This episode was recorded before the selection of the 2020 Sanford Lorraine Cross Award winner, Dr. Carl June.
Host (Simon Floss): Hello, and welcome to ‘Innovations,’ a podcast series brought to you by the experts at Sanford Health. You’re listening to our 18th episode, ‘Committing to a Cure.’ I’m your host, Simon Floss with Sanford Health News.
The practice of medicine goes far beyond clinic walls. The innovations podcast looks at the biggest issues facing healthcare today. Each episode offers the opportunity to see the ever-changing world of health and wellness through new eyes. Our leaders offer out of the box solutions to some nagging questions.
Today, we’re excited to be talking with Dr. Carl June. He’s the director of the center for cellular immunotherapies with the Perelman School of Medicine at the University of Pennsylvania. Dr. June has developed an FDA approved therapy to treat acute lymphoblastic leukemia or ALL. He’s also a 2020 Sanford Lorraine cross award finalist. Dr. June, it’s a pleasure to be talking with you.
Dr. June: Yeah, well, thank you. It’s a really a great privilege to be here.
Host: Let’s get to know you a little bit. Tell us about yourself and the work that you do.
Dr. June: So, you know, I trained in chemistry in college at the Naval Academy. Then, via Securitas route, ended up going into medicine. I became fascinated during my medical oncology training on how the immune system worked, because I saw examples of how it could go haywire after a bone marrow transplant. And, I saw the power of T-cells, which are the main part of our immune system that evolved to kill cancer. And I saw that at a time when we didn’t know how to grow T-cells even, or give them as a transfusion. So my initial entry into this field began back in the early 1980s, really with immunology as my goal to study the immune system.
Host: It might be a tough to answer the question or put into words, but since then, I mean, how much have you learned?
Dr. June: It’s been more than a 30 year journey, but first of all, we had to learn how to grow T-cells and that took about 10 years, because our therapy of making so-called CAR T-cells is the patient themselves starts the process by donating some blood. And then we actually made HIV, the virus that actually infects people and gives AIDS, a tool to reprogram the patient’s T-cells.
So they become leukemia specific tilt killers, and those are called CAR T-cells. So, we use the virus then as a Trojan horse, it brings in DNA code. It makes now the patient’s own T-cells kill cancer cells. We first started testing that and patients in 2010.
Host: What is your, why where’s your passion come from?
Dr. June: Mine was really very clear, and probably in two steps. I got fascinated by the immune system when I saw, as I mentioned, haywire T-cells able to kill people in just a few months. And that’s after a bone marrow transplant. Literally your T-cells can destroy an organ such as your liver, in just a few weeks.
Auto immune disease affects maybe 10 to 20% of people with diabetes psoriasis. My mother had an autoimmune disease called lupus and my daughter has one called juvenile arthritis. So, I got basic interest in immunology from there. That was my why of how the immune system can be controlled.
Host: Can you tell me the stories? I understand they’re incredible stories about Bill Ludwig and Emily Whitehead.
Dr. June: So, the way medicine goes ethically is we begin experimental therapies in adults, and then later children. So, the first patient we treated was in July 31st of 2010. And as you mentioned, his name was Bill Ludwig. He was a retired us Marine who had been in Vietnam and then was a prison warden.
In 2010 he had leukemia that was not responding to chemotherapy. He thought he was going to die. He’d already paid for his funeral. We treated him with these CAR T-cells in July, and he got very ill after. We didn’t know what was causing this, but he actually got worse, was an ICU, but he woke up about three or three weeks later.
At that point he was stable enough, the doctors examined him, they found his leukemia was gone.
Dr. June: We can do imaging with CAT scans and other things. We knew that he had had more than five pounds of tumor, and that all went away in three weeks.
Host: Oh, that’s incredible. What was, I mean, what was your reaction?
Dr. June: I’ll tell you, so we, I was incredibly surprised because it actually worked better in him than it ever did in our mice. So, when we got the report back and I’ll never forget this, cause I’ve looked back at the emails, it was day 28 and it said the bone marrow had no leukemia. So I said, “I don’t believe it. Please biopsy it again on the other side.” So, the bone marrow biopsies are done on one of the hips. They went to the other side, the same thing came back, no leukemia.
Host: Wow. How much pride did you have?
