Reacción a "Nobel Prize in Medicine or Physiology awarded to Mary E. Brunkow, Fred Ramsdell and Shimon Sakaguchi for understanding how the immune system is kept under control without attacking organs"

The award winners identified regulatory T cells (Tregs), the immune system's ‘security guards’ that prevent immune cells from attacking our own tissues. [Below are milestones related to their findings]:

• Sakaguchi's discovery (1995): he was the first to identify an unknown class of immune cells that protect against autoimmune diseases, challenging the prevailing belief that immune tolerance only occurred in the thymus.

• Brunkow and Ramsdell's discovery (2001): They discovered the Foxp3 gene while studying mice susceptible to autoimmune diseases and demonstrated that mutations in its human counterpart cause IPEX syndrome, a severe autoimmune disease.

• Connection between them (2003): Sakaguchi integrated both findings by demonstrating that the Foxp3 gene controls the development of regulatory T cells.

• Connection with previous work (1960 Nobel Prize in Medicine): Peter Medawar and Frank Macfarlane Burnet were awarded the prize for their discovery of central immune tolerance (how the immune system can tolerate its own or transplanted antigens).

• Study of genetic diseases that affect the immune system: primary immunodeficiencies. PIDs account for almost 10% of known genetic diseases. In addition, they are among the few genetic diseases that can be cured, basically in two ways: the most widespread is bone marrow transplantation (already recognized with a Nobel Prize) and gene therapy, which was originally developed for a particularly serious group of immune system defects, severe combined immunodeficiency (SCID). Work carried out by Alain Fischer's group at Necker Hospital in Paris.

• The 2018 Nobel Prize to James P. Allison for the discovery of the CTLA-4 molecule: This molecule, the first checkpoint inhibitor, is an essential element in the functioning of regulatory T cells and has revolutionized cancer immunotherapy. In other words, the impact of the discovery of Tregs has already saved thousands of cancer patients' lives.

His discoveries have been decisive in understanding how the immune system works and why only some of us develop autoimmune diseases. His work has opened up the field of research on peripheral immune tolerance, driven the development of new treatments for cancer and autoimmune diseases, opened up possibilities for more successful and longer-lasting organ transplants, and led to therapies currently in clinical trials.

To be honest, the impact of Sakaguchi's work is far greater than that of his fellow award winners, but being American always carries weight, and perhaps it is a moral boost to the US science system, which has been under attack in the last year.