Stopped self-destruction
A way to fight deadly diseases has been found
RIA Novosti, Nikolai Guryanov. A new type of therapy has caused remission in patients with lupus, one of the most severe autoimmune diseases. Why such ailments are the scourge of civilized countries and whether scientists have really found a way to save the body from self—destruction — in the RIA Novosti material. Retrained Killer Cells
Lupus of one form or another affects about five million people worldwide. The most common is the system red.
Unlike most autoimmune diseases, lupus can affect any organ — which means that patients cannot be treated "according to a template". It is difficult to make a diagnosis. Medications, including steroids, are not always effective, and they have serious "side effects".
Celebrities often became victims of the disease. For example, singer Yulia Nachalova died of lupus, and pop star Selena Gomez was transplanted with a donor kidney. Discoid lupus erythematosus left traces on Michael Jackson's face.
The causes of the disease are not fully understood. Researchers suggest that viruses, certain medications, as well as changes in the body during puberty and menopause can provoke lupus. Sometimes the disease occurs due to the action of the adaptive humoral immune system - when the so—called B-lymphocytes begin to attack the tissues of their own body. Treatment involves the destruction of such B-cells, and modern medicine knows how to do it.
They used to fight blood cancer this way. To do this, we have developed a powerful innovative tool — CAR-T-cell therapy. The name consists of two parts: chimeric antigen receptor, that is, chimeric antigen receptor, and T-lymphocyte. The active substance is not a medicine, but living cells.
During therapy, healthy lymphocytes are taken from the patient's body and genetically modified in a test tube. With the help of a special mechanism, a special gene is inserted into them. Then the "retrained" T-lymphocyte is returned to the patient's body, where it begins to destroy tumor cells.
A new study, the results of which are published in Nature Medicine (Mackensen et al. Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus), has shown the effectiveness of the CAR-T method against lupus as well. Doctors in Germany have achieved remission in five people — four women and one man. Patients were able to refuse to take heavy medications for a period of five to 17 months. Lupus affected several organs in all five of them. But after therapy, the symptoms — arthritis, fatigue, fibrosis of the heart valves and pneumonia — disappeared. The patients tolerated the treatment well. Blood tests showed that after about four months, the B cells recovered, but no longer produced abnormal antibodies.
A panacea? Perhaps, but not immediately
The authors of the article suggest that the same effect with the help of CAR-T-cell therapy can be achieved in the fight against other autoimmune diseases, such as multiple sclerosis or arthritis. However, according to immunologists, it is too early to consider technology a panacea for diseases associated with the "self-destruction" of the body.
"We were shown rather a pilot project. We need more or less full-fledged clinical studies that would show a net effect. But it is already clear that the prospects are very good," says immunologist Nikolai Kryuchkov, General Director of the contract research company KEG. He explains that by using conventional medications — hormones and antimetabolites, we hit the target with "guns". This severely injures the body from the inside, many necessary and important processes are turned off. "More targeted drugs are more difficult to develop, many nuances need to be taken into account. By lupus we mean a certain complex of related diseases, which means that there are individual characteristics. Such therapy is not suitable for all patients. But even if it helps at least a quarter, it will be a huge breakthrough," Kryuchkov explains.
In his opinion, success can be considered not only a complete cure, but also a significant prolongation of the life of patients.
CAR-T-cell therapy has several disadvantages. This is a complex and extremely expensive technology. In addition, it is little studied. This means that there is a potential danger of high oncogenicity and unexpected reactions from the immune system.
Cell therapy in general is a new direction, and its widespread use has already led to negative consequences. At one time, celebrities, including Russian ones, were fond of using "rejuvenating" stem cells from umbilical cord blood. It turned out that this technique provokes the growth of tumors.
However, immunologists are optimistic about the future of CAR-T therapy. This technology is being developed by several countries, scientists see in it prospects in the fight against oncology, autoimmune and infectious diseases (for example, HIV), as well as aging.
"The main thing is that the direction has already been found, which means that there will be breakthroughs. Moreover, CAR-T therapy is not the only promising way to treat diseases associated with impaired immune function. Doctors have high hopes for biological medicines, gene therapy, biomedical cell products," Kryuchkov notes.
According to him, an effective method of treating autoimmune diseases may appear in the next ten years.
The scourge of rich countries
Autoimmune diseases are much more common in residents of developed countries. And lately there are more and more patients. The exact reasons are unknown, but scientists have a few guesses.
"The number of immunodeficient people is growing, and autoimmune diseases are a variant of the immunodeficiency condition," says immunologist Vladimir Bolibok. — It sounds a little strange, because with autoimmune diseases, it would seem that the immune system should be activated. But in fact, there is a failure of regulation — that is, a defect, not an amplification."
Another factor he cites is the high xenobiological load. There is a lot of harmful "chemistry" in the human environment. The interaction of synthetic products and body proteins can trigger an autoimmune process.
"This has not been studied very well yet," the doctor notes. — I deal mainly with allergies, so I can say for sure: pollen antigens become more aggressive, being chemically modified by exhaust gases and other pollutants. In urban agglomerations, megacities, where the environment is environmentally unfavorable, the number of respiratory allergies in percentage ratio is many times greater than in the outback."
There is a controversial hypothesis that autoimmune diseases develop due to an obsession with hygiene. Supposedly disinfectants kill not only harmful, but also beneficial microbes that play a key role in the proper functioning of vital systems. In addition, a person ceases to interact with nature, for example, with animals — and this also negatively affects the microflora of his body.
Bolibok considers another theory more convincing — the "avoidance" of natural selection. People with defects in the body, born before the era of vaccination and antibiotics, simply did not live to see the manifestation of autoimmune processes, which often occurs after 35 years. However, the achievements of modern medicine significantly extend the time allowed by nature.
Anyway, CAR-T-cell therapy and other innovative techniques can not only increase the life expectancy of patients, but also improve its quality.
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