Engineered white blood cells may eliminate cancer?

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In summary, University of Pennsylvania engineers have manipulated white blood cells to eliminate solid tumors. By silencing the molecular pathway that prevents macrophages from attacking our own cells, they have manipulated these cells to eliminate cancer. This therapy is more targeted and effective than traditional surgery, but it is associated with significant risks.
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By silencing the molecular pathway that prevents macrophages from attacking our own cells, University of Pennsylvania engineers have manipulated these white blood cells to eliminate solid tumors.
https://medicalxpress.com/news/2023-06-white-blood-cells-cancer.html
Cancers that form solid tumors such as in the breast, brain, or skin are particularly hard to treat. Surgery is typically the first line of defense for patients fighting solid tumors. But surgery may not remove all cancerous cells, and leftover cells can mutate and spread throughout the body. A more targeted and wholistic treatment could replace the blunt approach of surgery with one that eliminates cancer from the inside using our own cells.

The challenge is to find a way for our own macrophages to recognize cancer cells, i.e., discern cancer cells from healthy cells.

Macrophages, a type of white blood cell, immediately engulf and destroy—phagocytize—invaders such as bacteria, viruses, and even implants to remove them from the body. A macrophage's innate immune response teaches our bodies to remember and attack invading cells in the future. This learned immunity is essential to creating a kind of cancer vaccine.

But, a macrophage can't attack what it can't see.

"Macrophages recognize cancer cells as part of the body, not invaders," says Dooling. "To allow these white blood cells to see and attack cancer cells, we had to investigate the molecular pathway that controls cell-to-cell communication. Turning off this pathway—a checkpoint interaction between a protein called SIRPa on the macrophage and the CD47 protein found on all 'self' cells—was the key to creating this therapy."

https://www.nature.com/articles/s41551-023-01031-3 (Subscription or purchase required)
 
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Generally, our immune system does recognise abnormal cells and for cancers to develop a range of mutations have to occur, one of which must protect the abnormal cells from being recognised and destroyed. There are an increasing number of the so-called biologic drugs which specifically target the molecular messengers that help protect the cancer cells. These can be combined with techniques to improve the recognition of the malignant cells, even at the level of a specific individual's cancer. There are unfortunately, a number of issue effecting the interactions between solid tumours and the immune system, a solid tumour characteristically will have areas of hypoxia containing dead or dormant cells and many of these cells will contain a variety of mutations which may potentially protect them.

People often consider our immune system to be a benign force to protect us, unfortunately it is far from benign, it requires careful control to prevent it attacking normal tissues, many of these drugs have their effect because they remove this control. So while these drug's are generally safer than traditional chemotherapy, they are still associated with significant risks.

Causing the death of a large number of malignant cells using drugs or radiation, does in itself activate the immune system and allows the immune system to recognise tumour cells. This effect becomes more powerful when combined with various biologic drugs that block some of the control molecules. The techniques described in the article describe the development of techniques based on vaccine technology, which represents further developments in fine tuning the immune responses and making them more specific.

A number of different approaches are already available but the cost of such individual approaches limits their use and solid tumours present a particular challenge. There is a lot of money going into cancer therapeutics and in some ways the pace of developments is staggering, perhaps the so called moon-shot in cancer research is paying off.
 
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1. How do engineered white blood cells eliminate cancer?

Engineered white blood cells, commonly known as CAR T-cells (Chimeric Antigen Receptor T-cells), are genetically modified to better recognize and attack cancer cells. They are equipped with special receptors that can identify specific proteins, or antigens, on the surface of cancer cells. Once these modified cells are reintroduced into the patient’s body, they seek out and destroy the cancer cells, potentially leading to remission in certain types of cancer.

2. What types of cancer can be treated with engineered white blood cells?

Currently, CAR T-cell therapy has been most successful in treating certain types of blood cancers, such as acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), and some forms of non-Hodgkin lymphoma. Research is ongoing to expand the use of this technology to other types of cancer, including solid tumors, but this presents additional challenges.

3. What are the risks or side effects of this treatment?

The treatment with engineered white blood cells can lead to significant side effects, the most severe being cytokine release syndrome (CRS). CRS occurs when the immune system is overly activated, leading to high fever, nausea, fatigue, and in severe cases, organ failure. Neurological side effects are also possible, including confusion, seizures, or loss of balance. Ongoing research aims to manage and mitigate these side effects.

4. How effective is this treatment in eliminating cancer?

The effectiveness of CAR T-cell therapy varies by the type of cancer and the individual patient. In some cases, particularly with certain blood cancers, this treatment has led to complete remission where other treatments have failed. However, not all patients respond to the therapy, and in some cases, the cancer can relapse. Researchers are continually working to improve the efficacy and reliability of this treatment.

5. Is this treatment available to all cancer patients?

Currently, CAR T-cell therapy is not universally available and is primarily offered through clinical trials or at specialized medical centers. Eligibility for the treatment depends on the type of cancer, its stage, previous treatments, and overall health of the patient. Additionally, the high cost and complex manufacturing of these engineered cells limit their widespread use. Efforts are ongoing to make this therapy more accessible and affordable.

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