What the sugar coating on your cells is trying to tell you | Carolyn Bertozzi

250,899 views ・ 2017-09-10

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This is a talk about sugar and cancer.
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I became interested in sugar when I was in college.
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Not this kind of sugar.
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It was the sugar that our biology professors taught us about
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in the context of the coating of your cells.
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Maybe you didn't know that your cells are coated with sugar.
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And I didn't know that, either,
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until I took these courses in college,
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but back then --
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and this was in, let's just call it the 1980s --
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people didn't know much about why our cells are coated with sugar.
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And when I dug through my notes, what I noticed I had written down
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is that the sugar coating on our cells is like the sugar coating
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on a peanut M and M.
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And people thought the sugar coating on our cells
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was like a protective coating
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that somehow made our cells stronger or tougher.
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But we now know, many decades later,
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that it's much more complicated than that,
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and that the sugars on our cells are actually very complex.
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And if you could shrink yourself down to a little miniature airplane
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and fly right along the surface of your cells,
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it might look something like this --
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with geographical features.
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And now, the complex sugars are these trees and bushes --
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weeping willows that are swaying in the wind
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and moving with the waves.
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And when I started thinking about all these complex sugars
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that are like this foliage on our cells,
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it became one of the most interesting problems that I encountered
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as a biologist and also as a chemist.
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And so now we tend to think about the sugars
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that are populating the surface of our cells
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as a language.
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They have a lot of information stored in their complex structures.
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But what are they trying to tell us?
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I can tell you that we do know some information
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that comes from these sugars,
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and it's turned out already to be incredibly important
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in the world of medicine.
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For example, one thing your sugars are telling us
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is your blood type.
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So your blood cells, your red blood cells, are coated with sugars,
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and the chemical structures of those sugars determine your blood type.
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So for example, I know that I am blood type O.
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How many people are also blood type O?
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Put your hands up.
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It's a pretty common one,
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so when so few hands go up, either you're not paying attention
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or you don't know your blood type, and both of those are bad.
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(Laughter)
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But for those of you who share the blood type O with me,
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what this means is that we have this chemical structure
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on the surface of our blood cells:
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three simple sugars linked together to make a more complex sugar.
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And that, by definition, is blood type O.
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Now, how many people are blood type A?
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Right here.
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That means you have an enzyme in your cells
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that adds one more building block,
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that red sugar,
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to build a more complex structure.
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And how many people are blood type B?
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Quite a few.
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You have a slightly different enzyme than the A people,
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so you build a slightly different structure,
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and those of you that are AB
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have the enzyme from your mother, the other enzyme from your father,
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and now you make both of these structures in roughly equal proportions.
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And when this was figured out,
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which is now back in the previous century,
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this enabled one of the most important medical procedures in the world,
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which, of course, is the blood transfusion.
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And by knowing what your blood type is,
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we can make sure, if you ever need a transfusion,
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that your donor has the same blood type,
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so that your body doesn't see foreign sugars,
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which it wouldn't like and would certainly reject.
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What else are the sugars on the surface of your cells trying to tell us?
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Well, those sugars might be telling us that you have cancer.
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So a few decades ago,
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correlations began to emerge from the analysis of tumor tissue.
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And the typical scenario is a patient would have a tumor detected,
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and the tissue would be removed in a biopsy procedure
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and then sent down to a pathology lab
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where that tissue would be analyzed to look for chemical changes
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that might inform the oncologist about the best course of treatment.
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And what was discovered from studies like that
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is that the sugars have changed
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when the cell transforms from being healthy to being sick.
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And those correlations have come up again and again and again.
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But a big question in the field has been: Why?
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Why do cancers have different sugars? What's the importance of that?
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Why does it happen, and what can we do about it if it does turn out
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to be related to the disease process?
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So, one of the changes that we study
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is an increase in the density of a particular sugar
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that's called sialic acid.
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And I think this is going to be one of the most important sugars
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of our times,
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so I would encourage everybody to get familiar with this word.
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Sialic acid is not the kind of sugar that we eat.
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Those are different sugars.
