Unknown Hero: Dr. Judah Folkman
There are people out there who change our world, and we have no idea who they are. I intend on highlighting them with "Unknown Hero" postings.
It takes decades of research to understand even the most basic diseases. People have worked their entire lives just to define what the disease is (bacteria, virus, fungus?). Dr. Judah Folkman dedicated his career to understanding cancer, and his work over the past three decades has defined the very hurdle of drug delivery to cancer cells. This is Judah:
In the 1960's, Dr. Folkman was working as a doctor in the Navy. He and a colleague discovered a rubber made from silicone that, when placed beneath the skin, could be used to gradually release medication into the bloodstream. This technique is used in Norplant, the birth control device.
That is just a footnote to his larger accomplishment in the cancer arena. He was also looking into blood substitutes for the Navy. In his research, he studied cancer closely and noticed an odd thing: in a laboratory, tumors grew to the same size. He started wondering what the difference between a petri dish and a human body was. (In the human body, tumors could grow to be much larger.) He published his conclusions in a paper in 1971, claiming that tumors could grow their own blood vessels, a process he called angiogenesis. He predicted that if we could choke off that access, the tumor would dry up and die.
The industry first ignored his ideas, continuing to focus on surgery and chemical treatments for cancer. But Folkman was right. Tumors undergo angiogenesis to build blood vessels and grow. See, cancer occurs when a collection of human cells starts growing and acting erratically. It can start from a single cell, but its rogue behavior can turn others until they are all growing and acting erratically in the same way. That is a tumor. That rogue behavior releases certain proteins to continue the growth of new, tainted cells and blood vessels. Once it is big enough, the tumor ejects representative envoys/ambassadors out into the blood stream to infect other cells and make them also grow erratically. That is called metastasis.
Now, we can kill any tumor cell in the laboratory, but as Dr. Folkman pointed out, the human body is much different than a petri dish. Once the tumor starts growing it's own blood vessels, it becomes a different ballgame. (The protein that causes blood vessel growth for tumors was discovered over a decade after Dr. Folkman predicted its existence.) What happens once the tumor starts growing blood vessels is that the pressure in the tumor rises to a level higher than the rest of the body. It is a laws of physics that things move naturally from areas of higher pressure to areas of lower pressure. In other words, cells can leave the tumor easily, but getting cells to get into the tumor is very tricky.
That's why metastisis is inevitable, but getting drugs into a tumor--into the source--is extremely tricky. You could pump the body full of drugs (which is what chemotherapy is), but that pressure differential going into the tumor will keep almost all of the drug from getting where it needs to go. That's why it's so hard to treat cancer.
Well, Dr. Folkman's assessment of tumors growing their own blood vessels was accurate, and his idea of choking off their blood source to kill them is accurate, too, on paper. In reality, and even Dr. Folkman agrees, blocking off that blood supply is very tricky.
In the late 1990's Dr. Folkman's announced that he had collaborated to find two drugs that, he claimed, stopped tumor growth in mice, dead in its tracks. (See, this is all very recent!) When other scientists tried to replicate the work, though, they failed. Even though Dr. Folkman's drugs haven't been recreated, drugs that take a similar approach are being researched feverishly now. Currently, over 1,000 laboratories are testing drugs that attack the tumor's blood supply. Ten drugs have already been approved by the F.D.A., and they combine to over 1.2 million perscriptions for cancer patients. Essentially, 37 years later the medical community has embraced his theory and is rallying. Inhibiting angiogenesis could be the future of many treatments, saving hundreds of millions of lives. (It is also found to be effective in treatment of macular degeneration.)
Dr. Folkman was a Professor at Harvard, director and founder of the vascular biology program and Children's Hospital Boston and a regular on the lecture circuit. In fact, he was on his way to a conference in British Columbia on January 14th, 2008 when he died of a heart attack in Denver airport. He was 74 years old.
