Showing posts with label vaccine. Show all posts
Showing posts with label vaccine. Show all posts

Your Body Has A Photographic Memory

Biology Concepts – innate immunity, acquired immunity, memory response, influenza

Your body is exposed to tens of thousands of foreign molecules every day. Some can do you harm, some can’t. Your immune system sorts them by matching receptors on immune cells to molecules on the foreign objects.

Legos and biology are a good fit. They can be used to analogize the 
rearrangement T cell receptor genes or hypervariable regions 
of antibody genes, or they can be used to model the entire 
body. One scientist uses them to model building 
complex systems from repetitive units. And they’re fun.
Thinkof the receptors as Legos; your DNA provides for several different types of Lego blocks to be made, and your immune cells can rearrange the different types and put them together as a receptor, so there can be millions of different receptors. Each immune cell has just one type of Lego receptor, although it may have many copies of that one form. Each different Lego receptor will fit, key in lock style, with a specific foreign molecule.

The receptors exist on many types of cells, and antibodies sometimes function as receptors when attached to the surface of specialized immune cells. Even circulating antibodies (Ab) in the blood take the form of key and lock systems, whether as single Ab, dimers (2) or pentamer (5) complexes.

The immune system of higher animals can be described as several sets of pairs. Each member of a pair attacks a problem in a certain way, and has independent pathways, but each pair also has overlap and must work together in an overall response. We could spend weeks just on this system, but lets look at the major parts by describing each pair, from largest to smallest.

Innate immunityvs. adaptive immunity – the innate immune responses are fast but short. They don’t depend on your immune system recognizing the specific foreign molecule (antigen) with a specific receptor, but respond with the same types of reactions no matter what it is. Almost all plants and animals have some form of innate immune system.

Vertebrates take the immune system further. They have developed an adaptive immune system that does depend on your immune system recognizing the specific foreign invader. It then generates a tailored response to that one foreign organism or molecule. The faster, but more general, innate response helps the slower, but longer lasting and more specific, adaptive response to kick in.

These are cartoons of an antibody. The model on the left is a much 
more realistic image. The Fc portion is the same through most 
antibodies (c= constant), while the gene rearrangement takes place 
in the light chain and heavy chain variable regions. The 
different variable regions are the Lego blocks that can be put 
together differently to make the millions of different antigen 
binding sites.
Humoral immunityvs. cellular immunity – when an antigen is recognized by an adaptive immune cell (often through antigen presentation by the innate system), an early response is for the cell to divide and make more of itself. You don’t get sick from one bacterium infecting you; many infect you at once and then divide to become many more. You need many copies of that specific immune cell in order to battle the invading horde of bacteria.

The immune cells can generate an antibody response (humoral immunity) and/or trigger specific killing and directing cells to be produced (cellular immunity). The antibody (produced by B lymphocytes) is a protein that recognizes the specific antigen. The cellular immune response is mediated primarily by T lymphocytes.

However, B cell-produced antibodies are important for T cells to do their work, and antibodies also help the innate immune response to keep working after specific recognition has been made. In addition, the cellular immune response can control and ramp-up the humoral response. You see what I mean about each pair being separate but connected.

Effector T cellsvs. regulatory T cells – There are pairs of T cells as well. I use the term “effector T” cells to lump CD8+and CD4+ lymphocytes together (CD = cluster of differentiation markers on the cell surfaces). Effector T lymphocytes are either directly cytotoxic (CD8+, cyto = cell and toxic = damaging) or command (CD4+) the many adaptive responses. Effector cells are contrasted with regulatory cells, which include regulatory and suppressor T lymphocytes. The purpose of these cells is to stem the effector response so it doesn’t get out of hand; parts of the immune response are inflammation and non-specific cell killing – too much of that and you die too.

Memory Immune System – This last part of the immune response is not a member of a pair. When your innate immune system is activated, it ramps up, does its job, and hopefully is turned back off. The adaptive immune system responds to the antigen by producing more cells, antibodies and chemical signals (cytokines), and after the invader is vanquished you want this response to diminish as well. The innate system always starts over from zero, but the adaptive system remembers the infection you had.

The dendritc cell on the left is an innate immune cell that works 
to present the antigen to the adaptive immune cells (Th1, 
Th2, and B cells). The adaptive cells reproduce and make 
cytokines to stimulate other immune cells. They also generate 
some memory cells that recognize the same antigen, but stay 
around for a long time and can react strongly and quickly.
Duringthe adaptive response, some of the produced immune cells become “memory cells,” they still recognize the antigen from the initial infection, but hang around in larger numbers; in many cases they circulate in your body for the rest of your life. If your body sees that specific antigen again, the memory response can be re-initaited very quickly and very aggressively. You might be infected again, but your memory response is so fast and effective that you never know it.

