John Sulston: Biologist, Geneticist and Guardian of our Heritage

 

Sir John Sulston died on 6 March 2018, an event reported world-wide by the press, radio and television. Having studied in Cambridge and then worked at the Salk Institute in La Jolla, California, he joined the Laboratory of Molecular Biology in Cambridge to investigate how genes control development and behaviour, using as a ‘model organism’ the roundworm Caenorhabditis elegans. This tiny creature, 1 mm long, was appealing because it is transparent and most adult worms are made up of precisely 959 cells. Simple it may be but this worm has all the bits required for to live, feed and reproduce (i.e. a gut, a nervous system, gonads, intestine, etc.). For his incredibly painstaking efforts in mapping from fertilized egg to mature animal how one cell becomes two, two becomes four and so on to complete the first ‘cell-lineage tree’ of a multicellular organism, Sulston shared the 2002 Nobel Prize in Physiology or Medicine with Bob Horvitz and Sydney Brenner.

Sir John Sulston

It became clear to Sulston that the picture of how genes control development could not be complete without the corresponding sequence of DNA, the genetic material. The worm genome is made up of 100 million base-pairs and in 1983 Sulston set out to sequence the whole thing, in collaboration with Robert Waterston, then at the University of Washington in St. Louis. This was a huge task with the technology available but their success indicated that the much greater prize of sequencing of the human genome — ten times as much DNA as in the worm — might be attainable.

In 1992 Sulston became head of a new sequencing facility, the Sanger Centre (now the Sanger Institute), in Hinxton, Cambridgeshire that was the British component of the Human Genome Project, one of the largest international scientific operations ever undertaken. Astonishingly, the complete human genome sequence, finished to a standard of 99.99% accuracy, was published in Nature in October 2004.

As the Human Genome Project gained momentum it found itself in competition with a private venture aimed at securing the sequence of human DNA for commercial profit — i.e., the research community would be charged for access to the data. Sulston was adamant that our genome belonged to us all and with Francis Collins — then head of the US National Human Genome Research Institute — he played a key role in establishing the principle of open access to such data, preventing the patenting of genes and ensuring that the human genome was placed in the public domain.

One clear statement of this intent was that, on entering the Sanger Centre, you were met by a continuously scrolling read-out of human DNA sequence as it emerged from the sequencers.

In collaboration with Georgina Ferry, Sulston wrote The Common Thread, a compelling account of an extraordinary project that has, arguably, had a greater impact than any other scientific endeavour.

For me and my family John’s death was a heavy blow. My wife, Jane, had worked closely with him since inception of the Sanger Centre and not only had his scientific influence been immense but he had also become a staunch friend and source of wisdom. At the invitation of John’s wife Daphne, a group of friends and relatives gathered at their house after the funeral. As darkness fell we went into the garden and once again it rang to the sound of chatter and laughter from young and old as we enjoyed one of John’s favourite party pastimes — making hot-air lanterns and launching them to drift, flickering to oblivion, across the Cambridgeshire countryside. John would have loved it and it was a perfect way to remember him.

Then …

When John Sulston set out to ‘map the worm’ the tools he used could not have been more basic: a microscope — with pencil and paper to sketch what he saw as the animal developed. His hundreds of drawings tracked the choreography of the worm to its final 959 cells and showed that, along the way, 131 cells die in a precisely orchestrated programme of cell death. The photomontage and sketch below are from his 1977 paper with Bob Horvitz and give some idea of the effort involved.

Photomontage of a microscope image (top) and (lower) sketch of the worm Caenorhabditis elegans showing cell nuclei. From Sulston and Horvitz, 1977.

 … and forty years on

It so happened that within a few days of John’s death Achim Trubiroha and colleagues at the Université Libre de Bruxelles published a remarkable piece of work that is really a descendant of his pioneering studies. They mapped the development of cells from egg fertilization to maturity in a much bigger animal than John’s worms — the zebrafish. They focused on one group of cells in the early embryo (the endoderm) that develop into various organs including the thyroid. Specificially they tracked the formation of the thyroid gland that sits at the front of the neck wrapped around part of the larynx and the windpipe (trachea). The thyroid can be affected by several diseases, e.g., hyperthyroidism, and in about 5% of people the thyroid enlarges to form a goitre — usually caused by iodine deficiency. It’s essential to determine the genes and signalling pathways that control thyroid development if we are to control these conditions.

