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For my final blog, I decided to research a monoclonal antibody drug that I have heard of easily three hundred times but really did not have a clue what it did: Humira. If you sit back and close your eyes, I’m sure that you, too, can hear the crystal clear advertisement voice telling you that Humira is the way to go to treat your moderate to severe rheumatoid arthritis. Humira is a monoclonal antibody, which is indicated by its scientific name, adalimumab. But what is a monoclonal antibody? A monoclonal antibody is a huge number of copies of the same specific antibody. This means that each of these antibodies recognizes one particular antigen. These antibodies are produced when an animal is exposed to a particular antigen. The animal’s lymphocytes that make antibodies against that particular antigen will be taken from the blood of the animal and separated from other things that may have been in the blood so all that remains is the pure product of the antibodies specific to the introduced antigen. Once these antibodies are fused with cancerous cells that continue to divide continuously, scientists can make many many copies of the antibodies so they can be used therapeutically in humans. Eventually, enough can be made to be used therapeutically in humans.

As previously mentioned, Humira is a monoclonal antibody. The drug works in the body by blocking tumor necrosis factor, or TNF. When TNF is not functioning properly, it acts in a variety of different ways that wreak havoc on the body. It activates inflammatory responses and specific lymphocytes, and even attacks the body’s own cells by inducing apoptosis. The effects this malfunctioning TNF has on the body can produce the various joint problems associated with rheumatoid arthritis, like swelling, stiffness, and pain. TNF is largely responsible for the condition of rheumatoid arthritis and various other conditions related to inflammation. As such, Humira can be used to treat more than just rheumatoid arthritis. It can also be prescribed for conditions like Crohn’s disease, ulcerative colitis, plaque psoriasis, psoriatic arthritis, and more. However, for the purposes of this blog I’ll be focusing on how it affects rheumatoid arthritis patients. Because Humira blocks the body’s faulty TNF, it reduces the associated pain, swelling, and stiffness in the joints that so many people with rheumatoid arthritis suffer from. Most importantly, it prevents the progression of the permanent joint damage rheumatoid arthritis can result in. Although adalimumab is generally considered a safe medication and will result in no problems for most of those who take it, in some people it can cause unwanted side effects. Such side effects could be mild symptoms to life threatening conditions such as:

• Irritation at the site of injection
• Upper respiratory infections
• Headaches
• Nausea
• Heart failure
• Blood, liver, and nervous system problems
• Serious infections (including Hepatitis B, Tuberculosis, and various others)
• Allergic reactions
• Problems with the immune system including psoriasis and a condition similar to lupus
• Cancer (commonly lymphoma)
• Demyelinating diseases
• Cytopenias
• Malignancies

Like all long lists of side effects, this looks pretty intimidating, especially if you’re already suffering from a condition that is affecting the way your body works. However, some of these conditions can be explained in terms of what Humira does for the body. Of course, when you alter any functional part of the immune system, it will result in the immune response not being as effective in eliminating infections as it was before. This accounts for the increased risk of infections. Because the adaptive immune system’s TNFs cannot activate macrophages and various other lymphocytes, the body is more susceptible to invasion by any form of bacteria, virus, or even fungus. However, it is more than likely that the other mechanisms in your immune response will be able to fight off these infections without the help of TNF, making taking Humira a “necessary evil” since the risk of irreparable joint damage is a greater threat than taking the chance of possibly getting sick more often. However, as previously mentioned, because of these effects on your immune system, taking Humira does increase your risk of getting Tuberculosis and Hepatitis B. You are also advised not to take Humira if you have a current serious infection, as it is likely that the medication’s effects on your immune system would lead to an altered ability to fight it off. Some of the more serious conditions like heart failure can be attributed to the disease itself and not the medication. Patients with rheumatoid arthritis are known to have higher incidence of heart failure. Other conditions can be due to drug interactions and more. Overall, Humira is generally considered a safe way to lessen the symptoms of rheumatoid arthritis.

