science Renaissance

Enter: The stone age of medicine:

In many ways, we are still living in the stone age of medicine. A prime example is that for the last 50 years, we have been making vaccines using chicken eggs. It usually takes over five months using this approach to make a vaccine, by which time the strain of virus may have mutated to some other form, immune to the vaccine. The yield of successful vaccines using this chicken egg approach is extremely low, roughly 33%. To complicate matters of this archaic approach further, chickens are birds, so they are killed off by the avian flu. Lastly, there are less than 10% of the eggs necessary for making vaccines for the world's population. It has been estimated that a pandemic today as virulent as the 1918 bird flu, which killed 50 million people, would kill one billion people. Throughout modern history, we have been threatened with a pandemic on average of every 35 years. 

See: http://blogs.sciencemag.org/scienceinsider/2009/05/in-case-of-pand.html

Often, we discover life threatening diseases too late into their disease cycle. Once we detect them, as with cancers, we apply further barbaric methods of chemotherapy and radiation - the modern day equivalent of blood letting with leeches. Often, these "therapeutics" create as many, or more, problems than they cure. To complicate matters more, doctors are taught too little or nothing about diet, holistic, and Eastern medicine in most medical schools, though that is slowly changing.

Moving out of the stone age:

Happily, we are living also in the renaissance of life sciences, starting with the mapping of the "nomes". With the mapping of the human genome (our genes), the proteome (our proteins), and the interactome (the interaction of our proteins), we are developing a much better understanding of what causes our diseases and even aging. With this better understanding, better therapeutics with fewer or no sides effects are being developed. 

The "nomes" are wonderful information, but even though we have mapped our roughly 30,000 genes, we only know the function of about one third of them. The same is true of our proteins and their interactions. Every day, scientists are making new discoveries on this front, and when they do, we get a few steps closer to curing more diseases.

Despite knowing so little about the details of our "nomes", there are many new exciting developments that can be applied to a large number of diseases. One great example is the work of Dr. Carl June and his team at the University of Pennsylvania. They have developed a method of quickly expanding the number of T-cells in our immune system that the fight cancer, thereby helping give the advantage to the immune system. This approach can be used with many cancers, since the T-cells our immune system creates are unique to the given cancer. So, by simply extracting, multiplying and reintroducing these T-cells into patients, customized, or personalized therapeutics are applied to fighting cancer. Furthermore, they create personalized vaccines from the patients' own cancer, which help the patient build their own antibodies to the cancer.

This is part of the new branch of personalized medicine. To underscore the importance and effectiveness of this personalized approach, Dr. June's therapy is now being offered by Harvard's Dana Farber in Boston, Memorial Sloan Kettering Cancer Center in NYC, MD Anderson in Houston, Johns Hopkins in Baltimore, Lee Moffitt Cancer Center in Tampa, Fred Hutchinson Cancer Center in Seattle, and of course the Abramson Cancer Center at the UPenn in Philadelphia. Last month Mass General just announced their personalized medicine lab. 

What Dr. June's team does is removes the T-cells that are fighting the cancer through a simple blood draw process, called apheresis, which takes about three hours as an outpatient. In the next 8-10 days, these extracted T-cells are multiplied in the laboratory between 1000 to one million times. Then, they put them back into the patient over a series of outpatient visits to give the patient's immune system an advantage over the cancer. The total process to fight the cancer with this approach is typically 12-16 weeks. 

Dr. June has 18 clinical trials cleared with the FDA for different cancers using this approach. He has treated over 400 patients, and even in Phase I of many of  these trials, there are dramatic results. One such success story is Patricia Dunn, former chairwoman of Hewlett Packard. She came to Dr. June in October, 2007 with late stage four ovarian cancer, after undergoing the drudgery of years of chemotherapy. Today, she is cancer free. To her tremendous credit, she is taking her story to help raise millions of dollars to help advance these trials for other women with ovarian cancer.

Earlier diagnostics:

Obviously, we want to discover our diseases as early as possible, when therapeutics can be most successful. Unfortunately, too often we do not have frequent check ups or screenings, and diseases develop unnoticed. To complicate it further, many diseases cleverly escape detection by our immune system.  For example, with smokers, in 2008 it was reported that nicotine helps disguise lung cancer from the immune system, so that by the time it is discovered, it is often too late. 

See: http://www.gbpcap.com/ja/news/read-article.html?article=5724

Additionally, nicotine helps speed the development of lung cancer. 

See: http://www.webmd.com/cancer/news/20060720/nicotine-speeds-lung-cancer

Detecting diseases earlier

The good news is there are improved new imaging technologies that are radiation free, or that use extremely low radiation to help diagnose many diseases and conditions better, faster, cheaper than existing standards. One example is hyperspectral imaging, which this blog will deal with in an upcoming edition. In short, every form of life, even cancers, have their own unique spectral image, and these can be seen with this new technology. Today, hyperspectral imaging, even in its relatively early stage of development, can detect 90% of skin cancers vs. the 70% of trained dermatologists.  

Better gene delivery, protein manufacturing and vaccine production

Knowing about a missing gene, or understanding that we are producing too much of one or more proteins that cause roughly half of our diseases is useful info, but only if there is a way of acting upon this information. Fortunately, there is one. The safest, most effective way of adding a gene to set of cells is with a technology called a lentiviral vector (LV). Ironically, LV is HIV stripped of 90% of its genes, so that it can do no harm, but it makes the resultant "vector" an extremely effective tool for realizing the potential of gene therapy, without the harmful side effects or shortcomings of other modified viral vectors. Furthermore, it is the most effective means of making proteins (a $120B industry) and vaccines for everyone on earth in a relatively short period (two to three months) of time without chicken eggs. 

There will be much more published on LV's in an upcoming blogs. The T-cell therapy and use of LV is an area of medicine called biologics, and it is in the process of displacing many drugs. Biologics deliver solutions where drugs fall short or have harmful side effects. Biologics do this by assisting or enhancing  the body's natural methods of operating properly. This is why Roche bought Genentech and Celgene just inked their $500M deal with GlobeImmune.  

So, we are well on the road to treating cancer with little or no chemo or radiation, detecting diseases earlier, and enabling gene therapy and growing proteins and vaccines better, faster and less costly than present methods. This is why we are in the midst of the life science renaissance. Given that the baby boomers are entering their disease prone years, and we are threatened with pandemics for which we have no way of making enough doses, this renaissance is coming none too soon. 

Best,

Dave