For this mapping Trubiroha’s group used the CRISPR method of gene editing to mutate or knock out specific targets and to tag cells with fluorescent labels — that we described in Re-writing the Manual of Life.

A flavor of their results is given by the two sets of fluorescent images below. These show in real time the formation of the thyroid after egg fertilization and the effect of a drug that causes thyroid enlargement.

Live imaging of transgenic zebrafish to follow thyroid development in real-time (left). Arrows mark chord-like cell clusters that form hormone-secreting follicles (arrowheads) during normal development. The right hand three images show normal development (-) and goiter formation (+) induced by a drug. From Trubiroha et al. 2018.

John would have been thrilled by this wonderful work and, with a chuckle, I suspect he’d have said something like “Gosh! If we’d had gene editing back in the 70s we’d have mapped the worm in a couple of weeks!”

References

International Human Genome Sequencing Consortium Nature 431, 931–945; 2004.

John Sulston and Georgina Ferry The Common Thread: A Story of Science, Politics, Ethics and the Human Genome (Bantam Press, 2002).

Sulston, J.E. and Horvitz, H.R. (1977). Post-embryonic Cell Lineages of the Nematode, Caenorhabitis elegans. Development Biology 56, 110-156.

Trubiroha, A. et al. (2018). A Rapid CRISPR/Cas-based Mutagenesis Assay in Zebrafish for Identification of Genes Involved in Thyroid Morphogenesis and Function. Scientific Reports 8, Article number: 5647.

Self Help – Part 1

It’s not easy to find good things to say about cancer and humour is equally elusive, as those of us who lecture on the subject know very well. But most people are aware of one cheering fact: cancers aren’t transmissible between humans – that is, they’re not like ’flu, venereal diseases and lots of other nasty things we pass around. Thus, if you transplant tumours from one animal to another of the same species (usually mice) generally they don’t grow – in much the same way that transplanted organs (livers, etc.) are rejected by the recipient’s immune system. Transplant rejection occurs because the body mounts an immune response to the foreign (i.e. ‘non-self’) organ: transplantation works when that is reduced by matching donor to recipient as closely as possible and combining that with immunosuppressant drugs.

But here’s an obvious thought: if tumours transferred between animals don’t grow, their immune systems must be doing a pretty good job of recognizing them as ‘non-self’ and killing them off. If that’s true, how about trying to boost the immune response in cancer patients as a therapeutic strategy? It’s such a good idea it’s become the trendiest thing in cancer science, the field being known as immunotherapy.

Immunotherapy

The aim is to give a patient’s immune response a helping hand so it can kill their tumours. The stars of the show are a subset of white blood cells called T lymphocytes: that’s because some of them have the power to kill – they’re ‘cytotoxic T cells’. So the simple plan is to boost either the number or the efficiency of these tumour-killing T cells. The story is complicated by there being lots of sub-types of T cells – most notably T Helper cells (that do what their name suggests: activate cytotoxic T cells) and Suppressor T cells that shut down immune responses.

To get the hang of immunotherapy we need only focus on ways of boosting T Helpers but in passing we can hardly avoid asking “why so complicated?” Well, the immune system has evolved on a tight-rope, trying on the one hand to kill invading organisms whilst, on the other, leaving the cells and tissues of the host untouched. It works amazingly well but it can fall off both ways when either it’s overcome by the genomic gymnastics of cancer or when it exceeds its remit and causes auto-immune diseases – things like type 1 diabetes in which the immune system destroys the cells in the pancreas that make insulin.

Shifting the balance

We’ve seen that T cells (of all varieties) are among the ‘groupies’ attracted to the scene of growing solid tumours (in Cooperative Cancer Groupies and Trouble With The Neighbours) and so the name of the game is how to tweak the balance in that environment towards more efficient tumour cell killing.

