NK cells are a type of white blood cell that travels in your bloodstream, patrolling the body, scanning cells to see if they are healthy or harmful. When the NK cell finds a harmful cell, it destroys it.

“What makes these natural killer cells so special is they do not need to be exposed to the harmful cells ahead of time,” said Don A. Stevens, M.D., a hematologist/oncologist, co-founder of Norton Cancer Institute and director of its hematologic cancer program. “Typically, the immune system needs to see something first in order to recognize it as harmful later on.”

While NK cells also can attack viruses, parasites and microscopic pathogens, it is their cancer-fighting ability that has caught the attention of researchers at medical centers around the world, including Norton Cancer Institute.

Norton Cancer Institute is one of six cancer centers in the United States now investigating whether these special cells can be used to fight a type of leukemia after other treatments have failed.  

Using NK cells as a cancer treatment involves harvesting umbilical cord blood or stem cells from healthy individuals. Cancer patients then receive a transfusion of NK cells, which have been specially reprogrammed to enhance their cancer-fighting ability.

This type of treatment that harnesses the immune system to fight cancer is called immunotherapy.

Tumor cells may have developed ways to evade a cancer patient’s own NK cells, but they are less prepared against specially reprogrammed NK cells from healthy donors.

Other types of white blood cells that fight diseased and infected cells, called T cells and B cells, need to recognize a previous exposure. Vaccines work by exposing these cells to potentially dangerous viruses or bacteria that have been rendered safe. NK cells are unique because they give the immune system “ready-to-kill” machinery.

To determine which cells are normal, healthy cells and which ones are unhealthy or invading cells, NK cells check the surface of neighboring cells for a chemical marker, a receptor called MHC 1. This “friend or foe” signal lets the NK cell know whether to leave the cell alone or attack it.

When it attacks another cell, an NK cell releases toxic chemicals that cause the cell walls of the harmful cells to rupture. NK cells are particularly effective because they have the ability to kill multiple adjacent cells rapidly. And because they work at a cellular level, NK cells are able target cancer cells without killing or damaging nearby cells.

In addition to their cancer-cell-killing ability, NK cells also communicate with other cells to boost the body’s immune response.

The scientific community is still learning about NK cells, which are thought to develop and mature in bone marrow, the tonsils, spleen and lymph nodes. In addition to traveling in the bloodstream, they also exist in lymph tissue and are located in organs such as your liver and lungs.

Current leukemia clinical trials and studies at Norton Cancer Institute

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he is nicknamed “Sunshine Joe.”

He shares the vivid life advice his father and grandmother gave him when he was a young boy growing up in the Jim Crow South. “Persevere, push forward, keep fighting.”

He details his relentless approach to establishing connections with others, reaching out to five people a day to give an encouraging word or push young people, especially Black boys, to look up, be hopeful, work hard.

He speaks to others living with sickle cell disease (SCD), offering himself as a living example of his advice: Don’t let the disease rule you, don’t be afraid to seek treatment when you need it, and by golly, live life when you come out of the painful episodes associated with SCD.

These are the threads of rich yarn that make up Joseph’s life tapestry. They do more than just give him his nickname. They sustain him. They uplift others. And they are why he has become a local legend and nationally recognized figure in his life’s true passion: stitchery and textile art.

“This is the only way I know how to live my life,” Joseph said. “It is the only way I want to live my life.”

Joseph’s sickle cell disease story began as many do — with a scary episode. He remembers driving home to Louisville from nearby Oldham County and feeling listless. He will never forget the most startling part: waking up sometime later in the driver’s seat of his car, which he’d parked along the side of the road. The sudden and consuming exhaustion brought on by SCD had so zapped his energy that he blacked out while driving.

The Air Force veteran was diagnosed with a variant of SCD called sickle beta plus thalassemia by doctors at the Louisville VA Medical Center, the first time Joseph had heard of the ailment.

“It’s not uncommon for people with Mr. Mallard’s variant of sickle cell disease to go undiagnosed until adulthood even though it is a blood disorder they are born with,” said Shawn D. Glisson, M.D., hematologist with Norton Healthcare’s Adult Comprehensive Sickle Cell Program. “Babies now are screened for SCD shortly after birth.”

The pain crises started coming more regularly a few years later. His joints ached. Throbbed. Nothing could be done to prevent the crises. Instead, he’d have to seek immediate treatment whenever he experienced symptoms.

