A Healthcare Revolution in the Making

The Story of César Milstein and Monoclonal Antibodies

Collated and written by Dr Lara Marks

Today six out of ten of the best selling drugs in the world are monoclonal antibody therapeutics. One of these, Humira®, which is a treatment for rheumatoid arthritis and other autoimmune conditions, was listed as the top selling drug across the globe in 2012 with a revenue of US$9.3 billion. Based on its current performance many predict the annual sales of the drug will surpass the peak sales of Lipitor, a treatment for lowering cholesterol, that is the best selling therapeutic of all time. Currently monoclonal antibody drugs make up a third of all new medicines introduced worldwide.

Portrait of César Milstein.
Photo credit: Godfrey Argent Studio

Monoclonal antibodies are not only successful drugs, but are powerful tools for a wide range of medical applications. On the research front they are essential probes for determining the pathological pathway and cause of diseases like cancer and autoimmune and neurological disorders. They are also used for typing blood and tissue, a process that is vital to blood transfusion and organ transplants. In addition, monoclonal antibodies are critical components in diagnostics, having increased the speed and accuracy of tests. Today the antibodies are used for the detection of multiple conditions, ranging from pregnancy and heart attacks, to pandemic flu, AIDS and diseases like anthrax and smallpox released by biological weapons. Beyond human healthcare, monoclonal antibodies help detect viruses in animal livestock or plants, prevent food poisoning and investigations into environmental pollution.

Monoclonal antibodies are indispensable in so many walks of daily life thanks to their ability to target a single type of cell. Produced in the laboratory, these antibodies are derived from naturally occurring proteins made by the body's immune system to recognise and fight foreign invaders, such as bacteria and viruses. The antibodies are generated through the fusion of a myeloma cancer cell with spleen cells taken from an immunised animal.

Yet the story of how these unsung microscopic heroes came into the world and helped change healthcare remains largely untold. Moreover, their significance was largely overlooked at the time of their creation. The journey of monoclonal antibodies all started when an Argentinian émigré called César Milstein arrived at the Laboratory of Molecular Biology in Cambridge, the same laboratory where Francis Crick and James Watson discovered the structure of DNA in 1953. It was to be here that Milstein, together with Georges Köhler, pioneered the seminal technique for the production of monoclonal antibodies in 1975 and showed their clinical application for the first time.

This exhibition of the life and work of César Milstein provides a window into the world where monoclonal antibodies were first developed. Showing Milstein's notebooks and writings for the first time, this exhibition provides first-hand the complexities that were involved in the creation of monoclonal antibodies and brings to life the many challenges scientists face in devising a viable biotechnological tool and its application in healthcare. Transforming monoclonal antibodies, which started life as a laboratory tool into something that could be of use in the outside world was neither straightforward nor inevitable.

From Milstein's papers we learn first-hand how the newly-created monoclonal antibodies spread from the confines of Milstein's laboratory in Cambridge to scientists across the world and were then adapted for clinical applications. They highlight the logistical difficulties Milstein and his team faced in transporting monoclonal antibodies to other laboratories, and the fact that other scientists initially had little idea about how to grow and maintain the antibodies, let alone any idea what purpose they might serve.

Strikingly, initially Milstein had very few requests for monoclonal antibodies. By 1977, however, he was being inundated with requests for samples and had to search for outside support in the distribution process. This was to pave the way to the earliest commercialisation of the technology with the help of Sera-Lab, a small British company set up to supply animal serum reagents to the scientific community. The relationship between Milstein and Sera-Lab illustrates the process of technology transfer in biotechnology during its formative years. All of this was done with little public fanfare and no venture capital or government support. Yet, the collaboration between Milstein and Sera-Lab laid the foundation for the wide-scale commercialisation of monoclonal antibodies.

The exhibition also offers a way of understanding why the original technology developed by Milstein and Köhler was not patented in Britain and instead formed the basis of patents taken out by the Polish-American virologist, Hilary Koprowski, and his team based at the Wistar Institute in Philadelphia. The latter were thus the first scientists to be granted patents for monoclonal antibodies. Generating major controversy in the late 1970s, the patent story told in this exhibition reveals some of messy business of patenting research science and the implications this holds for those working in both the laboratory and the commercial world.

It also provides some insight into Milstein's very early efforts to demonstrate the practical application of monoclonal antibodies. He and his colleagues paved the way for the use of monoclonal antibodies as tools for the purification of natural compounds for drugs and as reagents for blood typing. Their work also demonstrated the use of monoclonal antibodies as probes to investigate the pathological pathway of neurological conditions and a wide range of other diseases. This paved the way to the adoption of monoclonal antibodies as diagnostic tools and an invaluable platform in the move towards personalised medicine. The final part of the exhibition shows how Milstein encouraged the use of genetic engineering to improve the safety and efficacy of monoclonal antibodies thereby enabling their use as therapeutics on a large scale.

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