MAKING MEDICINE
BY CONNIE MITCHELL
Some call it the “therapeutic pipeline.” Others refer to it as “bench to bedside.” Both phrases refer to the scientific process that delivers new therapies, new medicines, to people who are sick. In the pipeline metaphor, an idea rushes along, like water in a hose, from the minds of researchers into the lab, through testing and approvals to the pharmacy or treatment room. In the bench metaphor, progress is similarly linear, advancing from the scientist’s bench in the lab to the patient’s bedside. But neither image paints an accurate picture.
Imagine instead a large Rube Goldberg machine, with cogs and wheels and diversionary paths. Research isn’t a straight-line prospect.
ILLUSTRATION OF CAR-T IMMUNOTHERAPY AT WORK. Photo courtesy of Science Photo
Washington University oncologist John DiPersio, MD, PhD, a nationally known expert in the treatment of leukemia and lymphoma, serves as deputy director of Siteman Cancer Center and director of the Washington University Center for Gene & Cellular Immunotherapy (CGCI). With more than three decades of experience as a physician-scientist, DiPersio has played an instrumental role in developing new therapies to treat blood cancers. Yet DiPersio, reflecting on his professional journey, notes that the work is never done. “It’s a constant iterative process of bench to bedside and back to bench again,” he says. His work with CAR-T immunotherapy is a clear example of what he’s talking about.
CAR-T immunotherapy isolates a person’s T cells—cells the immune system uses to find and destroy harmful invaders—and modifies them to home in on cancerous cells. Once modified, these cells are known as CAR-T cells: chimeric antigen receptor T cells. After modification, the CAR-T cells are returned to the body, where they find their malignant targets and, behaving as any T cell should, trigger a chain of reactions that destroys the targeted cell.
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