“Sickle cell trait is the most common inherited hemoglobin disorder,” Dr. Glisson said. “It gets its name because the red blood cells are shaped like a ‘C,’ or sickle, when there are other associated traits. The misshapen cells can get stuck and block blood flow, causing pain, infections and blockages to some organs.”

“I was determined that it wouldn’t define me,” Joseph said. “I would not be defeated by this sickle cell.”

Don’t just take Joseph’s word for that, either. Take some illustrations of that persistence, like the time he embroidered a denim shirt for then-President Jimmy Carter. Frustrated that no local contacts could help get the gift to the president, Joseph bought a round-trip bus ticket to Washington, D.C., and decided he wouldn’t leave until he found a way to the president. The first person he met with, Raoul Cunningham, who worked for U.S. Sen. Walter Huddleston and later became president of the Louisville branch of the NAACP, stepped in to help. By the time Joseph he returned home to Louisville, the story of his beautiful gift for the president was already in the Courier Journal. The shirt is now in the National Archives.

He became so good at his art that he quit his job to pursue his passion, even stitching a commemorative tapestry after President Barack Obama’s first term. These days, much of his time is spent hosting workshops that stitch together sewing skills with life skills. He is a regular speaker in classrooms across the country.

Back home, when Joseph faces a pain crisis, he knows he can head to Dr. Glisson’s office for personalized treatment of episodes. He also visits before long trips for an extra boost of hydration.

Historically, it’s been difficult getting prompt and appropriate care for SCD. Norton Healthcare recognized a need for patients to have a medical home and established the Adult Comprehensive Sickle Cell Program as a place to turn for both everyday management and in times of crisis.

The program is, Joseph said, “lifesaving” for him.

“They’ve provided an avenue for me to call Dr. Glisson and they can get my treatment started immediately,” he said.

When he is again able to get out into the world and spread his message of love and positivity, Sunshine Joe likes to read young students a poem he wrote:

Life is beautiful and it can be real

It all depends on your free will

Going places and doing things

Just naturally spreading your wings

Being honest and being real

Is the only way to give yourself a fair deal

Keep your mind open and your spirit high

You can do anything, even touch the sky

It only takes a short while to learn why Joseph’s message touches so many.

“I [turned] 79 years old on the 19th of June,” he said. “Even though I’ve had these crises that have been very demanding and very painful, I have still managed to live a vibrant life. I walk five miles every day. I try to get my rest and have a proper diet. I am not going to submit or succumb to these crises. I have to live through them and move on. I’m determined. I may be down for a while, but I’m not out.”

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Apart from his thirst for science and knowledge, Jaspreet Grewal, M.D., Ph.D., a hematologist and medical oncologist with Norton Cancer Institute, is passionate about patient care.

“Taking care of patients is an extremely satisfying experience. Patients come to you with a lot of hope and trust, which no other profession can provide. As an oncologist, you can make a difference in patients’ and their family members lives,” Dr. Grewal said.

After earning his medical degree, Dr. Grewal completed residency training in internal medicine and fellowship training in hematology and medical oncology. In addition, he holds a master’s degree in public health, a Master of Science degree in clinical laboratory science and a doctorate in tumor immunology.

From cancer-fighting drugs to patient care

After completing his fellowship training and his doctorate in tumor immunology, Dr. Grewal took a job with a pharmaceutical company in Boston. His plan was to spend his life developing drugs to fight cancer.

“However, just a couple of weeks into the job, I realized I missed taking care of patients,” Dr. Grewal said. “That was a real eye-opener for me. Even though I’m driven by science, coming back to patient care was something I needed to do.”

Related Content: Science and empathy: Dr. Agrawal mixes leading-edge cancer care with the human side of healing

Finding a home at Norton Healthcare in Louisville

Moving to Louisville was a homecoming of sorts for Dr. Grewal. He spent five years at the University of Louisville completing his fellowship training and earning his doctorate.

Dr. Grewal’s wife, Preetkanwal, is also a physician with Norton Healthcare. She is a geriatrician at nursing homes and rehabilitation facilities.

“We really felt that Louisville was the right fit for us,” Dr. Grewal said. “Not only is Louisville a livable city, people here are very personable and bond with each other.”

Dr. Grewal said he wanted to work at Norton Healthcare because of the focus on patients.

“We don’t forget who we work for and what we work for — patients,” he said. “I am certain that this is where I belong, and I look forward to offering my patients the best treatment options and clinical trials.”

Dr. Grewal sees patients with any type of cancer or blood disorder and focuses on gastrointestinal (esophageal; gastric; small and large bowel; pancreatic; liver and biliary tract cancers), head and neck cancers, melanoma and other skin cancers.

