Author: janehw

Monoclonal antibody- Belimumab

Belimumab (brand name: Benlysta) is a drug that uses monoclonal antibodies to treat patients with systemic lupus erythematosus (SLE).  Monoclonal antibodies use hybridomas, a fusion of B cells and myeloma cells. This hybrid can produce antibodies like B cells and also divide indefinitely like myeloma cancer cells so it’s like taking the best of both worlds. They are called “monoclonal” because the antibodies come from clones of one parent cell. Belimumab helps patients with SLE by creating antibodies that block the B-cell lymphocyte stimulator (BLyS) protein; blocking the protein decreases the number of B-cells.

Side-effects of the drug

Why decrease the number of B-cells? SLE is an autoimmune disease where the patient’s B-cells produce antibodies that attack healthy tissue. Symptoms of SLE include sun sensitivity, swelling, and a butterfly-shaped rash around the cheeks and nose. Most people with lupus can have a normal lifespan because the availability of treatments like Belimumab. But, Belimumab has complications of its own. The most common side-effects of Belimumab include: nausea, diarrhea, vomiting, stomach pain, fever, runny nose, cough, insomnia, limb pain, migraine, and sore throat. Some of these symptoms slightly overlap with those of SLE like joint pain. The additional side-effects include: swelling of the face, lips, tongue, mouth, throat, or skin, difficulty breathing, low blood pressure, dizziness, fainting, rash, and redness. All the possible inconveniences the drug may bring can be worth it though because without the drug, people with lupus can die from complications with the heart or kidney.

Regulatory submissions in 2020

The drug impacts the acquired response negatively by reducing the number of B-cells. Since the drug decreases the number of B-cells available, patients cannot receive live vaccines in fear of getting infected. In addition to infections, the drug increases the risk of certain cancers. Some patients taking Belimumab have reported signs of depression and suicide. With all these possible side-effects, does Belimumab really improve life for lupus patients? According to a BLISS-LN study, yes. The study showed a response rate of 43% and statistical significance compared to a placebo- taking Belimumab can improve the life of patients suffering from SLE despite the risk of other symptoms. Belimumab is on track for regulatory submission.

Corona Test Kits

Lab-based testing supplies run low as the Covid-19 pandemic grows- patients can use simple test kits as an alternative. The test detects viral-specific antibodies: IgM and IgG. The test shows whether the patient is positive for IgM, IgG, or both. Having only IgM antibody titers indicates the infection is recent and active; IgM is part of the primary response. The presence of both IgM and IgG titers means that the patient is likely to be in the middle of the infection. The last stage of the infection is shown by the primary presence of an IgG antibody titer – people in this stage are not infectious. If a patient can be primarily IgG positive, there is a possibility of long-term immunity to Covid-19.

Problems with this Test

Problems with this test is the pace of the human antibody response to Covid-19. Due to the slow response, antibodies for this virus may not be detectable until 3 days after the onset of symptoms. This makes it difficult to detect the virus during the asymptomatic stages; 20-80% of Covid-19 cases are asymptomatic. There is no perfect method to control the spread of corona large-scale testing can help identify carriers and isolating them. Of course, overall social distancing helps too.

Neutralizing Antibodies

Other than prevention, scientists are working on a treatment for corona patients. Wu and his colleagues observed a group of people in Shanghai who recovered from Covid-19. Out of the 175 individuals studied, 165 of them produced “neutralizing antibodies”. These antibodies “neutralized” the infectivity of the virus. These antibodies are usually produced 10-14 days after illness. The plasma of people with these neutralizing antibodies can be used to create a serum to help other patients. Hopefully, a way to prevent transmission of the virus will be developed soon too.

Dendritic cell therapy

Dendritic cell therapy is cancer treatment tailored to the patient’s own immune system. It takes advantage of the dendritic cell’s ability to present tumor-associated antigens (TAAs) and initiate the immune system. In addition to the TAAs, dendritic cells control inflammation by regulating cytokine and chemokine gradients. With dendritic cell therapy, instead of repeatedly injecting the patient with these cells, the goal is to activate the ones already in the tumor. Currently, the only FDA approved dendritic cell therapy is Sipuleucel-T (Provenge).