That is just a footnote to his larger accomplishment in the cancer arena. He was also looking into blood substitutes for the Navy. In his research, he studied cancer closely and noticed an odd thing: in a laboratory, tumors grew to the same size. He started wondering what the difference between a petri dish and a human body was. (In the human body, tumors could grow to be much larger.) He published his conclusions in a paper in 1971, claiming that tumors could grow their own blood vessels, a process he called angiogenesis. He predicted that if we could choke off that access, the tumor would dry up and die.
The industry first ignored his ideas, continuing to focus on surgery and chemical treatments for cancer. But Folkman was right. Tumors undergo angiogenesis to build blood vessels and grow. See, cancer occurs when a collection of human cells starts growing and acting erratically. It can start from a single cell, but its rogue behavior can turn others until they are all growing and acting erratically in the same way. That is a tumor. That rogue behavior releases certain proteins to continue the growth of new, tainted cells and blood vessels. Once it is big enough, the tumor ejects representative envoys/ambassadors out into the blood stream to infect other cells and make them also grow erratically. That is called metastasis.
Now, we can kill any tumor cell in the laboratory, but as Dr. Folkman pointed out, the human body is much different than a petri dish. Once the tumor starts growing it's own blood vessels, it becomes a different ballgame. (The protein that causes blood vessel growth for tumors was discovered over a decade after Dr. Folkman predicted its existence.) What happens once the tumor starts growing blood vessels is that the pressure in the tumor rises to a level higher than the rest of the body. It is a laws of physics that things move naturally from areas of higher pressure to areas of lower pressure. In other words, cells can leave the tumor easily, but getting cells to get into the tumor is very tricky.
That's why metastisis is inevitable, but getting drugs into a tumor--into the source--is extremely tricky. You could pump the body full of drugs (which is what chemotherapy is), but that pressure differential going into the tumor will keep almost all of the drug from getting where it needs to go. That's why it's so hard to treat cancer.
Well, Dr. Folkman's assessment of tumors growing their own blood vessels was accurate, and his idea of choking off their blood source to kill them is accurate, too, on paper. In reality, and even Dr. Folkman agrees, blocking off that blood supply is very tricky.
In the late 1990's Dr. Folkman's announced that he had collaborated to find two drugs that, he claimed, stopped tumor growth in mice, dead in its tracks. (See, this is all very recent!) When other scientists tried to replicate the work, though, they failed. Even though Dr. Folkman's drugs haven't been recreated, drugs that take a similar approach are being researched feverishly now. Currently, over 1,000 laboratories are testing drugs that attack the tumor's blood supply. Ten drugs have already been approved by the F.D.A., and they combine to over 1.2 million perscriptions for cancer patients. Essentially, 37 years later the medical community has embraced his theory and is rallying. Inhibiting angiogenesis could be the future of many treatments, saving hundreds of millions of lives. (It is also found to be effective in treatment of macular degeneration.)
Dr. Folkman was a Professor at Harvard, director and founder of the vascular biology program and Children's Hospital Boston and a regular on the lecture circuit. In fact, he was on his way to a conference in British Columbia on January 14th, 2008 when he died of a heart attack in Denver airport. He was 74 years old.
Dear John,
Thank you for writing this article about Dr. Folkman. I heard him give a plenary talk at the 2006 NSTI Conference in Boston and he was highly motivating with a "call to arms" for the audience to join the effort to understand and defeat cancer. He presented research results, during his talk, that identified platlets as the key cellular component of blood that enabled or suppressed angiogenesis and that biochemicals that stimulated tumor growth and those that suppressed it were segregated into different alpha granules within platelets. This physical separation of promoters and suppressors within the platlets raised the possibility of treatments that employed selective delivery of drugs to neutralize the promoter chemicals. It is, indeed, sad that he is no longer with us and "in the fight."
RPM
My pleasure, RPM. He was a great guy and his work was, indeed, revolutionary.
Thanks for reading.