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When Laila S. Agrawal, M.D., was a child, her mother was diagnosed with breast cancer. She underwent surgery and chemotherapy, and became a cancer survivor.

“I saw what she went through, and it really influenced me. I was drawn to medicine and from the beginning knew I would go into oncology,” said Dr. Agrawal, a hematologist and oncologist with Norton Cancer Institute.

She attended Indiana University School of Medicine in Indianapolis, did her internal medicine residency at Washington University in St. Louis, Missouri, and completed a hematology/oncology fellowship at Vanderbilt University in Nashville, Tennessee, where she also served as chief fellow.

Dr. Agrawal was inducted into the Alpha Omega Alpha Honor Medical Society and the Gold Humanism Honor Society.

When science meets empathy

As a hematologist/oncologist, Dr. Agrawal knows the latest and best treatments available, but she never forgets the human side of healing.

“It’s important for me to give the most cutting-edge medical recommendation, but it’s just as important to me to be present with the patient during those difficult moments,” she said.

Dr. Agrawal participates in the Norton Healthcare Breast Health Program. She practices at the newly opened Norton Cancer Institute – Brownsboro and at the Norton Cancer Institute – Downtown locations.

The Norton Healthcare Breast Health Program allows newly diagnosed patients to see a breast surgeon, plastic surgeon, radiation oncologist and geneticist on the same day. Services also include nurse navigators, who will guide patients through the new world of being a cancer patient.

“We all work very closely together to strive to give seamless, cohesive care to the patient,” Dr. Agrawal said. “I feel that the team approach dramatically improves the care patients are receiving.”

More precise cancer treatment

Research breakthroughs have led to a wave of new and better treatments for cancer patients.

“This is an exciting time to be in oncology because there is an unprecedented number of new treatments coming out,” Dr. Agrawal said. “These treatments are attacking cancer in new ways, like harnessing the immune system or targeting the cancer rather than the healthy body.

“We’ve reached a pivotal point where we can give more precise and personal treatment. We want to be able to treat cancer more effectively and at the same time minimize the side effects. We have learned that many patients with breast cancer do not need chemotherapy.”

Dr. Agrawal believes that having the option to participate in clinical trials is important.

“Clinical trials give the opportunity to receive treatments that would otherwise not be available to most patients and help improve cancer care for patients in the future,” Dr. Agrawal said.

Louisville means family

Dr. Agrawal and her husband, Arpit Agrawal, M.D., a cardiologist with Norton Heart Specialists, have two young daughters. Her husband was born and raised in Louisville.

“We came back to Louisville to be close to family,” she said.

In their spare time, they like to travel and spend time with family and friends.

“Before kids, we would backpack. Now we travel with diaper bags!” she joked.

Dr. Laila Agrawal loves being a doctor.

“I like to get to know every patient as an individual — what’s important in their life, in their family, their goals and how that plays into important decisions about their health,” she said. “I do this because I can make a difference in people’s lives.”

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Breakthroughs in gene therapy are starting to bring new reason for hope to patients with sickle cell anemia. The inherited blood disease can cause severe pain, strokes, organ damage and sometimes premature death.

The disease is more common in people of African descent. One in 12 African Americans carry a sickle cell gene, according to the American Society of Hematology. Hispanic Americans from Central and South America and people of Middle Eastern, Asian, Indian and Mediterranean descent are also prone to carry the trait.

Help for sickle cell anemia patients

Sickle cell symptoms can start as early as two-months of age and last a lifetime.

The Norton Children’s Sickle Cell Disease Program is the only place in Kentucky, and one of only a few locations in the country, to provide automated red cell exchange for children. Many adult patients also get their regular treatment at Norton Children’s Hospital.

The Adult Comprehensive Sickle Cell Program at Norton Cancer Institute works in tandem with Norton Children’s Hospital to prevent a sickle cell crisis in a patient, care for a crisis if it occurs and manage long-term effects of the disease.

Gene therapies showing promise

The outlook for sickle cell patients may be improving with promising results from experimental gene therapies.

Scientists are pursuing two strategies, according to Sickle Cell Anemia News. One removes certain stem cells from the patient and replaces the mutated gene with a healthy copy. Another approach alters a different gene in the stem cells to boost production of fetal hemoglobin. This form of hemoglobin naturally represses formation of misshapen cells. Babies typically stop producing it by 6 months of age.

The New York Times reported recently that a handful of patients receiving one of various experimental gene therapies no longer show signs of the disease. The testing is very limited, and any widespread use of treatments is years away.

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