Odds are that by now you’ve probably heard about the coronavirus. As suggested by the name, it is a virus- one that had been around for a really long time before now. However, it is believed to have recently mutated, giving it the ability to infect a new host: humans. COVID-19, like any other virus, is an obligate intracellular pathogen. This means that in order for the virus to replicate and spread, it must invade host cells. Fortunately, the human body has developed amazing ways of fighting off such diseases. Unfortunately, because our bodies have never seen a disease quite like this before, some people are unable to mount the immune response necessary to prevent life-threatening, and sometimes fatal, illness. There are a few different reasons why some people cannot fight off this illness as effectively as others. Patients who might be at a greater risk of serious illness from the coronavirus include the immunocompromised, those with preexisting conditions or those who were already sick, and those whose genes do not allow for the production of effective immune cell machinery. As you can see, the immune system plays a huge role in fighting off the coronavirus and infections in general. In the next couple paragraphs I’ll talk about how antibodies specifically interact with the coronavirus.

Antibodies and their interactions with COVID-19 antigens have been an essential part of testing for the sickness. As we have been studying, our bodies make millions of B cells with unique B cell receptors that are specific for a certain antigen. Once the B cell encounters this antigen within the body, with the correct signaling from a helper T cell, the B cell will become activated and produce millions and millions of copies of plasma cells, which will produce antibodies, and memory cells, which will help our bodies fight off the infection if we ever see it again. Because of the ways antibodies interact with antigens, doctors and scientists have been able to use our own antibody responses to the virus to determine whether or not we have been exposed to the virus. This is done by testing for antibodies that fight the coronavirus in our bloodstreams. As was mentioned before, antibodies will only be mass-produced after the virus is introduced into the body. Therefore, the presence of antibodies indicates that the patient either has the virus or had it previously and fought it off. These antibodies have been shown to provide resistance to future illness caused by the coronavirus in studies done in monkeys. This means that, according to this specific study, the antibodies those who are infected with the coronavirus make will protect them if they ever have to fight the illness again. Another interesting way of testing if someone has the coronavirus is taking a sample of the microbes in their upper respiratory secretions and applying it to special pieces of paper loaded with antibodies to the coronavirus. Then, some form of visual indicator will indicate whether or not the secretions contained coronavirus antigens.

Like I’ve tried to make abundantly clear, the body has amazing ways of protecting itself, and this is undoubtedly reflected in its immune response. For example, the body produces multiple types of antibodies. The relative concentration of antibodies can be measured in your blood with the use of titers. Titers can test for a couple different types of antibodies including IgM and IgG. IgM antibodies are the preliminary antibodies, the first ones your body produces in response to an infection. Although these antibodies are not particularly specific and do not fight off pathogens quite as efficiently as IgG antibodies do, they are a step in the right direction and an important first step in initiating the body’s defenses. Later on, as the immune response progresses, the immune cells produce IgG antibodies, which are “fine tuned” to fight off the specific infection at hand. It is present in the fluids of the body and will therefore be found in one’s blood. Someone with IgM antibody titers would be early on in their infection. As was said before, they have not yet begun producing specific antibodies to fight off this specific illness. However, someone with IgM and IgG antibody titers would indicate that they are actively fighting off the virus and that their adaptive immune system is actively working against the coronavirus specifically. Effector cells are doing their job fighting off the infection. If someone has an IgG antibody titer only, it indicates that the person has effectively fought off the infection and can no longer suffer from the same illness. The presence of IgG antibodies is exciting because it is a potential treatment for those who are suffering from the sickness now. These antibodies could be introduced to the bloodstream of someone fighting the coronavirus, giving them passive immunity and allowing them to get over the illness more quickly.

As I’m sure we’re all painfully aware, there is not much we can currently do to prevent the spread of the coronavirus besides “practicing social distancing” and washing our hands well. However, the outbreak of this virus has set the world moving at a pace never before seen searching for the cure. Although the virus is relatively new, there are already multiple treatment options being tested as quickly as possible as the virus continues to spread. I will be talking about two today.

