Author: hannahgpaul

Often within medicine, monoclonal antibody drugs will be used to treat a patient. Unlike antibody responses that are made from multiple B cells, monoclonal antibodies are antibodies that have been produced by a single B cell. This results in these antibodies having a homologous structure, including constant and variable regions, as well as the same sensitivity to a specific antigen and its epitopes. The structure of these monoclonal antibodies then allows for the antibodies to have the same function as well, creating a unified immune response within the body. Many drugs have monoclonal antibodies as their main ingredient, one of which being adalimumab better known as HUMIRA.

Adalimumab works to decrease inflammation within the body and decrease the signs and symptoms of diseases that cause inflammation in order to prevent damage to the body’s tissues. This drug is used often as a treatment for various forms of arthritis such as rheumatoid arthritis (RA) as well as other ailments such as Crohn’s disease and ulcerative colitis (UC). Adalimumab works by blocking a specific cytokine, tumor necrosis factor (TNF), that promotes inflammation within the body. TNF is produced naturally by one’s immune system and is used by immune cells to communicate that an inflammatory response is needed within the body. By binding to TNF and preventing it from reaching and communicating with other immune cells, adalimumab effectively prevents a large inflammatory response within the body which helps eliminate the severe signs and symptoms of diseases like arthritis.

While adalimumab can help many with inflammation and the diseases associated with the inflammatory response, the drug can also make one more susceptible to certain infections. Some infections that this drug can make one more susceptible to are Tuberculosis (TB), Psoriasis, a lupus-like syndrome, and Hepatitis B in carriers of the disease. Adalimumab makes one more susceptible to contracting these diseases as the monoclonal antibodies within the drug are negatively affecting the body’s innate immune system’s response, resulting in the immune system having a lower ability to fight off infection. While this drug does make one more susceptible to certain diseases, it also has other, possible side effects that one should look for when taking the drug. These side effects are listed below and could be the result of the body adjusting to the effects of the drug on its systems or an allergic reaction:

• fever, sweat, chills
• muscle aches
• cough
• shortness of breath
• blood in phlegm
• weight loss
• painful sores on the body
• diarrhea and stomach pains
• burning sensation during urination
• frequent urination
• fatigue

While these side effects and susceptibilities are troubling to discuss, it is also vital to discuss how drugs such as adalimumab that target inflammation have transformed the treatment of diseases such as rheumatoid arthritis (RA) in recent years. Adalimumab and other drugs work to relieve some of the pain and stiffness associated with diseases such as RA. These drugs are so successful in treating these signs and symptoms that they are often the first choice by physicians when attempting to treat these ailments. Despite this success, however, 30% to 40% of those taking drugs such as adalimumab stop taking these treatments and search for different possible cures as a result of experiencing various adverse effects from these drugs. While incidences of negative experiences with these drugs do occur, it is important to note that there are no personalized treatments for diseases like RA and that adalimumab and other drugs similar to it mark a great jumping-off-point for refining and finding the perfect treatment for those with diseases such as RA.

Resources

“Learn How HUMIRA Works for Moderate to Severe Crohn’s Disease.” HUMIRA, HUMIRA, https://www.humira.com/crohns/how-humira-works-for-crohns.

Zegarac, Jasenka. “Insights Into TNF Antagonism in Rheumatoid Arthritis.” Rheumatology Advisor, Rheumatology Advisor , 10 Apr. 2020, https://www.rheumatologyadvisor.com/home/rheumatoid-arthritis-advisor/tnf-antagonists-in-rheumatoid-arthritis-expert-insights/.

As Covid-19 has become a strong, disruptive force against “everyday life”, many groups have attempted to create new tests that more effectively measure the presence of Covid-19 within a population. One such group that is attempting to develop testing for the virus is at Stanford Medicine School and they have recently developed a new test for Covid-19 that examines plasma for signs of an immune response like antibodies. Unlike the current tests for the virus that examine for the presence of the genetic material of the virus, these tests are specifically screening for Immunoglobulin M (IgM) and Immunoglobulin G (IgG). IgM is an antibody that is made very early in the immune response and its presence in the body quickly declines. On the other hand, the antibody IgG increases slower in the body in response to a pathogen but tends to persist longer in the body.