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This is a kind of sugar that is actually found
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at certain levels on all of the cells in your body.
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It's actually quite common on your cells.
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But for some reason,
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cancer cells, at least in a successful, progressive disease,
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tend to have more sialic acid
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than a normal, healthy cell would have.
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And why?
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What does that mean?
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Well, what we've learned
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is that it has to do with your immune system.
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So let me tell you a little bit about the importance of your immune system
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in cancer.
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And this is something that's, I think, in the news a lot these days.
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You know, people are starting to become familiar with the term
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"cancer immune therapy."
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And some of you might even know people
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who are benefiting from these very new ways of treating cancer.
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What we now know is that your immune cells,
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which are the white blood cells coursing through your bloodstream,
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protect you on a daily basis from things gone bad --
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including cancer.
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And so in this picture,
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those little green balls are your immune cells,
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and that big pink cell is a cancer cell.
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And these immune cells go around and taste all the cells in your body.
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That's their job.
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And most of the time, the cells taste OK.
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But once in a while, a cell might taste bad.
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Hopefully, that's the cancer cell,
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and when those immune cells get the bad taste,
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they launch an all-out strike and kill those cells.
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So we know that.
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We also know that if you can potentiate that tasting,
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if you can encourage those immune cells to actually take a big old bite
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out of a cancer cell,
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you get a better job protecting yourself from cancer every day
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and maybe even curing a cancer.
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And there are now a couple of drugs out there in the market
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that are used to treat cancer patients
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that act exactly by this process.
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They activate the immune system
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so that the immune system can be more vigorous
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in protecting us from cancer.
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In fact, one of those drugs
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may well have spared President Jimmy Carter's life.
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Do you remember, President Carter had malignant melanoma
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that had metastasized to his brain,
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and that diagnosis is one that is usually accompanied by numbers
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like "months to live."
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But he was treated with one of these new immune-stimulating drugs,
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and now his melanoma appears to be in remission,
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which is remarkable,
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considering the situation only a few years ago.
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In fact, it's so remarkable
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that provocative statements like this one:
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"Cancer is having a penicillin moment," people are saying,
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with these new immune therapy drugs.
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I mean, that's an incredibly bold thing to say about a disease
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which we've been fighting for a long time
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and mostly losing the battle with.
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So this is very exciting.
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Now what does this have to do with sugars?
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Well, I'll tell you what we've learned.
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When an immune cell snuggles up against a cancer cell to take a taste,
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it's looking for signs of disease,
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and if it finds those signs,
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the cell gets activated and it launches a missile strike and kills the cell.
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But if that cancer cell has a dense forest of that sugar, sialic acid,
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well, it starts to taste pretty good.
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And there's a protein on immune cells that grabs the sialic acid,
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and if that protein gets held at that synapse
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between the immune cell and the cancer cell,
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it puts that immune cell to sleep.
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The sialic acids are telling the immune cell,
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"Hey, this cell's all right. Nothing to see here, move along.
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Look somewhere else."
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So in other words,
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as long as our cells are wearing a thick coat of sialic acid,
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they look fabulous, right?
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It's amazing.
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And what if you could strip off that coat
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and take that sugar away?
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Well, your immune system
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might be able to see that cancer cell for what it really is:
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something that needs to be destroyed.
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And so this is what we're doing in my lab.
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We're developing new medicines
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that are basically cell-surface lawnmowers --
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molecules that go down to the surface of these cancer cells
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and just cut off those sialic acids,
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so that the immune system can reach its full potential
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in eliminating those cancer cells from our body.
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So in closing,
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let me just remind you again:
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your cells are coated with sugars.
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The sugars are telling cells around that cell
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whether the cell is good or bad.
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And that's important,
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because our immune system needs to leave the good cells alone.
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Otherwise, we'd have autoimmune diseases.
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But once in a while, cancers get the ability
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to express these new sugars.
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And now that we understand
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how those sugars mesmerize the immune system,
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we can come up with new medicines to wake up those immune cells,
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tell them, "Ignore the sugars, eat the cell
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and have a delicious snack, on cancer."
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Thank you.
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(Applause)
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