Abstract

Abstract: The lecture will tell two stories, each with its own history, which came together in 1991 and then played out over the next 25 years. In 1975, César Milstein and Georges Köhler described a technique for making unlimited amounts of a specific antibody. Through protein engineering, these monoclonal antibodies were developed into a new class of medicines. A pioneering antibody – Campath-1H, developed between 1979 and 1988 – was soon tested in a variety of clinical settings. Although useful, it seemed that more could be achieved from such a powerful drug if the right disease could be identified and treated.

In 1823, Augustus D’Este, grandson of George III , became unwell. To the modern reader, his diary expresses the hopes and fears of the person with multiple sclerosis. By the late 1980s coherent ideas on the pathogenesis of multiple sclerosis began to take shape; and Campath-1H was the perfect medicine with which to test the emerging hypothesis on the core disease mechanism. The first patient was treated in 1991. There followed a roller-coaster series of successes and disappointments that taught much about the disease and led eventually to an understanding of pivotal events involved in damage to the brain and spinal cord. With the completion of large phase 2 and 3 clinical trials confirming its high efficacy and safety profile, Campath-1H (now renamed Alemtuzumab) was then licenced and prescribed around the world for this difficult and potentially disabling disease of young adults. By 2013, after 25 years, Campath-1H had found its disease.