News on the health front has been so depressing of late. Pressures on our Scottish Health Service continue seemingly unabated. Lengthy waiting times for treatment for some patients and the unforgiving and debilitating conditions resulting from Long Covid affecting around 175,000 people in Scotland (an increase of 122% since April 2021) have presented challenges to sufferers and impacted not only our health & social care services, but families, employers and the wider economy.
In this article I thought I would highlight some of the more positive aspects of what is happening as a result of all the negativity around the pandemic and post pandemic periods. A little publicised side effect of the pandemic: the race to find a Covid-19 vaccine has accelerated new scientific discoveries particularly in the development of potential cancer therapies.
Research into anti-cancer vaccines is nothing new. It’s been ongoing for decades but until the Covid-19 pandemic, no single mRNA vaccine regimen had been approved. Rapid production of mRNA vaccines is now an advantage which these vaccines have over conventional vaccines. Single vaccine regimens and those used in combination with immunotherapeutic drugs or other vaccines providing effective treatments for cancer and against emerging infectious disease, can be produced quickly, safely and at relatively low cost.
The design of an mRNA Covid-19 vaccine over a weekend was literally a life saver and an unprecedented feat in biomedical science. Given that mRNA was discovered by scientists Sydney Brenner, Francois Jacob, and Matthew Meselson in 1961, the development and the subsequent availability of an mRNA vaccine against Covid-19 in a matter of months was miraculous.
Some background to mRNA vaccines
There are several different types of vaccine, but since mRNA is the molecule that takes information from DNA in the nucleus of a cell to the protein-making machinery in the cell’s cytoplasm, its components can be manipulated/ altered to deliver different messages. This feature makes the mRNA vaccines ideal candidates for use in personalised vaccine treatments.
Using a modified mRNA, cells can produce a viral protein. The viral protein initiates an immune response when our immune system recognises this protein as foreign and produces antibodies. This unique ability of mRNA in producing proteins and the ease with which the mRNA molecule / sequence can be altered has opened up a whole new world in potential treatments particularly vaccines against the threat of infectious and other diseases.
Pancreatic cancer – small successful trial of mRNA vaccine
The recent application of a personalised mRNA vaccine therapy in the treatment of pancreatic cancer has been hailed as groundbreaking.
The most common type of pancreatic cancer is one of the deadliest. Despite advances in modern medicine, the 5-year survival rate of those people diagnosed with pancreatic ductal adenocarcinoma (PDAC) is only about 12%.
A research team led by Dr. Vinod Balachandran from Memorial Sloan Kettering Cancer Center (MSKCC) have developed a personalised mRNA cancer-treatment vaccine approach. Tumour samples from individual patients following surgical removal of PDAC were analysed for proteins which might trigger an immune response. The results of the analysis were used to produce a personalised mRNA vaccine for each of the 19 patients in the trial, based on the genomic sequence of the respective patient’s tumour sample.
These vaccines were used to develop a treatment protocol which resulted in 50% of the patients developing a powerful immune response and remaining cancer free at 18 months following vaccine administration. Obviously, more research needs to be done to identify why the other 50% of people in the trial did not have a strong immune response. But the signs are encouraging that personalised mRNA vaccine therapy is effective in treating disease which previously had such poor patient outcomes.
mRNA vaccines for flu and future Covid-19 outbreaks
mRNA flu vaccines will become the ‘norm’ soon. Clinical trials are ongoing in the US. The goal is to produce a combined vaccine which induces an immune response against two other common respiratory viruses – respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) as well as flu and the Covid-19 coronavirus, if it’s designated to become seasonal.
As there are currently no licensed vaccines against either RSV or hMPV, this would be a major advance. The combined vaccine could be given once a year, in the same way as the flu vaccine is at the moment. The advantage of mRNA vaccines is their formulations can be adjusted to address variants that emerge, affording vaccine manufacturers the capability of updating the vaccines as required.
Colon cancer – vaccine combinations are key
Metastatic colon cancer that has been unresponsive to immunotherapy will be the target of clinical trials of this combined vaccine therapy in 2024. Firstly an adenovirus vaccine is used to target the patients’ tumour and then this is followed by a personalised mRNA vaccine.
This dual precision vaccine treatment approach will also be trialled on melanoma and lung cancers.
What is the potential of personalised cancer vaccines?
In summary, early results indicate that personalised cancer vaccines currently being researched have real potential and results are encouraging. The U.K. government has entered a partnership agreement with a German company BioNTech to support research into the most common cancer types, and clinical trials will focus on those cancers where treatment approaches are currently not meeting clinical need. The long term goal of this partnership is to establish specialist cancer treatment centres which will allow access to personalised mRNA therapies for up to 10,000 patients by 2030.
mRNA – opportunities for Scottish life science sector
Vaccine development in Scotland is increasingly reliant on foreign investment, an unfortunate but necessary trend, since Scotland is not yet an independent country with its own Central Bank and currency.
Speaking at a meeting in March this year in the Scottish Parliament, Dr Paul Burton, the Chief Medical Officer of the US company Moderna, suggested that “Scotland’s size, NHS and close working relationships with its universities, give it significant advantages potentially to play a central role in clinical research around new technologies and therapies such as mRNA vaccination”.
Indeed, a resolution proposed for the establishment of mobile vaccine manufacturing hubs and featured in an article in the Times, was passed at the SNP party Conference in 2021. A mRNA manufacturing platform costing around $20 mn can produce over 1 billion vaccine doses worth of vaccine per year, including construction, equipment, validation and start up costs. All the manufacture taking place in a small facility using a small bioreactor with a working volume of 5 litres.
The Bioscience / Life Science sector has seen a significant increase in total turnover for pharmaceuticals manufactured in Scotland from £690 mn in 2019 to £1.65 bn in 2022. At the height of the Covid-19 pandemic manufacturing rose to £2 bn, showing that the potential is here in Scotland to grow the sector. However exports had fallen between 2018 and 2019 from £570 mn to £500 mn and the Association of the British Pharmaceutical Industry (ABPI) has now called on the Scottish Government to take steps to maximise the sector’s potential and secure more sustained long-term economic benefits.
There is potential in manufacturing mRNA vaccines in Scotland, with any surplus being exported and perhaps as a part of an independent Scotlands foreign policy, our Life Science sector could deliver anti-cancer vaccines and Covid-19 vaccine to other countries in need.
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