A Revolutionary Breakthrough in Oncology Treatment

T-cell-cancer

Cancer kills 9,000,000 (9 million) people each year and despite having searched for centuries, a cure has yet to be discovered by scientists. At the center of the immune system is the T cell, a type of leukocyte which respond against bacterial and viral infections alike in an effort to keep their host healthy and alive. T cells determine between threatening and non-threatening foreign and non-foreign bodies within a host by leveraging a molecule upon the surface of all cells referred to as the “T cell receptor”. Jim Allison was the first person to successfully isolate and purify the molecule which recognizes this lock and key model for infectious disease, auto-immune disease, and other innocuous substances within the body be they foreign or internally created. In 1987, French scientist Pierre Golstein and his team discovered a new protein upon the surface of T cells which he named “CTLA-4”. To study CTLA-4 in laboratory rats, Allison had to build and design a rat antibody, a Y shaped protein which would trigger a reaction by CTLA-4. Cancers are mutations and should in theory be visible to the immune system, which is why the scientific community has struggled with the paradox of why tumors go undetected by the immune system for decades. There is no discernible reason as to why the immune system can recognize and resist influenza or any other foreign or domestic body but not cancer. Allison theorized that tumors have evolved an ability to fool the immune system, engaging CTLA-4 which turns on the T cells response to halt its search and destroy measures. Allison hypothesized that if he inserted a Y shaped antibody to block the gap in between the tumor and T cells, the tumor would no longer have its ability to hide, a trait which has been evolved by tumor cells over hundreds of millions of years. This would allow the T cell to infiltrate, attack from within the tumor, shrink, and ultimately kill the growth. Allison spent the next decade trying to turn this revolutionary breakthrough discovery into a medication which could be provided to cancer patients. Allison found Alan Korman, a scientist creating medications for auto-immune disease which provided him with the expert he required to turn this idea into a reality. Korman was tasked with taking the CTLA-4 antibody which Allison and partner Max Krummell developed for laboratory rats, and turn it into a medication which could safely work within human beings with this medication subsequently being named “Ipilimumab” (pronounced “ipi-lim-ooh-mab”). Korman ended up collaborating with a friend from graduate school, Nils Lonberg to accomplish this task. Ipilimumab consists of an intramuscular injection into the leg and a 90 minute intravenous medication drip in comparison to chemotherapy and radiation therapy which take months of treatment to complete and have devastating effects upon overall health as both bad and good tissue are destroyed in an effort to eradicate all tumor cells. Allison’s work with laboratory rats demonstrated that with the help of this newly developed antibody, T cells gained the ability enter into tumors and expand their size in an effort to destroy them from the inside out. This means that the fact that tumors grow initially upon administration is a positive marker and indicative of the medication working as it demonstrates successful infiltration of the tumor cells themselves. Patients often report feeling better after a few treatment sessions, sometimes even a single session, despite computer tomography scans demonstrating that their tumors are growing larger, which under normal circumstances would make a patient feel worse. Some patients even noted increased improvement after having stopped the Ipilimumab treatment, with no further therapy required. On March 25, 2011, the U.S. Food and Drug Administration released approval for Ipilimumab. Ipilimumab and its successors have treated nearly 1,000,000 (1 million) patients worldwide with many of these patients achieving permanent remission which is essentially the definition of having been cured of cancer. Although these medications do not work in every single case, they have definitively demonstrated to be a miracle medication for hundreds of thousands of people thus far. After completing this revolutionary discovery, Allison was awarded the Nobel Prize in Medicine in 2018 for his series of discoveries related to T cells and their ability to halt cancer in its progression in perpetuity

Weight Lost Prior to Bariatric Surgery

bariatric-surgery

The reason bariatric patients are required to lose weight before undergoing bariatric surgery is because the liver becomes enlarged in obese patients and this enlarged liver sits directly atop of the area which needs to be operated upon. Shrinking of the liver is crucial prior to surgery to ensure the surgery is performed as safely as possible