Immunology is a relatively young field of research that is set to revolutionize modern medicine. Only 10 years ago, the idea of genetically engineering the human immune system to fight disease was considered science fiction. Today, the potential to treat or delay a vast range of disorders is evident. “Immunology research is essential in understanding the pathogenesis of many diseases,” says Akiko Iwasaki, professor of immunology at Yale School of Medicine. The immune system is involved not only in fighting off infectious diseases, but is also the mediator of many other pathologies, including autoimmune diseases, neurodegenerative diseases, metabolic diseases, heart disease, lung disease, and cancer. “This is because the immune system is a language used by the body to communicate between different organs.” “When it comes to treating most diseases, immunotherapy will be the answer,” says Gary K. Michelson, founder and cochair of Michelson Philanthropies and the Michelson Medical Research Foundation. “The human immune system, through its workhorse, inflammation, seems to be the common denominator.” A new vaccine age Until a few decades ago, scientists thought the central role of the immune system was to fight bacterial and viral infections. The development and widespread use of vaccines that aid the immune system have been the most significant medical contribution to doubling the average human lifespan over the past century. But vaccine development is challenging. Clinical trials can take years, cost hundreds of millions of dollars, and fail over 85% of the time.1 Over the last 5 years, advances in immunology research have built the groundwork for developing a universal vaccine structure using messenger RNA (mRNA) encapsulated in a lipid package. This technology can be applied effectively for new target bacteria or viruses by incorporating a snippet of genetic material coding for almost any antigen expressed by that pathogen into the package. Michelson likens it to a cassette player capable of playing any cassette. The mRNA technology—which was already being tested for other vaccines— allowed scientists to develop effective COVID-19 vaccines in just 66 days. “Immunology research played a vital role in the pandemic,” says Iwasaki. “Immunological studies before the pandemic were essential in building the foundation for today’s successful vaccines.” Likewise, she says that understanding how the immune system protects against COVID-19 and how aberrant immune responses cause severe and fatal infection enabled scientists to develop effective therapies, saving millions of lives. Cancer in the crosshairs This ability to use genetic sequencing to teach the human immune system how to fight a disease is a quantum leap in immunotherapy—the therapeutic application of immunology—and can be applied to several disorders other than viral infections. “Immunology goes way beyond fighting infectious agents,” Iwasaki says. One such disease is cancer. “We all now know the power of harnessing the immune response against cancers using immune therapies like checkpoint blockade or CAR [chimeric antigen receptor] T cells.” Scientists have long thought that the immune system had some role in surveilling cancerous cells in the body. Immunology research has shown that cancer cells must access adequate nutritional substances and have cloaking mechanisms to hide from the immune system to sustain a high growth rate. Traditionally, treatments have targeted tumors with very potent metabolic poisons, or chemotherapeutics, on the premise that these would kill highly metabolically active cancer cells before the patient. But cancer cells can mutate to become resistant to chemotherapy, and these mutations can differ widely between patients. Consequently, scientists are shifting their focus to enhancing the immune system. The magic of immunotherapy is its ability to be tailored to fit the antigen repertoire of each patient. “Two decades ago, no one thought immunotherapies would become mainstream in cancer treatment,” says Linda Liau, professor and chair of the Department of Neurosurgery at the University of California, Los Angeles (UCLA). “But now we are seeing the potential to cure cancers that were incurable. There will be a huge growth in cancer immunotherapy in the future.” A lot still to learn Over the last decade, it has also become clear that the immune system is in play in human aging. Degenerative neurologic disease is an area where scientists can expect to see important breakthroughs, says Liau. They have learned that neurologic conditions are associated with immune responses, and “if we can modulate those, we may be able to prevent some of these degenerative processes.” Another emerging area of research is understanding the link between the immune system and the gut microbiome. “We could modulate the immune system through what we eat, and that’s just fascinating!” Liau says. Michelson believes that decoding the mysterious workings of the human immune system is the best way to protect ourselves from diseases, aging, and future pandemics. It is this work hat will allow for immunotherapy to mean the treatment of all diseases. “The progress will be revolutionary—not evolutionary—and this will be the decade for that.” “I imagine that immunology will continue to make progress in the fundamental understanding of how cells of the immune system communicate with other systems like the nervous system, digestive system, and endocrine system,” says Iwasaki. “I also think there will be more dots connected between infections and autoimmunity. This will enable diagnosis and therapy, and place more emphasis on vaccines against common viruses.” Immunology principles lie at the heart of medicine and have a much broader impact than any other sub-speciality within medicine, says Liau. But we still don’t know enough, she emphasizes. “The more we learn about human immunology, the better we can strive to cure incurable diseases.” Michelson and a group of leaders in philanthropy, science, medicine, academic research, and government are working to create an ambitious new immunology and immunotherapy research center on the campus of UCLA. Michelson describes it as a “field of dreams” that will attract the very best scientists from around the world. Through multidisciplinary collaborations, the new center will push the frontier of biomedical research,and ultimately human health itself, translating breakthrough discoveries into real-world medications and treatments.“Groundbreaking discoveries are seldom the work of individual researchers,”says Michelson. “They require teams of workers across many disciplines. Interdisciplinary cooperation brings breakthroughs from bench to bedside more quickly.”
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