In a world without vaccines, you are infected, get the disease, recover (hopefully), and then have a memory immune system for that antigen. Vaccines take the initial infection and disease out of the equation; you get to develop a memory without having had the experience!

As we discussed last week with smallpox, vaccines present your immune system with the antigen in the form of a dead or weakened pathogen, or just the antigen molecule itself. Your body doesn’t know the difference, it develops an adaptive and memory response just as if it were the real infection.

In the majority of cases, you develop memory B and T lymphocytes when infected or vaccinated. However, there are exceptions. Most antigens cannot fully activate B cells to make antibody, they have to be helped along by antigen-activated T cells. But there are T cell-independent antigens that can fully activate B cells on their own. In these infections, you can develop a B cell memory without a T cell memory.

On the other hand, there are other infections that develop a full memory response, but it is not useful. Influenza is an example of this. Influenza has been around for thousands of years; some years we have severe epidemics or even world-wide pandemics. The 1918-1919 Spanish flu pandemic killed over 50 million people, many more than the contemporaneous WWI (16 million deaths).

Flu is difficult to vaccinate against because it keeps changing. Influenza virus has two antigens, called H (hemagglutinin) and N (neuraminidase). These are the molecules on the virus particle that your body mounts an immune response against.

The H molecule on the viral coat binds to sialic acid receptors on respiratory cells and allows the virus to enter. When the newly produced viruses bud off of the cell, they place H on the cell surface, but there are still host sialic acid receptors there as well. These receptors would bind up the H and prevent the new viral particles from attaching to and infecting other cells, so the N molecule cleaves the sialic acid receptors from the new viral particles.

Influenza virus can mutate by antigenic drift or antigenic
shift. The top line shows that by passing from person to
person, the antigens (and virulence) shift slightly. The lower
line shows that by passing through other animals and
recombining, the antigens can have small or big changes. When
shifted virus moves into humans, it’s a recipe for a pandemic.
Theproblem arises when the H and N antigens mutate.... and they do. Scientists have identified 16 different classes of H’s and 9 different N’s, and they can be paired up in many combinations. Small changes (antigenic drift) usually mean that memory might have a slight protective effect, and major epidemics do not occur. But major changes in H and N (antigenic shift) mean that previously infected people have no memory protection.

Different strains of influenza virus can infect the same animal (often pigs and ducks – thus avian flus and swine flus) and can mix their H’s and N’s. What emerges and might be transmitted to humans can be a virus with H’s and N’s similar to years past, or with new H’s or N’s. That is why a new vaccine must be produced each year, after scientists see which H’s and N’s the new virus has and how much they have drifted. Avian flu is H5N1, while swine flu is H1N1. However, antigenic drift means that each H1N1 will not be exactly like the previous H1N1 to emerge. The 1918 pandemic was caused by an antigenically shifted H1N1 sub-strain.

Like flu, other infections may not provide life-long memory. If the memory response is weak or the initial response was not strong, then memory may fade over time. This is why some vaccinations require boosters in later years. A fading of the memory response to influenza is also implicated in the need for yearly vaccinations.

Here's a great book that discusses both the biology
and sociology of influenza. There are great personal
stories as well as medical detective work. This
pandemic was a jolt that brought infectious
disease research into a new century. I highly
recommend it.
Now for the exception to the exception. Influenza changes each year, so memory does not help much, but a 2010 report from scientists in Hong Kong suggests that prior exposure to any seasonal influenza (either by infection or vaccination) might have been a contributing factor as to why the 2009 pandemic of antigenically shifted swine flu (H1N1) was much milder than expected.

The 2009 seasonal flu vaccine did not have any cross-reactivity with pandemic H1N1, so the scientists suggest that previous years seasonal influenzas did generate some memory response that was partially effective against 2009’s H1N1 swine flu. Cross-reactivity means that the H and N antigens were not identical to previous version; the Legos don’t fit together exactly, but they were similar enough to fit together and initiate a partial response. Once again, we see that getting sick may save your life down the line.

Next week will look at examples wherein having one disease can protect you from catching another.




For more information or classroom activities, see:

innate immunity:

adaptive immunity:

memory immune response:

influenza virus:
http://www.xvivo.net/zirus-antivirotics-condensed/

Lucky For Me, I’m Diseased

Biology Concepts – disease, vaccination, single nucleotide polymorphisms

Jill Bolte Taylor is an Indiana University neuroscience
professor who suffered a massive stroke. She recognized
what was happening and has translated her thoughts
and feelings into a narrative to help us understand. She
is eloquent in describing how her stroke has affected her
in a positive way. --- Soon to be a major motion picture!

