When Bruce Levine and his colleagues began attempting to engineer immune cells to fight cancer in the 1990s, few people thought they would succeed. “The wider community was very sceptical,” says Levine, an immunologist at the University of Pennsylvania Perelman School of Medicine in Philadelphia. When they presented their research at meetings, “we were in the last session on the last day, in a room no one could find”.
Today, these engineered immune cells, called CAR T cells, are among the most powerful therapies oncologists have to treat many types of blood cancer. And studies suggest that they might hold promise for brain cancer and other solid tumours, as well as autoimmune and other diseases. One research firm estimates that the value of the CAR-T-therapy market, expected to hit US$11 billion this year, will grow to nearly $190 billion by 2034.
But CAR-T therapies come with a serious downside — they are laborious to make and difficult to administer. After removing the immune cells, called T cells, from a person’s blood, physicians ship them off to a manufacturer, where technicians genetically engineer the cells to carry a specialized protein called a chimeric antigen receptor (hence ‘CAR T’) on their surface. The cells are grown and amplified into hundreds of millions more cells, frozen and returned to the hospital for re-infusion. Because of the complexity, only about 200 centres in the United States offer the therapy.
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