Prostate Cancer

Provenge targets prostatic acid phosphatase (PAP) to treat slow-growing prostate cancer. “Slow-growing” is important to set up this kind of treatment. Prostate cancer is a common form of cancer for men in the U.S.; the estimate of new cases this year is around 190,000. Along with the high number of cases, there is a high mortality rate- 1 in 41 American men will die of prostate cancer. Finding the right treatment becomes a higher priority for such a prominent disease, but is Provenge effective?

Provenge

NCBI states that it indeed is, citing a study where the drug was compared to a placebo- the study showed a statistically significant increase in overall survival, showing that Provenge is effective. However, there are other downsides to this drug: the cost and side effects. This treatment is very expensive, the full treatment costing around $93,000 (this price varies per manufacturer). The side effects include chills, fever, and headache, but nothing that can’t be endured to avoid death. More studies need to be done to combine Provenge with maybe not painkillers but rather other immunotherapies to optimize its potential.

Forget school…

Ever since the corona virus hit, I have been, obviously, stuck at home. Which is great and all since I get to see my dog and my family, but I get nothing done when I’m back at my parent’s house. Well, nothing in terms of school work; the amount of Netflix and Tik Tok I’ve managed to watch is actually quite amazing. Since my productivity levels are low, my life has been consumed with videos and Animal Crossing- multi-tasking the two of course. I’m not satisfied with the way I’m spending time but I have no motivation to do otherwise.

Is this the real world? posted by reddit user u/starstufft

Watch me throw it back

Strangely, I do feel the urge to learn every new TikTok dance/trend that I scroll past. I’m no Tiktoker- I don’t bite my lips nor stick out my tongue is some weird seductive manner- but I think I can hit a half decent “woah”. TikTok is a social media app owned by a Chinese internet company called ByteDance and has a value of $75 billion. This makes sense since I run into ads pretty often in the app. It still feels a little bit cringey to be a 20-year-old using TikTok but I promise I’m not making any videos… or at least not posting them.

Good morning, bakers!

Aside from TikTok, another video platform I indulge in is Netflix. I can spend all day watching The Great British Baking Show and still get surprised by how dumb some bakers can be. Like Nadia, how the heck are you going to start another puff pastry from scratch when you only have an hour of time left. I can’t bake, but I like to imagine that if I was in the show, I would definitely know to put sesame seeds on the outside of the bread and not the inside. Other than the face-slapping moments, The Great British Baking Show is so wholesome and a great distraction from the mess the world is in.

Cure to HIV

In good news, in the midst of the coronavirus crisis, there is a 2^nd person likely cured from HIV. The 1^st patient was dubbed the “Berlin Patient” and the 2^nd the “London Patient.” Both these patients were cured because they the blood stem cells they received through transplants carried a rare copy of a gene that provides resistance to HIV. Of course this method alone is not viable. This gene is very rare as in only 1% of donors carry this gene. Also, patients who require such a transplant rarely qualify and are usually too sick to survive such a procedure. But this discovery does open doors for a possible cure- scientists are looking to genetically engineer resistance to HIV into blood cells. Finding a cure can help reduce the reliance on chemotherapy which can be taxing both economically and health-wise.

Prevention

But the best way to stop HIV is to prevent the transmission of it. Prevention used to come in the form of the “ABC’s”: abstinence, be faithful, and condoms. The “ABC’s,” however, failed to address social, economic, and cultural factors that play into the transmission of HIV. Telling kids to just abstain doesn’t work anymore, especially in the hookup culture of America. There is also a lack of funding for HIV prevention. Without proper prevention, new HIV infections will continue to appear.