Yourarely hear someone say how glad they are to be sick – unless a business meeting, unit test, or visit to the in-laws is involved. Robust health is a sign of good genes, and animals (including humans) instinctually seek out good genes when selecting mates. We don’t like to be sick, and we don’t want others (potential mates) to see us being sick.

True, there is that one person in a thousand who argues quite eloquently that an illness showed them another side of life, expanding their world-view and making them a better person. I applaud this attitude, but did you ever notice that it’s only the survivors that can gain this insight?

Our entire health care system is based on the idea that it is preferable to not be sick. The best way to bring this about is to reduce the chances that we will encounter anything that might provoke a response from our body, including pathogens (disease causing organisms, from pathos = disease and genique = to produce) and allergens (living or non-living molecules that can induce an allergic response).

But what does it mean to be “sick?” If you are infected by a pathogen, are you necessarily sick? There are infections that are subclinical or asymptomatic (without signs of disease), and there are carrier states, when a person is infected and can transmit the disease, but does not have symptoms. Are these people still sick?

You can be in a social situation where you feel empathy or regret, “I feel just sick about how I treated her.” Is this true sickness? Your mental state of mind is important in your health; if you talk yourself into being sick, are you really sick?

Single nucleotide polymorphisms (SNPs) are one base
changes in a gene sequence. “Polymorphism” means
that the population will show different sequences at this
point. SNPs may produce no change in the protein, but in
some cases they may change the shape or function of the
protein just slightly. This may not cause disease, but may
affect the course of a disease, or how drugs will work in
that individual. SNPs may one day lead to personalized
medicines in a new science called pharmacogenomics.
Drugs will be designed to work best for your particular
DNA sequence.

What about genetic mutations? Can everyone with a genetic mutation be considered sick? If yes, then we are all sick, because everyone one of us has thousands, perhaps millions of single nucleotide polymorphisms (differences in a single base of DNA that might lead to change in function of a protein). I would suspect that most of us have larger mutations as well; the older we are, the more mutations we have. Some mutations render a person predisposed (more likely) to develop a disease – is this person sick even before he/she acquires the illness?

Osteoarthritis is a disease that can wear away joint surfaces and necessitate hip or knee replacement. My father has two artificial hips due to osteoarthritis, but does that make him sick or ill?

You see someone coughing, sneezing and blowing his/her nose. It could be due to respiratory allergies or a bacterial or viral infection. Are they sick in one instance, but not the other? I have seen TV ads that try to convince allergy sufferers that they are a menace to society, and should be embarrassed about their condition (unless they use their wonderful product). The entirety of the message in our society is that any illness or condition is a deficit.

To summarize our man-made rule: diseases are bad, and being exposed to diseases is bad, so keep your environment clean and antiseptic. Don’t get me wrong – I am not mocking the rule. I would rather not be sick - so much so that I am careful where I go and what I touch – in some places I simply choose not to breathe, just to be on the safe side. Disease prevention is an important part of life expectancy.

But are there exceptions? Is it sometimes good to get sick, either in general or with some specific disease? I think you know there must be exceptions, otherwise we would just be left with an interesting discussion of what it means to be sick. I bet you can even come up with at least example on your own. There are in fact boatloads of general and specific exceptions to this rule. Let’s take a few weeks and cover a few examples that are exceptions to "disease is bad" rule.

Our first exception is one that you may have already thought of – vaccines. With many vaccines, getting the disease is the key to not getting the disease – counterintuitive, isn’t it? I will use smallpox as an example of the idea that sickness prevents sickness, but there are many others.

Smallpox survivors had a very distinct look. It was
unfortunate that the lesions showed up most heavily on
the face and arms. Thankfully, the disease has been
eradicated, and the virus only exists now in two
laboratories, at the Centers for Disease Control in Atlanta
and the “vector” lab in Siberia. Whether these stocks
should be destroyed is a matter of some debate.
Smallpox, until recently, had been a scourge on mankind for thousands of years. The infection is caused by a virus (Variola major or minor) and may present in several different forms. It was a very dangerous disease, the hemorrhagic form was almost universally lethal. Those that survived smallpox were marked for life (see picture).

In the 1790’s, Edward Jenner of Gloucestershire, England noticed that milk hands and milkmaids seemed to be immune (from Latin, immunis = exempt) to smallpox and he wondered why that might be. The milking workers told him they felt protected because they worked with diseased cows, those that had a mild disease called cowpox. For some reason, having had cowpox kept the milkmaids from catching smallpox.