Broadly speaking, there are two forms of cancer immunotherapy. In one T cells are removed from the patient, grown to large numbers and then put back into the circulation – called ‘adoptive cell therapy’, we’ll come to it in Part 2. The more widespread approach, sometimes called ‘checkpoint blockade’, uses agents that block inhibitory pathways switched on by tumours – in effect releasing molecular brakes that prevent T cell hyperactivity and autoimmunity. So ‘checkpoint blockade’ is a systemic method – drugs are administered that diffuse throughout the body to find their targets, whereas next time we’ll be talking about ‘personalized medicine’ – using the patient’s own cells to fight his cancer.

There’s one further method – viral immunotherapy – which I wasn’t going to mention but has been in the news lately to the extent that I feel obliged to make a trio with “Blowing Up Cancer” to follow Parts 1 & 2.

There’s nothing new about this general idea. Over 100 years ago the New York surgeon William Coley noticed that occasionally tumours disappeared when patients accidentally picked up post-operative bacterial infections and, from bugs grown in the lab, he made extracts that, injected into solid tumours, caused about one in ten of them to regress, with some patients remaining well for many years thereafter.

A new era

Even so, it took until 1996 before it was shown that blocking an inhibitory signal could unleash the tumour killing power of T cells in mice and it was not until 2011 that the first such agent was approved by the U.S. Food and Drug Administration for treating melanoma. In part the delay was due to the ‘agent’ being an antibody and the time taken to develop ‘humanized’ versions thereof. Antibodies (aka immunoglobulins) are large, Y-shaped molecules made by B lymphocytes that bind with high specificity to target molecules – antigens – humanized forms being engineered so that they are made almost entirely of the human protein sequence and therefore do not provoke an immune response.

92 FigCheckpoint Blockade Activates Anti-Tumour Immunity

Interactions between Receptors A and a suppress T cell activity. Antibodies to these receptors block this signal and restore immune activity against tumour cells.

Unblocking the block

We picture the tumour microenvironment as a congregation of various cell types with chemical messengers whizzing to and fro between them. In addition, some protein (messenger) receptors on cell surfaces talk to each other. The receptors themselves become messengers thus drawing the cells together – essential to bring killer cells into contact with their target. You can think of all these protein-protein interactions as keys inserting into locks or as molecular handshakes – a coming together that passes on information. Antibodies come into their own because they bind to their targets just as avidly as the normal signaling molecules – so they’re great message disruptors.

The sketch shows in principle how this works for two interacting receptors, A and a. The arrival of a specific antibody (anti-A or anti-a) puts a stop to the conversation – and if the upshot of the chat was to decrease the immune response, bingo, we have it! Targeting a regulatory pathway with an antibody enhances anti-tumour responses.

Putting names to targets, CTLA-4 and PD-1 are two key cell-surface receptors that, when engaged, trigger inhibitory pathways and dampen T-cell activity. Antibodies to these (ipilimumab v. CTLA-4; pembrolizumab and nivolumab v. PD-1) have undergone a number of clinical trials and the two in combination have given significant responses, notably for melanoma. So complex is immune response control that it presents many targets for manipulation and a dozen or so agents (mostly antibodies) are now in various clinical trials.

Déjà vu

So the era of immunotherapy has well and truly arrived but, as ever with cancer, it is not quite time to break open the champagne and put our feet up. Whilst combinations of antibodies have given sustained responses, with some patients remaining disease-free for many years, at the moment immunotherapy has only been shown to work in subsets of cancers and even then only a small fraction (about 25%) of patients respond. My correspondent Dr. Markus Hartmann has pointed out that the relatively limited improvements in survival rates following immunotherapy might be significantly enhanced if we took into account the specific genetic background of patients and determined which genes of interest are expressed or switched off. This information should reveal why some patients benefit from immunotherapy whilst others with clinically similar disease do not.

The challenge, therefore, is to characterise individual tumours and their supporting bretheren in terms of the cell types and messengers involved so that the optimal targets can be selected – and, of course, to make the necessary agents. It’s a tough ask, as the sporting fraternity might put it, but that’s what science is about so onwards and upwards with William Coley’s words of 105 years ago writ large on the lab notice board: “That only a few instead of the majority showed such brilliant results did not cause me to abandon the method, but only stimulated me to more earnest search for further improvements in the method.”

