JNS
A joint project led by Professors Liran Shlush and Amos Tanay could fundamentally change the means of diagnosis and treatment of this pernicious form of cancer.
During the Iranian missile attacks that rocked Israel in the second half of June, few stories captured the resilience of the Israeli spirit like the one that occurred at the Weizmann Institute of Science in Rehovot.
On June 15, Weizmann labs took a direct hit from Iranian ballistic missiles, obliterating years, and in some cases, lifetimes worth of irreplaceable scientific research. While luckily there were no casualties, the hit was a significant loss to an institution dedicated to expanding the scope of human knowledge.
Notably, the Cancer Research Unit was severely impacted, with entire labs destroyed. Yet despite the mayhem, a joint project led by Professors Liran Shlush and Amos Tanay published a startling breakthrough in leukemia diagnostics, which could fundamentally change the means of diagnosis and treatment of this infamously pernicious form of cancer.
Breakthrough in the bloodstream
Leukemia, or cancer of the blood, is an aggressive cancer that originates in bone marrow and causes rapid proliferation of malformed blood cells. These cells compromise the body’s ability to fight infection and circulate oxygen.
Current screenings for leukemia require a bone marrow biopsy, a painful procedure to extract bone marrow and test for leukemic cells. Shlush and Tanay’s research analyzed the proliferation of free-floating stem cells in the bloodstream, an innovative angle of attack as the established consensus is that stem cells are found in bone marrow.
However, Shlush and Tanay were able to show that these free floaters are found in all adults in low amounts, but their numbers and specific genetic abnormalities could be used to accurately diagnose leukemia in patients, making painful bone marrow biopsies a thing of the past. Additionally, a simple blood test procedure could screen for leukemia non-invasively, well before symptoms begin to express, revolutionizing the ability of the medical community to effectively target and treat the disease.
Shlush, the head of the Weizmann Medical School and co-lead researcher with Tanay, spoke to JNS about the finer points of their research.
“We characterized [stem cells in the bloodstream] in a unique way, for the first time across hundreds of people, and created the first reference range [for healthy adults],” said Shlush. “Now we can compare the cells of a patient to the norm, and define all the unique abnormalities… Instead of doing bone marrow biopsies that are used to diagnose [leukemia], we can diagnose from the peripheral blood.”
Shlush explained the significance of the achievement, saying, “Bone marrow [biopsies] are painful, costly … It's a horrible test. The ability to do it from the blood is a major leap forward.”
Science and war
Their paper was published in Nature Medicine just days after their lab was struck in one of the missile attacks. The missile hit at 3 a.m. as Israelis in central Israel huddled in bomb shelters.
Shlush recalled how he heard the news. "The head of my department, Shalev Izkovitz, who is also a good friend, called me at 4 o’clock. At 4:30, we were already there,” he said.
While describing the degree of damage, Shlush said, “Some scientists at the Institute lost everything. Complete labs were destroyed. My lab has been damaged … and we lost around 25% of our [collected stem cell] samples, which I think is our most precious resource and it's not replaceable. Equipment, you can replace, reagents, you can replace ... These are samples that were either sent to us or we collected ourselves from diseases and projects that we and others have in the Institute, and that's the major loss.”
When asked about the continuation of their research, Shlush said, “The building is ruined. We are not allowed to get into the lab,” but emphasized the strength of the Weizmann community, saying “the institute is resourceful and considerate. People are giving up part of their labs [for us] to come and work…They are sharing their space with us, generously.”
While a missile destroying years of work is a harsh reality to adjust to, the administration and staff at the Weizmann Institute have rallied together to deal with the fallout and support their research teams.
Next steps
Shlush and Tanay are not putting their research on hold. Instead, they have already moved on to the next stages to make leukemia an easily and non-invasively diagnosed disease. Shlush explained that their immediate research has allowed them to efficiently diagnose leukemia from a simple blood test. However, their future goal is to identify people with a high likelihood of developing leukemia before they develop the disease.
“We are conducting a large clinical trial now, which is the continuum of this manuscript, where we will follow patients over time, and we hope that this assay will allow us to predict who is going to progress to leukemia,” Shlush said.
While the team remains excited for future possible applications of their research, Shlush emphasized the immediate implications, saying, “We hope that bone marrow [biopsies] will be obsolete.”
Clinics around the world are joining their project, as more scientists and physicians catch wind of this startling new method of diagnosis. “Now we have clinics in the United States, Taiwan and Europe. It's approximately 30 more clinics and this will exponentially grow. The manuscript is also helpful because physicians are now convinced that this can work. And so that’s the next step,” said Shlush, adding that further clinical trials would culminate in the incorporation of blood-drawn leukemia diagnosis into mainstream medical practice.
When asked how long before the team expected to have its own lab space again, Shlush replied that it would likely take a few years. However, more important was the continuation of their work, saying that they would also be extending their work to pediatrics.
“Families that have bone marrow failure syndrome,” explained Shlush, “have a higher risk of developing leukemia, so doctors do a bone marrow test on these poor children, once a year.”
It is their research aim to bring their discovery to pediatrics as quickly as possible so that children with a predisposition to leukemia can receive much gentler medical care, Shlush said.
A personal note
Shlush concluded by acknowledging the key members of the team, “the people who did the work,” who were so instrumental in bringing this discovery to light. When discussing his co-lead, Shlush praised “the nice collaboration between Amos Tanay and me. Amos is a mathematician and I am a physician-scientist, so we combine different tools and ways of thinking.”
Shlush also credited Nili Furer, Nimrod Rappoport and Oren Milman. "These are the students, really talented students. Nili has now moved on to do her post-doc at Stanford. Nimrod is a young father, a very successful physician-scientist and occupational biologist. Oren Milman is doing work on another type of leukemia and he continues to work with us.”
Though the return to normalcy in the Weizmann Institute labs will take years, this team of scientists is as committed as ever to the important research they have undertaken. Their story is just one example of the ingenuity and dauntlessness of the Israeli spirit.
While Israel fought the Iranian enemy, Shlush, Tanay and their team advanced the fight against cancer—and they scored a win.
