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Journalism of Courage
— Amit Kumar
(The Indian Express has launched a new series of articles for UPSC aspirants written by seasoned writers and erudite scholars on issues and concepts spanning History, Polity, International Relations, Art, Culture and Heritage, Environment, Geography, Science and Technology, and so on. Read and reflect with subject experts and boost your chance of cracking the much-coveted UPSC CSE. In the following article, Amit Kumar, a doctoral candidate at IIT Delhi, describes CAR-T cell therapy, its procedure and benefits.)
CAR-T cell therapy, chimeric antigen receptor T-cell therapy, is an immunotherapy-based cancer treatment that uses the power of a patient’s own immune system to fight cancer. The immune system is the body’s defence network against infections and diseases. White blood cells (WBCs) play a pivotal role in the immune system.
WBCs, or leukocytes, are produced in the bone marrow and circulate in the blood and lymphatic system. The key types of WBCs include:
i) Neutrophils – Engulf and destroy pathogens
ii) Lymphocytes – Target specific invaders and remember past infections
iii) Monocytes – Differentiate into macrophages and dendritic cells, ingesting pathogens and presenting antigens
iv) Eosinophils – Release enzymes and toxic proteins that kill parasites and modulate inflammatory responses, and
v) Basophils – Release histamine and other chemicals that contribute to inflammation and allergic symptoms.
Together, WBCs identify, attack and eliminate harmful invaders, ensuring body protection.
The immune system protects the body from infections using two main strategies: innate and adaptive immunity. Innate immunity provides immediate, non-specific defence through barriers (skin, mucous membranes), phagocytic cells (neutrophils, macrophages), and inflammatory responses.
Adaptive immunity involves lymphocytes – a type of white blood cells. Adaptive immune responses are carried out by different classes of lymphocytes called B-cells and T-cells. B-cells (originate and mature in the bone marrow) produce antibodies targeting specific pathogens (antigens), while T-cells (originate in the bone marrow and mature in the thymus) destroy infected cells.
Upon pathogen entry, the immune system recognises antigens, activates immune cells, eliminates the threat, and forms memory cells for faster future responses. This coordinated effort ensures rapid and targeted defence against harmful antigens, maintaining overall health and preventing disease.
T-cells are primarily used in CAR-T cell therapy because of their pivotal role in the immune system’s response to pathogens and malignancies. These cells can be genetically engineered to express chimeric antigen receptors (CARs), which are specifically designed to recognise and bind to antigens on the surface of cancer cells. Once bound, these modified T-cells can efficiently kill cancer cells.
Other cells like B cells or natural killer cells also play roles in immunity but don’t have the same adaptability and memory capabilities as T cells, making them less effective for the persistent and targeted action required in CAR-T cell therapy.
The CAR-T cell therapy starts by collecting a patient’s T-cells through a process called apheresis, which separates these cells from the blood. These T-cells are then sent to a lab where scientists modify them to add special receptors called chimeric antigen receptors (CARs).
These receptors help the T-cells find and kill cancer cells. This modification process takes a few weeks. Afterward, the modified T-cells are grown in large numbers before the modified T-cells are given back to the patient’s bloodstream.
This therapy is particularly effective for certain types of blood cancers like leukaemia and lymphoma, where traditional treatments may not have worked.
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It represents a form of personalised medicine, as the therapy is tailored to each individual’s specific cancer.
CAR-T cell therapies are also called “living drugs” because they use a patient’s own living T-cells, genetically engineered to target and destroy cancer cells. These cells actively seek out, proliferate, and persist in the body, providing a dynamic and personalised defence against cancer, unlike traditional static drugs.
CAR-T cell therapy has emerged as a transformative treatment in oncology – a branch of medicine that specialises in the diagnosis and treatment of cancer – offering significant benefits for patients.
1. Targeted Precision: CAR-T cell therapy is designed to target specific antigens present in cancer cells. This specificity allows the therapy to directly attack cancer cells while sparing normal, healthy cells. The precision minimises collateral damage and reduces the risk of side effects compared to traditional treatments like chemotherapy, which can affect both cancerous and healthy cells.
2. Personalised Treatment: The therapy is highly personalised. T-cells are extracted from the patient’s own blood, engineered in the lab to express specific receptors targeting cancer cells, and then infused back into the patient. This personalised approach ensures that the therapy is tailored to the unique characteristics of the patient’s cancer, enhancing its effectiveness.
3. Long-Lasting Effects: In some cases, CAR-T cells have demonstrated the ability to persist in the patient’s body for an extended period, potentially providing long-lasting protection against cancer recurrence. The engineered T-cells can continue to recognise and attack cancer cells long after the initial infusion.
4. Reduced Hospitalisation and Supportive Care Costs: The targeted approach and effectiveness of CAR-T cell therapy can potentially lead to fewer hospitalisations and less need for supportive care. It reduces the frequency and duration of hospital stays and ongoing treatments, ultimately contributing to cost savings.
5. Advances in Treatment Options: CAR-T cell therapy represents a significant advancement in cancer treatment, offering an alternative to conventional therapies. It has opened new avenues for research and development in immunotherapy, contributing to the evolution of cancer treatment strategies and expanding options for patients.
The technology behind CAR-T cell therapy is continually evolving, allowing for the development of new and improved CAR constructs targeting different antigens or combining them with other therapeutic modalities. This adaptability enhances the therapy’s potential to address a broader range of cancers and improve patient outcomes.
6. Affordability: As technology has advanced, the cost of CAR-T cell therapy has become more affordable. NexCAR19 (India’s Indigenously Developed CAR-T Therapy) is significantly more affordable, making it a more accessible option for patients.
Overall, CAR-T cell therapy stands out for its precision, personalised approach, the potential for remission, and long-lasting effects, making it a promising option for patients with difficult-to-treat cancers. As research continues, its benefits are likely to expand, offering hope and improved outcomes for more individuals battling cancer.
What are Car-T Cells?
What is Car-T Cell therapy? How does it work?
How is Car-T Cell therapy different from other cancer treatments?
NexCAR19 is a cutting-edge CAR-T cancer therapy developed in India. Comment.
(Amit Kumar is a doctoral candidate at IIT Delhi. In the second part of the article, he will underline challenges and the way forward.)
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