It is important to check for the presence of antibodies within the body as it is ultimately a large descriptor for how long a person has been infected and how immune they are to reinfection of the virus. For the test developed by Stanford Medicine, the results can read to describe the presence of the individual antibodies, IgM and IgG, as either positive or negative. If someone tests positive for IgM and negative for IgG, it’s possible that they could have recently begun to recover from Covid-19 as the levels of IgG present within the body aren’t detectable. If someone tests negative for IgM and positive for IgG, it is likely that this person has already been infected with the virus and that their body has created an effective response to it that has prevented the person from getting reinfected or infecting others. As tests, such as the one designed by Stanford Medicine, can be used to effectively determine if someone has been infected by the virus even if they were asymptomatic, many have begun to question the information that these screenings can give to researchers and the general public alike.

While the antibody screening tests don’t offer a method for diagnosing early infection of Covid-19, they do offer a way that researchers can measure the presence of an antibody response within a given population. Recently, the CDC has begun an attempt at using these tests to determine who has already been infected by the virus in order to more properly gage the incidence as well as the mortality rate of Covid-19. As one could be asymptomatic or only experience mild symptoms if they are infected with the virus, it is possible that they couldn’t have even known they had contracted the virus and therefore never gone to get tested. This would ultimately skew the data presented about the virus as the full population of people is not considered when examining the virus. As antibody tests for Covid-19 continue to be developed, it’s possible they could be used to determine if someone can return to school or work safely. Ultimately, it’s important to note that these screenings could play a crucial part in determining when the world can return to a seemingly “normal” routine.

Resources

Digitale , Erin. “Test for Antibodies against Novel Coronavirus Developed at Stanford Medicine.” Stanford Medicine , Stanford University, 10 Apr. 2020, http://med.stanford.edu/news/all-news/2020/04/stanford-medicine-develops-antibody-test-for-coronavirus.html.

Mandavilli, Apoorva, and Katie Thomas. “Will an Antibody Test Allow Us to Go Back to School or Work?” New York Times, New York Times, 10 Apr. 2020, https://www.nytimes.com/2020/04/10/health/coronavirus-antibody-test.html.

As many diseases aren’t coupled with effective treatments, many researchers have shifted their work to focus on new ways to cure these seemingly “impossible” cases. This has led many researchers to look into the body’s natural defenses in an attempt to find a cure. Two specific facets of the body’s immune system that are being studied and tested today against many incurable diseases are T cells and Dendritic cells. One research team from Japan has begun testing T cell therapy on mice in an attempt to find a way for the human body to fight against tumor growth. Within this study, engineered T cells were used in an attempt to eradicate solid tumors in mice.

The experiment described above is one of many that are currently being conducted around the world in order to further research CAR-T cell therapy. Within this type of therapy, T cells are collected from a patient blood sample and placed together with CAR (chimeric antigen receptor) molecules before being placed back within the patient’s body. The hope is that the CAR molecules will allow the T cells to recognize cancer-specific antigens found on tumors and kill the identified antigens. Within the experiment, it was recorded that none of the subjects experienced adverse effects, marking it as a possible option for tumor treatment that isn’t as harsh on the body. While many researchers continue to research T cell immunotherapy and what it could mean for curing cancer, others have begun to focus on the dendritic cells of the body and their healing powers. For example, a therapeutic dendritic cell vaccine against HIV was recently tested and was shown to decrease the presence of the virus in those who had received the treatment.

Much like with the T cell therapy, the dendritic cells used in the HIV experiment were engineered to be more effective against the disorder it was attempting to cure. The dendritic cells within this experiment were myeloid derived-dendritic cells (MD-DC) meaning that the cells came from bone marrow within the human body. The vaccine used during the trial was composed of the MD-DC, inactivated HIV, and interferon-alpha. The experiment included 36 males who had HIV, only 14 of which received the vaccine. Of the 14 that received the vaccine, none showed any adverse side effects and all showed a decrease in the virus’s presence within their bodies. As more research is done using Dendritic cells, T cells, and other aspects of one’s immune system, it is important to note the incredible healing powers the human body contains.