Remdesivir was produced many years ago as a drug that could generally help us fight viruses. It targets the specific machinery certain viruses use to replicate their RNA encoded genetic information. Although this treatment was pushed many years ago to help relieve the ebola epidemic, it did not amount to much in the treatment of that illness. However, testing indicates that it could be effective in the treatment of the coronavirus, MERS, and SARS viruses. Although it is obviously still in the trial phase, it is speeding its way through and will hopefully emerge as a possible treatment before too long, as it does seem to be a promising option.

Next, scientists are now exploring the effectiveness of providing patients with passive immunity. In this treatment, survivors of the coronavirus would donate their blood plasma and, therefore, the antibodies they produced while fighting the disease to patients who seemed unable to fight it off themselves. This kind of treatment is called “serum therapy” and also seems very promising. This treatment uses the same antibodies that were effective in fighting off the coronavirus in other patients and puts them into someone new who needs them. Passive immunity is not a new concept, babies gain passive immunity from the antibodies in their mother’s milk and their blood while they are still in the womb, so it follows that transferring functional antibodies from one person to another intravenously would be just as effective.

These are only two of the many possible treatment options for the coronavirus, and as time goes on I’m sure the world will come up with more and more. However, as we all know, for now, all we can do is do our part and avoid unnecessary social contact and keep ourselves safe by practicing good hand hygiene and being careful about touching our faces.

As we all know by now, the immune system is a vital part of a well-functioning human body. Thanks to our immune systems, we are generally able to fight off a variety of infections and illnesses without much of a problem. The immune system is also key in our bodies’ ability to know how to deal with these specific microbial invaders more efficiently if we ever see them again. Two very important cells functioning within the immune system are T cells and dendritic cells, two lymphocytes very important in the adaptive immune system. Each is very important in the activation of different kinds of cells and responses within the immune response. It is incredible how intricate and complex these body mechanisms have come together to keep humans and other organisms healthy. However, as with all things, the immune system cannot always work perfectly. For example, when the cells of the immune system fail to recognize abnormal growth of a self cell, it can lead to the growth of a cancerous tumor. Scientists are working tirelessly to try to find ways to treat these immune cells and return them to their normal function. One way they are investigating is with T cell and dendritic cell therapy.

One kind of promising T cell therapy is CAR T-cell therapy. CAR T-cell therapy is currently used only to treat patients with two specific types of cancer: large B-cell non-Hodgkin lymphoma and acute lymphoblastic leukemia. The first type of cancer is a cancer that mutates the body’s B cells, which are extremely important in the production of antibodies. Acute lymphoblastic leukemia affects the bone marrow, in which are the precursors of the white blood cells, the essential components of the immune system. As of right now, use of these treatments is limited to these specific types of cancers, which are generally either advanced or extremely persistent, but there is always hope that further research will bring about advancements in the treatment, and, as always, scientists are working on developing similar treatments for other cancers. However, the process can be complicated as it is essentially genetic modification of the patient’s own T cells that are not eliminating cancer cells as they should.

Through ways similar to platelet donation, doctors filter the T cells out of a patient’s blood and insert a chimeric antigen receptor (abbreviated as CAR) to the surface of the T cells. This allows them to recognize the cancerous cells as abnormal so they can attack and kill them. Once enough of the patient’s T cells have been genetically altered, they will be reintroduced to his or her body to do their job and hopefully kill any existing cancer cells. This procedure has been fairly successful and only rarely has serious side effects. Several of these include usually mild cases of cytokine release syndrome, low red and white blood cell counts, and very rarely abnormal brain conditions, but generally these can all be treated relatively easily.