It turns out that cowpox and smallpox are enough alike that having one will prevent you from having the other. It was on this basis that Jenner developed the first vaccine (Latin from vaccinus = from cows, coined by Louis Pasteur as a tribute to Jenner). By pricking the skin of a young boy with a needle contaminated with the pus from a young milkmaid with cowpox, Jenner showed that this could prevent infection with smallpox (Jenner wasn’t the first to vaccinate with cowpox, just the first to prove it prevented smallpox).

Contracting cowpox, a mild disease that did not kill or scar, could prevent one from catching smallpox, a terrible disease that often killed and left survivors with permanent reminders of their ordeal. Maybe getting sick ain’t always so bad. We will talk more next week about just how vaccination works to produce a protective immune response.

Cowpox vaccination is an example of using one disease to prevent another, but even 100 years before Jenner it was recognized that you could prevent smallpox by giving people smallpox. Strange, isn’t it? Variolation was performed by blowing ground smallpox scabs up the nose of another person, or by pricking them to place the material under the skin.

The virus in the olds scabs was definitely variola, it was just weakened (attenuated) by its age and its time outside of healthy cells. The virus was recognized by the body and an immune response is mounted, but the virus was too weak to produce a fulminant infection was eliminated by the body. But not before it helped the vicitim become immune to subsequent smallpox infection.

Poliomyelitis infection led to a paralysis of the muscles.
This could include the respiratory muscles, so iron lungs
were used to force air in and out of the patients’ lungs.
Before a vaccine was developed, a treatment was
developed by an unaccredited nurse from Australia.
Sister Elizabeth Kenny overcame much professional and
gender prejudice to show that heat and passive exercise
to retrain muscles was better than the then used
immobilization therapy. Try to see the biopic “Sister
Kenny” on TCM some time.

Attenuatedvaccines do carry some risk. Paralytic poliomyelitis has almost been eradicated thanks to Jonas Salk’s inactivated (dead) vaccine injections and Sabin’s orallly taken, attenuated vaccine. The attenuated vaccine is better at preventing a natural infection, but in rare cases the vaccine virus can revert back to a wild form and result in iatrogenic (iatro = doctor and genique = to cause) polio, also called vaccine associated paralytic poliomyelitis (VAPP). Thankfully, widespread use of the Salk and Sabin vaccines in the 1950’s has made vaccination in the US (as of 2000) and UK (2004) unnecessary.

Many of the vaccines used today are engineered in a laboratory from just a portion of the organism. By using only the antigenic portion (that part that elicits an immune response) of the virus, there is no risk of iatrogenic disease. If the viral portion is produced in a laboratory using DNA technologies, it is called a recombinant vaccine. In some cases, the antigenicpart of the virus is weak on its own, so these subunit vaccines may be conjugated (joined to) some other molecule that will elicit a stronger immune response.

Unfortunately, there is a growing number of people ignoring history and putting are their children and the population at large at risk. Some parents’ reluctance to vaccinate is based on a single 1998 study in which vaccination was linked to autism, even though the author of the paper, Andrew Wakefield, has been convicted of scientific fraud and banned from the practice of medicine. Wakefield was an investor in a company that was going to offer medical testing for vaccine-associated autism and as well as assist in autism/vaccine lawsuits, so he falsified his data in an effort to make his company profitable.  

As a result of the vaccine scare, the UK has seen a rise in the number of measles, mumps, and rubella cases in the last decade. These are diseases associated with childhood, but can cause severe disease or death in many victims, especially adults.

Pertussis, also called whooping cough, is transmitted only
from person to person. If no around you has it, you can’t
get it. However, symptoms may not show for 6 weeks after
infection, so everyone should be vaccinated. The coughing
can be so violent that it breaks blood vessels around the
eyes and nose – and it can kill young children.

Manyin the US are also selecting to apply for vaccination exemption due to medical, religious, or personal beliefs; therefore, disease incidence is rising in America as well. In July, 2012, the CDC reported that the US had 18,000 cases of pertussis (whooping cough) in the past year, including an epidemic of more than 2500 cases in Washington state from January to June. This points out the need for vigilance in monitoring, as some of these patients had been vaccinated. This suggests that that the protection may not be lifelong; a booster vaccination may be necessary, although it is also telling that Washington state has one of the highest vaccination exemption rates in the country.

Next week we will look at vaccine driven immune responses in a bit more depth, in an effort to understand why we have to get a flu vaccination every year.

Centers for Disease Control and Prevention (CDC) (2012). Pertussis epidemic - washington, 2012. MMWR. Morbidity and mortality weekly report, 61, 517-22 PMID: 22810264

For more information on these subjects, or classroom activities, see:

Sick/diseased/ill:

Single nucleotide polymorphisms and pharmacogenomics:

Vaccines:

Lack of vaccination:
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