October 22, 2006
From October 22 to 23, 2006, internationally renowned scientists from Germany, the European Union and the United States met in Potsdam near Berlin, to discuss the future of chronic inflammatory disease treatment. The title of the symposium organized by the Schering Stiftung was “Immunotherapy in 2020—Visions and Trends for Targeting Inflammatory Diseases.” How recent findings in immunological research can lead to improved diagnostics, new drugs and better therapies—possibly even cures—was one of the key questions of this meeting.
Many chronic inflammatory diseases belong to the autoimmune disease group. These disorders are characterized by uncontrolled reactions of the immune system towards the body’s tissues and organs. The immune system somehow recognizes own tissues as foreign and starts attacking them. The most common autoimmune disease is rheumatoid arthritis. Others include psoriasis, multiple sclerosis, type I diabetes, Crohn’s disease and many others.
The immune system is a complex structure which protects the body from foreign harmful influences and invading pathogens. It recognizes bacteria, viruses, fungi, unicellular organisms and other pathogens. It fights and eventually eliminates them. Furthermore the immune system registers changes that occur within the body’s tissues. Once it detects these changes it proceeds to break down and degrade old, dead or malignant cells that could lead to cancerous growth. But what happens when something goes wrong? How does the immune system go completely off the tracks? Which are the driving mechanisms behind these devastating chronic inflammatory diseases? These are just some of the questions that were discussed by around 50 experts from academia, the pharmaceutical industry and hospitals at the meeting in Potsdam.
One of the greatest hopes of most scientists is not only treating diseases in an ever improving fashion but to eventually completely cure patients of the disease. Professor Andreas Radbruch, scientific director of the German Rheumatism Research Center (DRFZ), Berlin, introduced a promising method for the treatment of rheumatoid arthritis patients. He showed how particularly those individuals who do not respond to conventional treatment can now be aided by immunoablation, a treatment which completely destroys the immune system. Although this sounds rather harsh, the ablation aims to destroy the immunological memory. Once it is wiped out, it is rebuilt from scratch by injecting the patient’s own, previously removed and cleaned, haematopoetic stem cells. “Our results are very promising. The majority of patients treated can be considered cured and do not need any further kind of therapy,” explained Professor Radbruch. However, the time period between the complete destruction and the slow rebuilding of the immune system is very dangerous since no immunological protection exists. “For the time being it will remain a treatment for those, who cannot be helped in any other way,” said Andreas Radbruch.
The future of antibody therapy was discussed by Dr. Roland Bülow, CSO of Therapeutic Human Polyclonals, Mountain View, CA. Antibody therapy is used to treat symptoms caused by infectious diseases, toxins from spiders or snakes, autoimmune diseases, and cancer. Polyclonal antibodies, harvested from sera of immunized vertebrates, fell out of fashion during the successful rise of monoclonal antibodies. However, the German scientist who lives and works in the United States thinks that there will be a multitude of new applications for polyclonal antibodies in the near future. Their advantage lies in their ability to tackle diverse antigens of heterogeneous cell populations, i.e. as occur in tumor cells. Monoclonal antibodies are only ever able to attack one target antigen and therefore cannot produce an effect as strong as polyclonals.
The topic most important to all participants of the Schering Stiftung workshop was the better understanding of the immunological reactions in the individual patient. Professor Volk from the Charité hospital, Berlin, Germany, reported on recent advances in solid organ transplantation. “Currently we are not treating patients as good as we could. Frequently patients are all treated the same, at least initially, with body weight being the only indicator for drug dosage. And then we act surprised that a third of all patients do not respond adequately,” says Volk. Precious time is wasted, during which the disease can progress further, and money is lost since wrong treatments result in high costs for the health system. But how can current treatments be improved? Biomarkers are small molecules that fuel the hopes of many scientists for obtaining a better understanding of the progress of autoimmune diseases and their therapies. The experts think that by finding significant markers for these diseases they will be able to detect the body’s response to the treatment within days or weeks, this being dependent on the disease in question, since response times can vary greatly between them. Biomarkers would thus allow to predict therapeutic success early on. For some illnesses like rheumatoid arthritis or for solid organ transplantation such biomarkers already exist. “We can use them to determine at a very early stage of treatment, whether the patient is responding,” explained Hans-Dieter Volk. The director of the Institute for Medical Immunology at the Charité hospital of the Humboldt University Berlin, Germany, wants to reduce the amount of drugs given to patients after solid organ transplantation to the minimal, individually necessary levels. This not only reduces the severe side effects for the patients but also saves a lot of money. Soon these biomarkers are to be used more widely.
During the final session of the symposium everyone was engaged in small group brainstorming called break-out-discussions. “People were able to take a closer look at the others’ point of view. Thus participants covering research from bench to bedside were able to talk freely about their concepts and beliefs,” said Wolf-Dietrich Döcke, co-organizer and member of the inflammatory research division of Schering AG, Germany. Interdisciplinary thinking could take place resulting in new impressions and ideas. In the end, researchers from academia, the applied pharmaceutical industry as well as clinicians agreed: only close co-operation of everyone involved in the research and development process as well as intensive discussion, like at this symposium, can lead to a better understanding of complex diseases such as the autoimmune diseases.
The results of the symposium will be published by the Springer publishing house and will be available through bookstores. The “Scientific Symposia” series of the Schering Stiftung will continue on November 15–17, 2006, with a workshop on “Cancer Stem Cells: Novel Concepts and Prospects for Tumor Therapy” in Berlin, Germany.
Prof. Volk, Charité, Berlin
Prof. Radbruch, German Rheumatism Research Center, Berlin
Dres. W. Doecke, K. Asadullah, Dermatology, Schering AG, Berlin
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