Even more recent reports state that, as expected, CAR T cell therapies are looking more and more promising. Because of the unique way this treatment utilizes the patient’s own cells, the “treatment” is able to work with the human body in a way that most medicines cannot. The article mentioned before reports that as research and experimentation progresses, genetically modified T cells are able to stay in the body longer and longer, and that the body itself is able to replicate more and more of these cancer-fighting cells. They are also working on ways to make these T cells stronger and more efficient, along with experimenting with ways to use the cells of donors. By taking donor cells, doctors believe they could avoid several of the side effects of the current treatment and even store the treatment before it was needed so the patients would not have to go through the lengthy process of having their own cells modified. Scientists are also looking into what benefits the use of stem cells could offer. All of this to say, T cell therapy seems to be promising in the treatment of cancer patients.

Antibiotic resistance is a growing problem. For thousands of years, antibiotics were a resource only available to the microbes that produced them. However, scientific research of these incredible products revealed them to be invaluable in the treatment of some bacterial infections. Again, for thousands of years, people were only able to pray that the illnesses they suffered from would pass before they caused too much damage. The discovery of antibiotics promised a revolutionary new way to treat illnesses. However, doctors started prescribing medications without understanding the consequences of overusing these miracle drugs.

Bacteria mutate quickly and often. When antibiotics are thrown into the picture, this creates a perfect storm of selective pressures that select for the strongest and most durable bacteria. Put a different way, when antibiotics are used “inappropriately”, they can kill off the least fit, or weakest, bacteria, until only the strongest remain. Essentially, using antibiotics when they are not needed can select for stronger bacteria that is harder to kill. These kinds of microorganisms are known as superbugs. They are often multi-drug resistant, and because we have been relying on the same antibiotics for a very long time, as microorganisms are becoming resistant to more and more antibiotics, we are running out of treatment options for people who contract these superbugs.

However, the problem gets even scarier when you consider the implications for pharmaceutical companies. Now that doctors are aware that overprescribing antibiotics is leading to drug-resistance, they are (rightfully) recommending antibiotic use more sparingly. However, as less and less antibiotics are being used, this does not provide pharmaceutical companies with much of an incentive to a) produce antibiotics and b) conduct research to find new ones. Companies that were happy to produce products that were used freely and often are not quite as motivated to make products that are only used when there is no other option. Furthermore, when microbes develop resistance to these drugs, they become irrelevant, and all the research into and production of that drug is rendered completely useless. The combined effect of the issues is leading pharmaceutical companies to terminate their antibiotic departments and discontinue research on antibiotics in fear of wasting time and resources. This obviously creates a problem: what would the world look like if all pharmaceutical companies followed suit?

Growing antibiotic resistance threatens to take life back to the way it was a hundred years ago before we even knew about antibiotics. Once again, simple Staphylococcus aureus infections could have the potential to kill, and doctors would be powerless to stop them. This sounds like an awful and terrifying way to live, so it is imperative that companies keep investigating new ways to fight off microbial infections so this world doesn’t become a reality.

We are lucky to live in the world that we live in. For most of us in modern day America, worrying that something as simple as a scratch from a rosebush or even something as horrifying as rabies or tetanus will end our lives is a thing of the past. Thanks to advancements in medicine, humans are able to fight off all kinds of threatening microbes that could otherwise lead to devastating illness or even death. Although some of these medical “interventions,” such as antibiotics, have some unwanted effects on human health, there is little known disadvantage to vaccinating people against all kinds of pathogens.

Vaccines can protect people from illness through various mechanisms, but basically work by exposing the body to a form of the pathogen that cannot hurt it. However, the immune system still recognizes the pathogen as an invader and fights it off as if it were virulent. This way, when it encounters “the real deal,” the immune system will recognize the invader much more quickly and be able to fight it off before it can do any significant damage. Vaccines are truly amazing. Between the incredible functional capability of the immune system and the fact that scientists are even able to strip viruses of what makes them dangerous is mind-blowing to me. The two main kinds of vaccines are attenuated and inactivated. Attenuated viruses are reduced in virulence in some way that makes them much less threatening to someone with normal and healthy immune function. Inactivated viruses are rendered unable to replicate, which takes away their ability to impair the body in any serious way. Without being able to replicate, the pathogen cannot overcome the body’s immune system, and the body kills it off easily. Each type of vaccine has their own advantages, which is why it’s very important to follow the recommendations of your healthcare provider when getting your vaccinations.