References

Balbi, Amanda. “Therapeutic Dendritic Cell Vaccine Against HIV Shows Promise.” Infectious Diseases Consultant, HMP Global, 29 Mar. 2020, https://www.consultant360.com/exclusive/infectious-diseases/therapeutic-dendritic-cell-vaccine-against-hiv-shows-promise.

eLife. “Novel cell-based cancer immunotherapy shows promise in early studies.” ScienceDaily. ScienceDaily, 31 March 2020. <www.sciencedaily.com/releases/2020/03/200331130006.htm>.

The Covid-19 pandemic is effectively changing every single facet of the world. It’s changed how learning will be completed, how we can interact with people, and the medical world since it’s discovery. With those changes, I have been experiencing some stress as I attempt to adjust to online learning and the specific obstacles that come with that. For example, I am having some difficulty managing my time at the moment as my usual schedule and routine have needed to be readjusted completely. However, within the past week, as these online classes have started, I feel like it is now a little easier to structure a routine, as I now have something to build that routine upon.

Other than the stresses that go along with school, I am also extremely stressed about my loved ones during this time. As I live farther away from many of my elderly relatives, it has been very frustrating knowing that I can’t help them or spend time with them during this tough time. Overall, I’ve been trying to practice social distancing as much as I can as this class has allowed me to further understand the importance of that act during times such as these. Along with social distancing, I’ve been washing my hands consistently and trying to avoid touching my face whenever I can. While I understand why UNC needed to move to a remote learning model, I am deeply upset that I won’t be able to spend one of my favorite times of the year with my friends in Chapel Hill.

While I have found that there are many things to stress about during this time, I have also found and adopted ways to combat that stress to ensure that I stay as healthy as possible during this time. Some of the ways in which I have coped with stress these past few weeks is exercising, reading, cooking, as well as “zooming” with my friends from school. All of these ways have ultimately prevented many freak-outs in the past few weeks and I recommend them to anyone who asks what I do to cope with the changes brought on during this time! As this time is so daunting for all of us, I try to remind myself that I am not in this alone. We all can contribute to making this situation better by practicing social distancing, washing our hands, and practicing many other protocols professionals have recommended. If we all practice these protocols and realize how effective they are, then I believe that we can flatten the curve and hopefully come out of this more united than we were before.

Also, to whoever is reading this: I hope you are doing well during this hectic time. I hope you are safe and with loved ones or at least can be in contact with a loved one during all of this. Thank you for all the work that you do with this class and beyond!

Sexually transmitted infections (STI) are an ailment that almost anyone who’s sexually active will encounter at some point in their life. While STIs have been around for centuries, a recent spike in reported cases of STIs in the United States has become a cause of concern for organizations like the CDC. According to the CDC, cases of syphilis, gonorrhea, and chlamydia in the U.S. had increased by about 100,000 cases from 2018 to 2019. The CDC believes that this increase in STIs is the result of a decline in condom use, increased number of screenings, as well as budget cuts that have resulted in sexual health programs at both the state and local level being defunded. These health programs being defunded has ultimately resulted in many areas being left without a place to safely get counseling and testing for STIs, leading to many being untreated and contagious to others.

This increase in the amount of STI cases has resulted in other rates such as the number of congenital infections increasing as well as STIs contracted by the mother spread to her child. An infant can often contract a congenital disease from their mother as they pass through the birth canal and come into contact with mucus membranes that spread the STI to the infant. With this rise in STIs, and as a result other health crises like congenital diseases, many organizations and researchers have begun to look for new ways to cure and prevent some of these infections. One of the STIs that is being heavily researched and tested to find a cure for is the human papillomavirus (HPV). As HPV is the most common viral infection of the reproductive tract in both men and women, it is vital that a cure or prevention is found.