I’m grateful to Dr. Markus Hartmann  (Twitter: @markus2910) for constructive comments about this post.

References

Coley, W. B. (1910). The Treatment of Inoperable Sarcoma by Bacterial Toxins (the Mixed Toxins of the Streptococcus erysipelas and the Bacillus prodigiosus). Proceedings of the Royal Society of Medicine  3, 1-48.

Twyman-Saint Victor, C. et al. (2015). Radiation and dual checkpoint blockade activate non-redundant immune mechanisms in cancer. Nature 520, 373–377.

Wolchok, J.D. et al. (2013). Nivolumab plus Ipilimumab in Advanced Melanoma. N. Eng. J. Med., 369, 122-133.

Obesity and Cancer

Science, you could say, comes in two sorts. There’s the stuff we more or less understand – and there’s the rest. We’re pretty secure with the earth being round and orbiting the sun, the heart being a pump connected to a network of tubes that keeps us alive, DNA carrying the genetic code – and a few other things. But human beings are curious souls and we tend to be fascinated by what we don’t know and can’t see – why the Dance of the Seven Veils caught on, I guess.

Scientists are, of course, the extreme example – they spend their lives pursuing the unknown (and, as Fred Hoyle gloomily remarked, they’re always wrong and yet they always go on). But in this media era they pay a public price for their doggedness because they get asked the pressing questions of the moment. Is global warning going to finish us off soon, why is British sport generally so poor and – today’s teaser – does being fat make you more likely to get cancer?

A few facts go a long way

The major cancers have become familiar because the numbers afflicted are so staggering – but the one good thing is that the epidemiology can tell us something about the disease. Thus for cancers of the bowel, endometrium, kidney, oesophagus and pancreas and also for postmenopausal breast cancer there is clear evidence that being overweight or obese makes you more susceptible. In other words, if you compare large groups with those cancers to equally large numbers without, the disease groups contain significantly more people who are fat. We should add that the above list is conservative. A number of other cancers are almost certainly more common in those who are overweight (brain, thyroid, liver, ovary, prostate and stomach tumours as well as multiple myeloma, leukaemia, non-Hodgkin lymphoma and malignant melanoma in men).

Sizing up the problem

The usual measure is Body Mass Index (BMI) – your weight (in kilograms) divided by the square of your height (in metres). A BMI of 25 to 29.9 and you’re overweight; over 30 is obese. In England in 2009 just over 61% of adults and 28% of children (aged 2-10) were overweight or obese and of these, 23% of adults and 14% of children were obese. And every year these figures get bigger.

How big is the risk?

Impossible to say exactly – for one thing we don’t know how long you need to be exposed to the risk (i.e. being overweight) for cancer to develop but in 2010 just over 5% of the total of new cancer cases in the UK was due to excess weight. That’s another conservative estimate, but it means at least 17,000 out of 309,000 cases, with bowel and breast cancers being the major sites.

What’s going on?

Showing an association is a good start but the important thing is to find out which molecules make that link. For obesity and cancer detail remains obscure but broad outlines are emerging, summarised in the sketch. In obesity fat (adipose) cells increase in both number and size (so it’s a double problem: more cells – and the fat cells themselves are fatter). As this happens other cells are recruited to adipose tissue and, from this cellular cooperative, signalling proteins are released that have the potential to drive tumours. This picture is similar to that of the microenvironment of tumours themselves, where many types of cell infiltrate the new growth. Initially this inflammatory and immune response aims to kill the tumour but if it fails the balance of signalling shifts so that it actually helps the tumour grow. In addition to signals from fat cells themselves, obesity is usually associated with increased levels of circulating growth hormones (e.g., insulin) and of lipids, both of which may also promote tumour development.

Thus many signals with cancerous potential arise in obese individuals. In principle these could initiate tumour growth or they could accelerate it in cancers that have started to develop independently of obesity. So it is complicated – but at least as new signalling strands emerge they offer new targets for drug therapy.

In obesity abnormal signals from fatty tissue can combine with others arising from perturbed metabolism to help cancers develop

Reference

World Cancer Research Fund (WCRF) Panel on Food, Nutrition, Physical Activity, and the Prevention of Cancer (WCRF, 2007).