Dr. June: Well, it was surprise at that point. He was delighted. He came back in August of 2020, just in the middle of this pandemic this summer, and he still had no leukemia. So, it was durable. He got to see his grandchildren, where he thought he was going to die.
What we didn’t know then was, was that some miracle, sometimes the first patient works and then it’s, it’s a dud after that? Well, it worked reproducibly two of the first three patients retreated, like their last week have been in remission now for 10 years. And the other person had a partial remission.
Host: That’s incredible. Tell, talk to me about Emily.
Dr. June: Emily was the first child we ever treated. She was six years old and Bill Ludwig she had and as you mentioned at the top of the show, acute lymphoblastic leukemia, ALL, which when it becomes resistant to the chemotherapy given for the leukemia, it’s usually a six weeks survival. So, she went onto the study with that prognosis, we treated her, and within days she became much worse.
She had a fever of 106 degrees. We didn’t know what was causing it. It turned out, um, she had a very high level of a blood protein called interleukin six, which causes fever. It was actually caused by her CAR T-cells killing her leukemia. And within three weeks, just like Bill Ludwig, she was in complete remission.
Host: Really. Wow.
Dr. June: I had dinner with her father last night. She’s now 15 years old and a straight ‘A’ student in high school.
Host: What a moment that you were able to, to share with them, and even last night, you know, recollecting that with, with her father. Did you forge kind of a relationship and a bond?
Dr. June: She’s almost like one of my children. I have a daughter who’s a year older and she’s an only child and you can imagine if you would lose your home and child. They’re very grateful and she’s now, I learned last night, she has more than 400,000 followers on Twitter and is encouraging other children to get vaccinated as soon as they’re approved. So, she is spreading really good things now herself, as now being the beneficiary of a new therapy for cancer.
Host: Let’s switch gears now and talk about the Sanford Lorraine cross. What’s it like to be a nominee? Uh, what does this recognition mean to you?
Dr. June: Well, I had not heard of it. Then, it’s been delayed a bit because of COVID, but it’s been really exciting journey.
First of all, there’s been the other co-finalists. To meet them and hear their stories, one thing common between us all, I think has been persistence. It takes a long time for when you start a new scientific field to prove it actually works. You have to be persistent. So that’s really been great. I hadn’t known about this amazing network that Sanford Health has and it’s been great to learn about that. And in fact, the international outreach.
Host: What have you enjoyed most about this entire process?
Dr. June: I think meeting new people and that’s the fun part of, now medical research, it’s international. All people are supplicating cancer. They have friends or relatives I’ve had that. And, we have a lot of different languages, but there’s only one language internationally. And that’s this medical research connected to improved health.
Host: You mentioned persistence. What do you love most about this life-changing work? And then, is there something that motivates you to keep persevering when you run into any roadblocks, or anything like that, in the work that you do?
Dr. June: I like to make the analogy to sports. I played football and basketball when I was in high school and you have to be used to failure. In sports, batting average, if you’re a baseball player and you can hit one out of three times, that’s success, that’s really good.
So science is one of, you have to have the ability to mostly fail. Most experiments don’t work, which is why we call it an experiment. Every once in a while you hit a home run. And when that happens, it’s extraordinarily rewarding. So you have to have that persistence to keep trying and trying different things until you finally get it right. And I think that’s, what’s in common with scientists.
Host: How would you hope to motivate future science and medical researchers?
Dr. June: That’s a great question because a number of surveys have shown that the lay public isn’t aware of the benefits that have happened because of medical research. I think unfortunately COVID has given us a great boost to this. People have learned about the immune system, where they’ve really never thought about viruses and immune system much before, unless they were an infectious disease specialist or an immunologist. So one of the things science has probably failed at has been lay education. And I think this is a great outreach part of what the Stanford Lorraine cross award is about.
Host: Well, Dr. June, once again. Thanks for coming here today and talking with us, it’s been a great time to talk with you.
Dr. June: Thank you. I really appreciate this opportunity and hopefully the importance of science and medical research can really be spread.
Host: Before wrap up today, I’d like to remind you that the Sanford Health Innovations Podcast is now available on your favorite podcast apps like Apple and Spotify, as well as our website, Sanford Health News.
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Thanks for listening, I’m Simon Floss with Sanford Health News.