While low-risk strains of HPV can usually be taken care of by one’s immune system, high-risk strains of the virus can’t be eliminated by the body and can eventually lead to certain types of cancer. While there is no definitive treatment for HPV yet, a vaccination for HPV is being administered to prevent future HPV infections and cancers caused by the high-risk HPV strains. There are three main different types of HPV vaccines that are being used widely around the world with one containing the two most common high-risk HPV strains, a second that contains four HPV strains, and a third that contains nine HPV strains. Studies show that the bivalent and quadrivalent vaccines protect against the high-risk strains of HPV and the cancers they cause the best. As various types of STIs continue to increase in occurrence around the world it is important to monitor the progress of the creation, and the effectiveness, of various preventions and cures. It is also extremely important to get tested for STIs if one is sexually active to ensure that both one’s self and their partner(s) are being as safe and healthy as possible.

References

Stack, Liam. “Sexually Transmitted Disease Cases Rise to Record High, C.D.C. Says.” The New York Times, The New York Times, 8 Oct. 2019, https://www.nytimes.com/2019/10/08/health/cdc-std-study.html.

Wiley. “Assessing different HPV vaccines and vaccine schedules in adolescent girls and boys.” ScienceDaily. ScienceDaily, 22 November 2019. <www.sciencedaily.com/releases/2019/11/191122093428.htm>.

One of the largest health issues beings studied today is the resistance to antibiotics seen within certain infectious organisms. As this resistance results in antibiotic therapy becoming ineffective for healing patients, new ways to cure the infections caused by the resistant organisms have had to be created. One organism that this antibiotic resistance is present in is the bacterium streptococcus, specifically group A streptococcus. These strains are resistant to penicillin and other beta-lactam antibiotics. As the resistance seen in these strains is expected to spread to other strains and possibly become resistant to other antibiotics, the impact of this resistance is being heavily monitored by infectious disease scientists around the world.

As strep throat is one of the most common infections seen within young children, much of the research conducted regarding streptococcus’s resistance to antibiotics has surrounded how this resistance will affect the number of children infected. According to James M. Musser, the chair of the Department of Pathology and Genomic Medicine at Houston Methodist Hospital, “if this germ becomes truly resistant to these antibiotics, it would have a serious impact on millions of children around the world.” As the group A strains of streptococcus bacterium cause 20-30% of sore throats in children and 5%-15% of sore throats in adults, research must done in an attempt to understand and control the spread of antibiotic resistance between bacteria. Some of this vital research is currently being conducted at Duke University. At Duke, biomedical engineers released a study that concluded that at least 25% of antibiotic-resistant bacteria can directly spread their resistance to other bacteria.

While innate antibiotic resistance is already a large issue within microbiology and healthcare, it is worsened by the fact that this resistance can be spread to other bacteria that don’t innately have antibiotic resistance. This transfer of “information” between bacteria occurs through the exchange of plasmid from an antibiotic-resistant bacterium to a non-antibiotic-resistant bacterium in a process known as conjugation. As this process results in widespread antibiotic resistance, most of the studies conducted today regarding an organism’s antibiotic resistance are focusing on what specific variables increase or decrease the process of conjugation. With this objective in mind, scientists hope to find a variable that can decrease the rate of conjugation to a level that makes the spread of antibiotic resistance a lengthier process, giving scientists time to figure out a new way to eliminate the possibility of antibiotic resistance. As more organisms become antibiotic-resistant, and their resistance to these antibiotics increases, it is vital that a solution is found to avoid large scale health crises around the world.

References

Duke University. “One quarter of bacterial pathogens can spread antibiotic resistance directly to peers: Antibiotics do not affect the speed at which pathogens share resistance genes.” ScienceDaily. ScienceDaily, 29 January 2020. <www.sciencedaily.com/releases/2020/01/200129125554.htm>.

