To: scaram(o)uche who wrote (384 ) 5/21/2004 9:28:57 PM From: tnsaf Respond to of 12215 This letter to the editor in The Scientist looks relevant to the discussion of cancer vaccines, especially the last two paragraphs.biomedcentral.com To the Editor: I read “Necrosis used to kill cancer,” by John Dudley Miller and its source paper with great interest. I agree that this nice piece of research has much for cancer biologists to ponder. However, I also agree with comments from other investigators that in the field, this particular occurrence will likely be rare due to preemption by apoptotic mechanisms. As for the conclusion that necrosis induction would be preferable to apoptosis induction because apoptosis suppresses immunity, I'm with Dr. Evan that this suppression is not complete in any case when massive death occurs. In fact, it is a breakdown in such immune suppression that is thought to cause the temporary presence of anti-dsDNA antibodies in mononucleosis patients. The thought of inducing immune responses to tumor cells is of course not new. For example, about 100 years ago, the New York surgeon William B. Coley noted that cancer patients experiencing a bacterial infection would sometimes show spontaneous regression of a tumor. He then used bacterial extracts that he injected into tumors such as sarcomas. Occasional regressions were observed, and subsequent investigations co-injecting irradiated tumor cells together with bacterial adjuvans showed further limited responses. The immune system appears to be activated by such “vaccines” more or less nonspecifically, and the tumor cells were thought to be killed more as bystanders than as targets. I think it is most likely that a similar largely non–tumor specific immune responses would ensue from killing tumor cells piecemeal. My worry is that if any response does ensue in this situation, the tumor-specific response is not only going to be drowned out by other responses, but that we would actually induce very undesirable autoimmune responses. It is, I think (partially) for this reason that most investigations attempting immune induction focus on identification of tumor-specific antigens. Many investigators may say or feel that autoimmunity is not a problem, as their patients would otherwise be doomed anyway. I would argue that lupus-like diseases show that quality of life can be severely reduced by autoimmune diseases, and therefore we should be especially careful not to try therapies that potentially induce gross autoimmune reactions in anyone with a possibly appreciable amount of life ahead of them. I would use (drug-induced as well a ordinary autoimmune) lupus as a perfect example of why we actually require apoptosis to suppress the immune system and why we should not meddle with this too much before we understand immune regulation more fully. Nick Henriquez (N.V.Henriquez@lumc.nl) Links for this article J.D. Miller, “Necrosis used to kill cancer,” The Scientist, May 17, 2004.biomedcentral.com W. Zong et al., “Alkylating DNA damage stimulates a regulated form of necrotic cell death,” Genes Dev, 18:1272-1282, June 1, 2004.genesdev.org