Raphael Thys
Illustration: Fernando Cobelo
Around halfway through 2022, we will have witnessed a number of significant breakthroughs in ways in which we can engineer the body’s immune system to fight disease. The pandemic has already led to the development of new types of vaccine, such as those based on mRNA, and their use will be expanded next year to protect us against other pathogens. But we will also see other ways of harnessing the immune system to fight disease.
One of these will be new types of antibody-based medicine. Antibodies are produced by the body in response to infection and we have worked out ways of using artificially manufactured antibodies to mark cancer cells for destruction. We can also boost the body’s immune cells’ reactivity against cancer or dampen the immune activity that causes problems in rheumatoid arthritis. Indeed, antibodies are already the basis of seven out of ten of the world’s most profitable medicines.
These antibodies are used in a way which exploits their natural ability to lock onto specific targets. The design of antibodies themselves has been left relatively untouched. In 2022, all that will change.
Now, using genetic engineering or by separating and recombining parts of the protein chemically, we have tools which can alter the basic structure of what an antibody is. These will enable us to produce all manner of antibody-based medicines. For example, we will be able to manufacture antibodies that can recognize and attach to three separate targets at once—maybe a cancer cell, a receptor protein that activates immune cells, and another immune cell protein that strengthens the response. Already in development is an antibody that can lock onto three different parts of the outside coating of a virus, such as HIV. This should make it harder for the virus to mutate and avoid being targeted.
Another type of immune-based medicine set to gain prominence in 2022 is CAR T-cell therapy. Here, T-cells are extracted from a patient’s blood and genetically manipulated to endow them with a new receptor that targets the patient’s own cancer. The engineered T-cells are then infused back, hopefully now able to kill the patient’s cancer cells. To some extent this type of therapy is already used: some children or young adults with B-cell acute lymphoblastic leukemia have been given CAR T-cell therapy with some striking results, but also unwanted side effects and relapses in some patients. Next year, this type of therapy will expand by using different types of immune cell, or different versions of receptors, and so on. CAR T-cells could be engineered, for example, to kill off a problematic subset of the body‘s own immune cells which are causing an autoimmune disease.