Houston Methodist. “Discovery reveals antibiotic-resistant strep throat may be too close for comfort.” ScienceDaily. ScienceDaily, 29 January 2020. <www.sciencedaily.com/releases/2020/01/200129131430.ht

The poliovirus is often thought of as an antiquated disease that is not a prevalent risk to people’s health around the world. However, the poliovirus is still wreaking havoc throughout many countries and is becoming increasingly harder to control. While in late 2019, health officials announced that two out of the three wild strains of polio had been eradicated, there was one strain, Type 1, that was still causing health crises in various parts of the world. While it might be assumed that because a vaccine for the virus had been developed and therefore it should be easy to eradicate, that unfortunately could not be further from the truth. As several obstacles, such as rumors surrounding the vaccine and what it is being used for, have deterred people from receiving the vaccine, no other obstacle has been as much of an impediment as the health issues surrounding the oral polio vaccine (OPV).

While the OPV is a widely used form of the polio vaccine, it has been found to have the ability to mutate into a specific form of polio that can paralyze those who are unvaccinated, specifically children. The other vaccine used is the inactivated polio vaccine (IPV) which includes an inactivated poliovirus within the vaccination; the OPV includes an alive, but weakened, poliovirus that usually can’t cause disease. This health crisis caused by the mutated OPV virus has resulted in the need for a new vaccine that is not only cost-effective but contains a virus that will not mutate and cause paralysis and other side effects in those infected with it. While this has led to certain organizations, such as the Bill and Melinda Gates Foundation, to step in and help with funding and distribution, many research institutes and universities have also begun to develop and test new vaccines that could solve the issues surrounding the OPV. One of these universities testing and researching new vaccinations and new methods of manipulating the poliovirus is the Uniformed Services University (USU).

As the issues surrounding OPV have become prevalent, organizations like the WHO have urged that researchers attempt to develop a safer, but still cost-effective, vaccine that will eradicate the chance of new strain of polio being spread. The WHO also stresses that it would be beneficial for the new vaccine to be an OPV instead of an IPV as those vaccines tend to be less cost-effective as well as the fact that IPV’s can be dangerous when developing as they contain deadly “wild” strains of the virus. These demands have been the driving principles for the research being done at USU, where a new polio vaccine that contains strains of the virus exposed to large levels of gamma radiation has been tested successfully. In a recent study published by the USU regarding the newly developed vaccine, they claim that inactivating the virus with gamma radiation is not only cost-effective but could also be the solution to the current polio issue surrounding the OPV. As the poliovirus and its vaccines have caused a plethora of health crises in the past and now, it is important to note how the research conducted and the solutions proposed as it is very likely that this problem will once again arise in the future concerning another virus and its vaccine.

References

McNeil, Donald. “Two Strains of Polio Are Gone, but the End of the Disease Is Still Far Off.” The New York Times, The New York Times, 28 Oct. 2019, https://www.nytimes.com/2019/10/23/health/polio-strain-eradication.html?searchResultPosition=1.

“Scientists Develop Safer, Less Costly Polio Vaccine.” News Wise, Uniformed Services University of the Health Sciences, 31 Jan. 2020, https://www.newswise.com/articles/scientists-develop-safer-less-costly-polio-vaccine.

One’s microbiome can largely determine one’s overall health and they are often studied within the health field. As the microbiome doesn’t fully develop until the age of three, many different variables can influence how the microbiome develops, and, therefore, how it affects one’s health. Recently, studies have been conducted to observe the link between a child’s microbiota and their behavioral issues. The studies were first conducted as an attempt to see if certain behavioral issues could be explained by differences in a child’s microbiota. However, the purpose of the studies has now shifted from attempting to prove a cause-and-effect link to studying the correlation between a child’s behavior and their microbiota.

