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The Immunotherapy Revolution

Immunologist Professor Daniel Davis' book The Beautiful Cure is up for the Royal Society Book Prize - here he tells us how our immune system could help in the battle against cancer.

The Nobel-prize winning physicist Richard Feynman once told a story that I often think about. He recalled how an artist friend of his looked at a flower, marvelled at its beauty and commented that when scientists take it all apart, the beauty is lost and the flower becomes dull. Feynman replied that this view was simply ‘nutty’. Because he can also easily appreciate the beauty of a flower but that as a scientist, he could also imagine the cells in there, and the wonders of molecular activity inside the cells, the processes that give cells their colour, and how the colours in the flower evolved in order to attract insects, which implies that insects might have also some sense of aesthetics, and so on. In short, Feynman reasoned that surely ‘knowledge only adds to the excitement, the mystery and the awe of a flower.’

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The insides of the human body are not obviously beautiful in the same way that a flower is. But hidden from view, the details of how the human body works amount to something profoundly beautiful and far more intricate than a flower. Arguably, the complex process within us which has been studied the most is in how our immune system works. For decades, if not centuries, we have been picking apart what happens in the body to defend us against disease, which has opened up a thrilling view of what we are.

On the face of it, our human immune system has a straight-forward task; to protect us from infections and other diseases. But there are countless complications. The human body, which the immune system should not attack, changes over time; some bacteria are not harmful and do not require a response; dangerous germs try to avoid being detected, and so on. To achieve this simple-sounding mission – to protect us from disease – our bodies use an unfathomable number of cells, proteins and other components, which altogether make up a system as elaborate as anything else we know of in the universe. For me, this is one of the greatest and most important frontiers of modern science. Not only for the wonder of it all, but also because understanding how the immune system works leads us to important ideas for our health and well-being.

Royal Society Insight Investment Science Book Prize 2018

My book, The Beautiful Cure, discusses how understanding the immune system leads us to new ideas for treating auto-immune diseases, cancer, and many other illnesses. Here, let me give one example; of how a basic discovery about how the immune system works leads us to new treatments for cancer. If you were infected with a virus, say the ‘flu virus, the particular immune cells in your body which were best able to fight that type of ‘flu would multiply in number. But after the virus had been cleared from your body, you wouldn’t need so many of those specific immune cells in a heightened state of activity. To deal with this, there are brakes built into the immune system to dampen its activity after some time, to bring the body back to its normal resting state.

However, if the immune system was engaged in a longer battle, such as might be needed in killing cancerous cells, then it could very well be problematic if the immune system’s brakes were turned on; this would seemingly weaken the body’s ability to fight the illness over time. This does happen and even worse, some types of cancer even exploit this part of the immune system by deliberately engaging the system’s brakes to switch off its activity. This leads to a big new idea for medicine. If we block the immune system brakes – switch off the off-signal, as it were – we might be able to boost our natural immune response to long-term problems such as cancer. And for a small number of patients with certain types of cancer, this has proved to be a successful idea. Some patients have, against the odds, lived for many years by taking medicines that unleash their own body’s immune response to better fight their cancer.

Of course, it’s important not to over-hype the success. This type of treatment has, so far, only worked for a limited number of patients with specific types of cancer. But I don’t think it’s over-hyping the situation to suggest that this is just the tip of the iceberg. Many more immune-based therapies are on the horizon. There are, for example, many different types of brakes on the immune system. And we can try blocking each one separately or in combination, or in combination with other types of treatments. And there are entirely different types of immune therapies which also look promising. Such as the idea of isolating a person’s immune cells from blood, genetically modifying the cells to include a receptor protein able to target a patient’s cancer, before then infusing the modified immune cells back into the patient’s blood stream.

These discoveries do not come easy. One new medicine has been estimated to build upon the work conducted by 7,000 scientists at 5,700 institutions over a hundred-year period. Some people have made huge individual contributions but overall, it is the collective work of thousands of scientists over decades – a great human endeavour that deserves to be widely known and celebrated – that has brought us to this point, a tipping point, in which our understanding of how the body fights disease is perhaps about to enable swathes of new medicines and bring on the immunotherapy revolution.

This article is based upon ideas in The Beautiful Cure (Bodley Head, 2018).

The Royal Society Insight Investment Science Book Prize celebrates the best of science writing for a non-specialist audience. The winner of the 2018 Prize will be announced on 1st October.

The Beautiful Cure (Bodley Head, 2018).

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