One disease that can be prevented through vaccination is the polio virus. There are two main forms of immunization against polio- the Inactivated Polio Vaccine (IPV) and the Oral Polio Vaccine (OPV). At first, only the IPV was available, and although it was very effective in reducing cases of the disease, because it is made with an inactivated virus, patients need to receive multiple doses to attain full immunity. However, the OPV is administered orally and made of an attenuated virus, providing longer-lasting immunity. Due to the fact that the OPV is administered orally, receiving the vaccine by this method delivers the attenuated virus directly to the tissues of the throat and gastrointestinal tract- the tissues that are targeted by the wild-type virus. The OPV is more effective at preventing disease because it kills the virus almost immediately after it is introduced into the body. As was previously mentioned, these vaccines did a lot to lower rates of the illness. However, there is a new “polio-like” illness spreading that has been a cause for concern. It is called Acute Flaccid Myelitis, and it is affecting, but generally not killing, children infected with other similar viruses like Polio or West Nile Virus. Hopefully before too long, scientists and doctors will be able to find a vaccine for AFM as well.

Research conducted over the past few years has revealed the human microbiome to be more and more important. But what is the microbiome? It may be a little alarming to learn that there are far more microbial cells in your body than there are human cells. However, this microbial “invasion” is nothing to worry about. In fact, the microbiome represents an essential part of human health. Though these microbes, including bacteria, protozoa, fungi, and even viruses, have invaded and colonized our bodies, in normal conditions, most do not do us any harm, and many actually help and protect us from other pathogenic microbes. They do this in a variety of ways including using up the resources “bad” bacteria need to flourish, helping us digest food that we cannot digest ourselves, and even fighting off pathogens that make their way into our systems. However, the microbiome must be in good health to provide people with these benefits. A few things that could throw off someone’s microbiome are taking antibiotics, getting sick, certain unhealthy habits, and more. When the balance of the microbiome is disturbed, some kinds of bacteria that normally don’t affect us start to take over, causing different kinds of illness and disease. However, a healthy microbiome can and will help its host in all kinds of ways.

It has been found over and over that microbes in one part of the body can have significant effects on totally different parts of the body. For example, the bacteria in your gut can impact your mood and brain function, and have even been linked to the autism. This study examined autistic children with frequent gastrointestinal and digestive problems and aimed to see how manipulating their gut microbial composition could impact both conditions. It was found that not only did altering the gut microbiome significantly relieve the gastrointestinal issues, but it was even found to reduce autistic behaviors. Although this news is exciting and implicates a new kind of treatment for autistic patients, it is not totally surprising that a change in microbiome might have this effect on people. It has been well documented that the microbes that live within us affect our personality and mood, as is mentioned in the same article, so it follows that altering the microbiome of autistic patients would impact their behavior as well. The studies found that after the alteration of their microbiomes, the behavior of nearly half the subjects no longer qualified as autistic based on autism scale tests. This example shows just one of the many ways our microbiomes affect our health.

Another study shows that the presence of certain bacterial strains in someone’s microbiome can lessen the symptoms of Parkinson’s disease. This bacteria prevents the formation of the misfolding of proteins that cause the disease. Although scientists still have not found out what causes the proteins to misfold in this way and have been unable to find a cure, they have found, once again, that microbiome composition plays an important role in the way the disease behaves. The presence of one strain of bacteria in the gut has effects that reach all the way up to the brain. Although this is one of the first studies of this specific microbial interaction, scientists emphasize that it will not be the last. They have found yet another important implication for the treatment of disease through the alteration of the microbiome.

