In 1890, an American cancer surgeon discovered the case of Fred Stein, a German immigrant with a rock-hard lump in his neck. It was an inoperable, malignant tumor – a sarcoma. In addition, the poor patient developed a skin infection caused by the bacterium Streptococcus. Doctors were flabbergasted when Stein’s deadly tumor disappeared after the infection. Dis-satisfied with standard treatment of malignant sarcomas at the time, the surgeon experimented on hundreds of patients with terminal, inoperable tumors, injecting bacteria or bacterial products. A large percentage of the patients showed complete tumor regression.
In 2017, while walking on a warm and sunny beach in Country X, I wandered away from the scattering of bikini-clad European tourists, into a cluster of palm trees. There I ran into two natives of the country who were at work with rakes and plastic bags, keeping the beach clean. After hellos, they burst into an enthusiastic expression of national pride. “Do you know about the vaccine we created? It cures cancer!”
On a level not immediately obvious, these two events are connected. As are the Coronavirus vaccine and modern cancer treatments. Let’s dive in.
When I entered Med School, Medical Science had progressed from Gross Anatomy (what your eyes can see in the dissection lab), down into increasingly smaller components of our bodies only visible in a microscope. And we were teetering on the verge of an exciting new, much deeper world with the electron microscope. With it, we could observe the interior of our cells in much greater detail.
Also at that time, most cancers were considered very difficult to treat. As an example, the most common childhood cancer, Acute Lymphoblastic Leukemia (ALL), was considered incurable.
The progress bequeathed to us by Medical Science since those days has been stunning. ALL is now curable in 90 to 95% of kids. We treat most cancers with surgery, radiation and chemotherapy. I think of these therapies as blasts from a shotgun, sometimes hitting the target of cancer, but often causing a lot of collateral damage to normal tissues. As someone once described chemo to me, “we hope to kill more cancer cells than normal cells.”
But now, we are again teetering on the verge of an exciting revolution in both prevention of infectious diseases and in cancer treatment. This progress is due to our having gone deeper into the human body than even the electron microscope could take us. Down to the level of molecules.
Molecules, you may recall, are the chemicals that are composed of atoms. Like water (composed of hydrogen and oxygen) or table salt (sodium and chlorine). The molecules which are the building blocks of Life are larger and mostly carbon-based. And with all the dizzying activity required to keep living organisms like us going (turning food into energy, turning an egg and sperm into a person, repairing our bodies when we damage them) there are two molecules that keep it all from descending into chaos. You know them: DNA is the keeper of all the codes that govern how the body functions; RNA is the workhorse that turns the codes into action.
Think of DNA as a string of pearls. Each one of the pearls along the string is responsible for giving one very specific message to your body, with it’s own set of instructions. Each pearl is called a gene. This priceless string of pearls remains deep inside our cells, protected within the nucleus in the center of the cell, like a princess behind the fortress wall. RNA takes orders from the DNA by making the proteins, allowing the DNA code to be implemented for our bodies.
Scientists can now find the exact make-up of the DNA code in our cells, and of RNA which carries out the orders. Taking that information, they have created maps of the genes. Going further, scientists can cut out certain unwanted genes or insert needed genes. We are now even able to build a piece of RNA to use to our benefit. This is “genetic engineering.”
You’ve already experienced it.
Vaccines:
When you got a Covid test, the lab searched your nasal swab for the exact RNA in Coronavirus. And when you got the m-RNA vaccine, it consisted of a small piece of engineered RNA, made to look just like the gene which the virus uses to make the “Spike” protein on its surface. The vaccine RNA never got into the nucleus where your DNA is. Beating the virus to the punch, this RNA directed your cells to manufacture a protein identical to the “Spike” which the virus uses to infect you. The vaccine RNA was then destroyed, and your immune system began creating antibodies against this Spike protein, ready to repel the virus.
Cancer:
Recall that, back in Med School days, we perceived cancer as an attack of a hoard of abnormal cells that couldn’t stop multiplying. Our current concept of cancer is that it starts with a single error in the DNA of a cell. As that cell reproduces, the offspring may accumulate more errors in its genes. At some point, your immune system should recognize abnormal cells and destroy them.
However a few abnormal cells may survive because changes in their structure helps them evade immune attack, even though the immune system has many different ways to kill cancer cells.
Think of this like what happened with bedbugs. The same species of this pest can be found in Florida and New York. But studies reveal that the New York bugs have quickly evolved mutations to protect them from pesticides. They are many times more resistant than their Florida cousins.
Cancer, too, evolves, but on a microscopic scale.
Sometimes, the immune system needs help in this fight. What we want is some sniper rifles instead of more shotguns. Well-aimed bullets instead of chemotherapy and radiation with all the collateral damage. We might be able to specifically target cancer cells by strengthening the immune system.
Cancer Immunotherapy:
This is the rapidly expanding field of harnessing the body’s own immune system to successfully attack a tumor. Lucky for us, tumor cells have targets on them. We start by finding the genes and molecules that cancer uses. Let’s focus on three: first, many tumors have genes that produce Tumor Antigens (molecules) which are displayed on their surfaces. A lot like Coronavirus Spike proteins on the surface of the virus. Second, scientists have found genes in tumors that control multiplication of the cells, spread of the tumor, and resistance to the Immune system. Third, tumors use various external molecules as Growth Factors. Examples include hormones that stimulate growth of prostate cancer or breast cancer.
Knowing this, we can now help the Immune system target a tumor specifically, and reduce damage to normal cells. Here’s how:
- One unique treatment – some have called it “a living drug” – involves incubating cancer cells with normal immune system cells (B cells) in the lab. The immune system cells make antibodies against the cancer cells. Then the gene for making these antibodies is snipped out and inserted into the patient’s own immune system T-cells (Killer cells). These T-cells are multiplied in the lab, then are injected into the patient. When they encounter cancer cells, the antibodies they carry from the lab help them recognize the target. Like well-aimed bullets, they attack and kill the cancer cells.
- In cancers that depends on external Growth Factors, one method of reducing these is to develop a vaccine which will direct the Immune system to destroy these molecules. That’s what Country X did with its CIMA-Vax . Another approach is to use antibodies against the Growth Factor as a treatment.
- Using bacteria in a lab, scientists are working to create RNA vaccines that can force production of Tumor Antigen. The body’s Immune system would then learn to build antibodies against that antigen to lead the attack. Pretty much like the m-RNA vaccines for Coronavirus stimulated antibody production. See how that works?
- Emerging information shows that some bacteria can enhance or diminish tumor growth, most likely by producing specific molecules activating the Immune system. One example currently in use is the administration of modified Tuberculosis germs into the bladder to treat bladder cancer. Immune system cells stream to the bladder to kill the TB, and then also attack the cancer. So our sarcoma doctor in the 1890’s was doing cancer Immunotherapy, even though he didn’t realize it.
As with any scientific efforts, there will sometimes be setbacks with vaccines or cancer therapies. But the goal is always to do much more good than unintended harm.
Science, including Medical Science, advances both by serendipitous discoveries like the 1890 observations of our sarcoma doctor, and by building upon the foundations established by preceding scientific work. As did Country X. We are now exploring the detailed complexity of the human Immune system at the molecular and genetic level, and already reaping benefits for protection against pandemics and against many kinds of cancers.
Sex, Drugs, and Public Health 