Combination prevention

A new prevention strategy called the combination prevention replaces the “ABCs” and takes these factors into consideration. The combination prevention also has 3 categories, but these categories are more extensive- this holistic approach includes biomedical interventions, structural interventions, and behavioral interventions. Biomedical intervention reduces transmission by testing individuals after medical procedures such as a circumcision. Structural intervention addresses the factors and attempts to remove the stigma surrounding HIV prevention. Easy access to condoms can help economically and help make it more acceptable in societies. Sex education is also a big part of structural intervention as it involved changing the viewpoint on sex. Behavioral intervention uses education to reduce “risky behaviors” such as having many sexual partners or not using condoms. The combination prevention would do a lot more than blindly pushing abstinence, but again, there is a lack of funding for HIV prevention.

What are superbugs?

A superbug is an organism that developed resistance to antibiotics. An obvious problem with superbugs is that antibiotic don’t work, so it’s up to the individual’s own immune system to fend off the disease. Organism continue to develop resistance, including organisms like Bordetella pertussis and Mycoplasma genitalium. With more and more superbugs developing, there is the danger of losing the effectiveness of antibiotics. The CDC states that in the U.S., there are more than 2.8 million cases of superbug infections- the availability of working antibiotics is an imminent problem. Losing antibiotics is like going back in time to when even a minor wound can get infected and be life-threatening.

Superbugs in farm animals

We are about to lose to superbugs because of inappropriate use of antibiotics in farm animal production. Antibiotics are used to treat sick animals, control sickness in animals, and prevent sickness in other animals. In addition to its use in sickness, farmers use it for promoting growth and feed efficiency in animals. There is no regulation against such abuse of antibiotics. The label “antibiotic free” does not mean that the animal does not have any antibiotic-resistant organisms- the animal can carry superbugs in its guts. This is not a label approved by the USDA.

Drug-resistant Shigella in humans

Aside from farm animals, Humans can also carry gut superbugs. A drug-resistant strain of Shigella sonnei was reported in December 2019. This drug-resistant Shigella was found in 172 male and 12 female patients in Australia. Testing shows that this strain is resistant to all oral antibiotics. Shigella is mainly spread through sexual practices so please practice safe-sex.

Polio vaccines

Polio cannot be cured but through herd immunity, the spread of the virus can be prevented. There are 2 versions of the polio vaccination: an inactivated virus (IPV) and an attenuated virus (OPV). IPV can contain the disease better than OPV because OPV is made of attenuated strain of the virus which can exit the patient and continue to spread. However, IPVs take multiple doses to provide protection; not everyone is willing to take a series of vaccinations because of the time and effort it takes. Instead, OPVs are used throughout the world. By vaccinating children, polio can be eradicated from the world.

WPV1

The WPV3 strain of polio was eradicated globally just last year on October 24. WPV2 was eradicated globally in 2015. However, one strain of the polio, WPV1, continues to spread in Afghanistan and Pakistan. The efforts to eradicate polio are completely undermined by anti-vaccination movements. The eradication of the other two strains show that the polio disease can be eradicated; it’s a shame that people go against this fact, fighting against what would help the world.

Polio in Pakistan

The anti-polio movements are present in Pakistan, one of the places where WPV1 is still present. Antonio Guterres initiated a campaign in Pakistan to eradicate polio. A third of the children in Pakistan miss vaccinations because of inconvenience or misconception about vaccines- the campaign targets these children, aiming to vaccinate more than 39 million children. By vaccinating more children, herd immunity can protect the immunocompromised and the virus can be contained. It seems like a dream come true to end polio, but of course misinformation about vaccines are spread by anti-vaxxers, ruining the efforts to eradicate polio.

The Microbiome

Not all bacteria is bad – microbes, in fact, contribute to human physiology, taking a role in the human digestive and immune system. Gut microbiota aid in the former; they extract nutrients for humans from otherwise indigestible substrates. In addition to digestion, the NCBI highlights their role in protecting against irritable bowel disease, Clostridium difficile, and other diseases involved with the digestive system. But these microbes appear to affect more than human physical health; humans seem to have developed a dependence on these microbes, not just nutritionally, but also mentally.