As more studies are conducted, it’s possible that the findings could result in a way to predict a child’s behavior based on their microbiome. According to Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children’s Medical Center of New York in New Hyde Park, “research examining the clinical implications of the gut microbiome is still in its infancy.” While some research surrounding the microbiome is focused on behavioral issues in children, other studies are focused on how the microbiome appears different in those diagnosed with certain endocrine diseases. A recent study showed that teenage girls with an endocrine disorder known as Polycystic Ovary Syndrome (PCOS) have more “unhealthy” bacteria in their GI tract then the average teen. In previous studies of the relationship between PCOS and the microbiota, it has been indicated that a change in the levels of bacteria within the body, and therefore a change in one’s microbiota, could be involved with the disease.

As this disorder is distinguished by elevated testosterone levels, other issues such as obesity and an increased risk of Type 2 Diabetes are also associated with the disorder. Therefore, both the disease and its side effects are factors that could result in large changes in one’s microbiota. The study described above that focused on PCOS and obesity in teen girls found that “the gut microbiome may play a role in PCOS and its related metabolic conditions” according to Dr. Melanie Cree Green, the study’s corresponding author. While this study didn’t come to any major, definitive conclusions, it’s important to note that studies like these lay down the groundwork for future research that could further our understanding of how the microbiota determines one’s health. As these studies continue, it’s possible that a new understanding of the microbiome’s importance to various aspects of the body is discovered and new ways are cultivated to support this vital body system.

References:

Gordon, Serena. “Could a Kid’s Microbiome Alter Their Behavior?” U.S. News, U.S. News, 21 Jan. 2020, https://www.usnews.com/news/health-news/articles/2020-01-21/could-a-kids-microbiome-alter-their-behavior.

The Endocrine Society. “Teens with obesity and PCOS have more ‘unhealthy’ bacteria: Gut microbiome may play a role in PCOS and its related metabolic complications.” ScienceDaily, ScienceDaily, 23 January 2020, https://www.sciencedaily.com/releases/2020/01/200123090342.htm.

When many people first think of a virus they immediately think of the flu. This infamous virus is one that everyone dreads and takes great precautions, like vaccines, to avoid contracting. According to the CDC’s latest Flu Report, the occurrence of the virus within the United States has steadily increased in the last 3 weeks. This is evident in the larger percentage of positive clinical lab results that have increased from 28.4% to 29.8% in the last week. As well as the increase in positive lab tests for the flu, the majority of states/jurisdictions have reported local or widespread influenza during the last week of January.

This increase in the occurrence of the influenza virus within the United States has ultimately resulted in various other factors to become more common as well. For example, within the past week, the number of people hospitalized who had contracted the influenza virus increased to 35.5% per 100,000 cases. The percentage of patient deaths attributed to influenza and secondary infections like pneumonia has also increased to about 7.1% of patients. Those that have the flu are more likely to contract secondary infections, such as pneumonia, as the contraction of the influenza virus makes them immunocompromised and therefore not as able to fight off other infections. The total pediatric deaths caused by influenza this season so far is 78, with 10 of those deaths occurring in the last week of January.

As the flu season begins to reach its peak, it’s important to understand the types of viruses that are being spread. For this season, it appears that nationally a specific B virus, B/Victoria, and a specific A virus, A(H1N1)pdm09, are the strains that have been contracted the most. While type B virus outbreaks occur each year and are often not as severe, type A viruses tend to cause widespread epidemics and infections with more severe symptoms. While the CDC has stated that they do not yet have concrete data on the effectiveness of the vaccines for this flu season, they have concluded some similarities between the strains being spread this season and the strains that were included in the vaccine. For example, the viruses in the vaccine seem to share similarities with the A(H1N1)pdm09 and the B/Yamagata being spread this flu season. However, the CDC has found that the viruses within the vaccine have a reduced similarity to the B/Victoria and A(H3N2) viruses that have been seen this season. Regardless of the effectiveness of the vaccine, it is still important to receive a flu vaccine each season as it could ultimately lessen the severity of signs and symptoms if one contracts the influenza virus.

Resources

“Frequently Asked Influenza (Flu) Questions: 2019-2020 Season.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Jan. 2020, https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm.

“Weekly U.S. Influenza Surveillance Report Prepared by the Influenza Division.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 7 Feb. 2020, https://www.cdc.gov/flu/weekly/#S5.