Harnessing the Immune System to Improve Patient Outcomes

By Brooke Walker, Department of Surgery

Duke Health introduces new research initiative to overcome hurdles of immunity

Our immune system works around the clock to keep us safe from disease, kicking out invading pathogens that mean to do us harm, while partnering harmoniously with the healthy viruses, fungi, and bacteria that live within us. But what happens when this beautiful symphony starts playing out of tune and our immune system is unable to recognize friend from foe?

Cancer and autoimmune diseases are the result of an immune cacophony that occurs when the immune system cannot distinguish between the self and non-self. In transplantation, a transplant recipient’s immune system may reject a donor allograft because it does not recognize the graft as one of its own. In contrast, certain infectious diseases caused by viruses, such as the human immunodeficiency virus (HIV), manifest because these pathogens have evolved to deftly disguise themselves as a host immune cell.

“Every disease is influenced by immunity,” says Allan Kirk, PhD, MD, David C. Sabiston, Jr. Professor of Surgery and Chair of the Department of Surgery. “The immune system has evolved over millions of years to maintain homeostasis despite continuous threat, and those threats can come from the outside, microorganisms or trauma, but also from the inside when cells that are normal transform into cancer cells or when our immune system inappropriately recognizes our own cells as being foreign, such as an autoimmune disease.”

While significant advances in immunology have led to major breakthroughs in the prevention and treatment of disease, precisely controlling the immune system remains a major obstacle in modern medicine.

In September 2017, Duke Health launched the Translating Duke Health initiative, a multidisciplinary program to address major health challenges in areas where Duke Health can have the greatest impact. Translating Duke Health materialized from Duke Health's Advancing Health Together Strategic Planning Framework, launched in January 2016. The initiative focuses on five key areas of health: cardiovascular disease, neuroscience, children’s health, cancer, and immunology.

Dr. Kirk leads the immunology component, “Controlling the Immune System.” A major goal in advancing understanding of immunity is determining why different patients experience different disease outcomes. Are there certain immune characteristics specific to each individual patient that affect a patient’s disease prognosis?

“The understanding of how immunity can be harnessed as a tool to protect us better to prevent those errors from happening is the real focus of this initiative,” says Dr. Kirk. “The solution we’re seeking is to completely characterize and understand the signals used in that network so they can be harnessed, recognized, mobilized as a tool themselves to bring to bear at will for immunotherapy against cancer, to reverse type 1 diabetes or multiple sclerosis, or, in the most dramatic cases, allow for transplantation of organs from one person to another.”

To accomplish this, the team will define how the immune systems of different patient populations respond to disease. By identifying these “immune signatures,” investigators can devise therapeutic and preventive strategies to control immunity, such as improving immunotherapy as a treatment for cancer, minimizing or eliminating the need for immunosuppressive drugs in transplant recipients, and enhancing immune responses to vaccines against HIV and other infectious diseases.

The initiative aims to develop novel vaccines and therapeutics that will keep the immune symphony playing in harmony, ultimately improving patient health both at Duke and around the world.