You quite often hear cancer referred to as a ‘fight’ – a term lots of parents and patients really don’t like. It gives the impression that the patient is in control of their cancer outcome, based on how hard they ‘fight’ against it.
As part of this idea, we often think that any healthy body cells must be fighting against the cancer, working hard to eradicate it. Some of this is true as a lot of the cells within the immune system do attack broken cells all the time. But sometimes, cancer is smarter.
It goes without saying that cancer cells aren’t actually ‘smart’ – they don’t have thoughts or plans - their DNA is just broken, which leads to them behaving very differently to healthy cells. However, some of these changes can make cancer cells rather sneaky by disguising themselves as healthy cells or recruiting healthy immune system cells to help them grow and spread.
So, the reality is that it’s not all of the healthy cells fighting against a cancerous tumour – the tumours themselves are complicated environments with lots of different types of cells, not all of which are cancerous. One way of thinking about this is as a ‘society’ of cells where each cell has an important role to play working for or against the cancer, and each cell impacts the other cells around it.
In order to develop better treatments, researchers need to know more about what is going on inside cancerous tumours, such as what cells are present and what they are doing there.
This is a hot topic at the moment for ependymoma, the second most common type of malignant childhood brain cancer. Researchers in Denver USA have shown that, in a subtype of ependymoma called posterior fossa A ependymoma, there are many types of both cancer cells and immune cells.
Posterior fossa A ependymoma is very difficult to treat, and can often come back after treatment. Current treatments such as radiotherapy and chemotherapy don’t work very well, in part because of the immune cells present in the tumour.
Dr Tim Ritzmann is working on a Little Princess Trust funded project, running alongside the Denver team’s work, to find out more about the different types of cells in PFA ependymoma.
He said:
We think if we understand more about the immune system in this type of ependymoma, then we can find medicines that will help to change the immune cells. This would allow us to make standard treatments such as radiotherapy and chemotherapy work more effectively. Our hope is that this work will lead to better and more effective treatments for children and young people.
Based at the University of Nottingham, Tim started work on this project in 2021. Using a new technique called ‘Multiplex Immunofluorescence’, which can dye whole groups of tumours cells different colours, his team has been able to get data about what cells are present in these brain tumours, where they are and what they are doing.
One of their most interesting findings was that immune cells group around any damage to ependymoma tumours, a bit like they would with cuts and scrapes. This has led to a change in the way both Tim’s team and the Denver team think about ependymoma.
He said: “We have begun to think of ependymoma like a wound that cannot be effectively healed, and that the immune cells we see are actually making things worse by the way they communicate with the cancer cells."
By better understanding this, we are starting to identify drugs that may be able to block the communications between cancer and immune cells - future research will test these drugs in more detail in models of ependymoma and, ultimately, in patients with this terrible disease.
Tim has been working with the team in Denver for a number of years. One of these researchers is Andrea Griesinger, who won an award at the 2022 International Symposium on Paediatric Neuro-Oncology recognising the work of the Nottingham and Denver teams on the immune system in childhood ependymoma.
Tim said: “It is a great honour to be part of the team that won the award, and really important to us that our international collaboration has been so successful.
“The whole team are incredibly proud to have won this award – we were over the moon that our research has been recognised in this way and we are all very excited about how we take this work forward to bring better outcomes for children with ependymoma.”
If you'd like to learn more, you can read more about Tim's project.
Ellie Wilkinson is CCLG’s Research Communication Executive.
She is using her lifelong fascination with science to share the world of childhood cancer research with CCLG’s fantastic supporters.
You can find Ellie on Twitter: @EllieW_CCLG