Link to Depression

Two separate studies of Europeans found that the absence of certain gut microbes could be linked to depression, with an emphasis on the word “could” because there is not enough data to back up causality. The groups observed consisted a group of 1054 Belgians and another of 1064 Dutch people. The link between microbiota and mood was shown in several tests with mice, but a Belgian microbiologist called Jeroen Raes wanted to apply it to a larger group. The Belgian study observed the “normal” microbiome, but the study’s focus shifted to the abnormal. Out of the 1054 Belgians, 173 of them were either diagnosed with depression or had a poor quality of life. Comparing their microbiomes to the rest of the group, these Belgians were missing two microbes: Coprococcus and Dialister. The Dutch study also found the same two microbes missing from the participants diagnosed with depression.

More studies and treatments

Including the study of mice, there have been 3 independent studies that suggest a link between the absence of Coprococcus and Dialister and the presence of depression. Of course, it is still too early to claim anything final, but further studies can help solidify this connection. Raes suggests that this connection can lead to “novel therapies” including oral bacterial supplements and fecal transplant. Finding a link can change the way mental health patients are treated- promoting the growth of beneficial microbiota or replacing the lack of can possibly improve mental health.

Be aware/ Beware

It’s flu season. The flu may seem common – just last year, there was an estimate of 45 million cases of the flu – but the flu is still a dangerous and contagious disease. Contrary to the common cold, the symptoms of the influenza are more severe. But the severity of the disease also has to do with the risk of getting a secondary disease, specifically pneumonia. Vaccination is a great way to prevent the spread of the disease but also, for those already ill, stay at home and get some rest.

Vaccine effectiveness

CDC does not have a measure of the effectiveness of the flu vaccines for this season yet because it is only February, but the viruses circulating are similar to the viruses tested. Receiving the vaccine is important: it can prevent spread of the virus and protect people against the flu. Even if the vaccine does not include the circulating strain, the vaccine can help lessen the severity of the flu. According to CDC, taking the vaccine can help reduce the risk of the flu in the overall population by 40-60%; preventing the spread of the virus helps protect the people who cannot receive the vaccine. For example, people with severe egg allergies used to not be able to take some previous vaccines.

No eggs.

Previous vaccines were made using an egg-based manufacturing process. The flu vaccines could potentially cause an allergic reaction in people with egg allergies (this is more common in children than in adults). The flu vaccine can also be considered inappropriate for people who follow a vegan diet. However, this season offers vaccines that are not egg-based – the vaccine is instead grown in a cell culture. These cell-grown vaccine viruses may be more similar to the circulating viruses, but there is no data to support this so there is no preference between the egg- and cell-based vaccines.

The Experiment

In 1988, Andrew Wakefield and his colleagues published a report suggesting a causal link between the MMR vaccine and the development of autism in children. According to the GI Society, Wakefield’s cohorts consisted of 12 patients. The small sample size increases the margin of error, decreasing the precision of the results. But, these results were biased from the start. Wakefield failed to conduct a blind study to reduce bias: the 12 children were either specifically chosen by Wakefield or by the lawyer who funded him.

Money Bias

His motivation was another problem in this study- money seems to be the root of the problem with Wakefield’s journal. The study was funded by a lawyer who was funded by parents against vaccinations. Not only was Wakefield helping the lawyer with his anti-vaccine lawsuit, but he also worked with a parent of one of the patients to patent a new “safer” version of the measles vaccine. He even worked on multiple businesses to treat a syndrome he made up in the study. Despite the unreliability of Wakefield’s journal, many parents refused to vaccinate their children.

Anti-Vaxxers

The NCBI claims that in response to the publication of Wakefield’s study, scientists around the world made efforts to expose the fraud of the study. Nevertheless, the number of MMR vaccines received decreased, while the occurrence of measles increased; the nonvaccination of children caused the measles outbreak in the UK in 2008 and 2009. Parents chose to believe one study, but not the numerous other studies that refute its claims. By choosing not to vaccinate, anti-vaxxers put other children at risk. Herd immunity can only do so much without a large percentage of the population vaccinated- by avoiding the “risk of autism,” anti-vaxxers risk the health of their children and the rest of the population. The Wakefield study has been labeled as a scientific fraud, but its “results” continue to fuel the irrational fear of vaccines.