As we know, influenza is a virus that can be prevented, or at the very least have its effects lessened, by the flu vaccine. The vaccine against the influenza virus is updated each flu season to protect against the flu strains experts believe will be the most infectious in the upcoming flu season. The flu vaccine for this season will include protection from four different strains of the virus. And now, the flu shot is not made in eggs anymore so even those with egg allergies can be safe. It is recommended that everyone get a flu vaccine before September, towards the end of October. It’s important to know that people of different age groups get different vaccines since some age groups are more vulnerable to the virus than others. For example, people above the age of 65 can be affected severely by the flu: It can even be life threatening. However, for healthy young adults, it is rarely more serious than a few days of not feeling well.

Although it is difficult to determine how effective the flu vaccine will be each season, it is definitely in everyone’s best interest to get what protection they can from the vaccine. The CDC says that the flu vaccine is generally between 40% and 60% effective in preventing illness. However, as I already said, even if you still get the flu after getting the vaccine, you’ll likely get a much milder strain and be able to recover much more quickly. Apart from calculating how many individual cases of illness the flu shot prevents, there are a few different ways to assess the effectiveness of a flu vaccine. It can be based on how many strains the vaccine protects against, how long the protection lasts, or how high of a dose the vaccine provides.

However, if you are unfortunate enough to come down with the flu, there are several antiviral drugs that can help you recover faster. The CDC approves of four different antiviral medications for the treatment of the flu. They can be ingested as pills, injected into the patient’s veins, or inhaled into the lungs. These antiviral medications can greatly lessen the effects of the virus and are extremely important for people who are at higher risk of developing complications because of the flu. These people mainly include the immunocompromised and the elderly. Some people may even be prescribed the medications before they show symptoms if they are at high risk. These medications are capable of saving lives and have made a huge impact in the treatment of the influenza virus.

The anti-vaccination movement began in the last remaining years of the 1990’s when Andrew Wakefield, a British medical doctor examining the ties between bowel complications and seemingly reversed development in children, suggested that the MMR vaccine could have played a role in this reversed development as well. A summary of the study can be found here. Wakefield conducted his research on twelve children, each of which had been referred to Wakefield, a gastroenterologist. Of the children, 11 were male and all had been brought to him by their parents, who were seeking help with their children’s digestive problems. His sample was clearly flawed; he used a group of children with conditions associated with autism, but still implied that it was the MMR vaccine that had ultimately been the reason they developed autism. Wakefield’s research undoubtedly unsound: his sample size is far to small, his subjects were not random but unhealthy children seeking help, and the way he obtained information about their vaccination seemed to indicate that he had led the parents to believe their children’s conditions were brought about by the vaccine- he was plainly biased.

It is important to note that no other studies been published confirming Wakefield’s conclusions. In fact, the reputable studies that have been conducted regarding the tie between the MMR vaccine and autism have found the opposite to be true. All the major relevant studies have found that there is no connection between the MMR vaccination and the development of autism. It was discovered years later that Andrew Wakefield had been paid to look into this relationship by lawyers hoping to be hired by outraged parents who believed their children’s autism had been caused by the vaccine, leading them to sue the companies that produced them. It is, therefore, not unreasonable to conclude that Wakefield, who was later stripped of his medical license due to his unsound research practices, published his research for his own financial gain to the detriment of public health.

The anti-vaccination movement has prompted some noteworthy changes over the past years. An overview of these changes can be found here. First, and most obviously, the world is seeing recurrences in illnesses that had all but disappeared, like the measles. As more and more people refuse to vaccinate their children, more and more children are put at risk of contracting these illnesses and spreading them to others. On a less bleak note, with all of the problems caused by deciding not to vaccinate children, the market for researching and preventing the diseases that are suddenly a problem again is growing. More resources are being put into investigating these illnesses and more people are becoming interested in the field.