In this blog, I am going to discuss the monoclonal antibody adalimumab, or more commonly known as humira. There are several monoclonal antibodies that are used clinically today and they have a wide variety of uses. This characteristic is largely attributed to the fact that a monoclonal antibody utilizes the mechanics of the natural immune system, which plays a role in all healing processes in the body. Monoclonal antibodies are simply man-made antibodies that have a similar effect in the body as natural antibodies would. These antibodies are programmed with genetic material that specifically combat proteins in the body that attack healthy “self” tissue. These antibodies are produced from cloned immune cells. Like natural antigens, these artificial antibodies only bind to one antigen. This is where the “mono” part of the term “monoclonal antibodies” comes from. These have been extremely helpful in the diagnosing of diseases and the construction of vaccines and treatments for different diseases.

Humira is a monoclonal antibody that is effective against several different diseases including rheumatiod arthritis, psoriatic arthritis, ankylosing spondylitis, chron’s disease, and plaque psoriasis. The main function that this antibody performs is to inhibit the protein TNF alpha which play a role in the inflammatory process. The blocking of this protein results in the blocking of the inflammatory response. While inflammation is a needed part of the immune system, in diseases listed above inflammation causes pain, fever, and joint swelling. If inflammation continues it will cause damage to body tissues. Excess inflammation can lead to further damage the the initial infection was causing. Humira aids in controlling the inflammatory process and helps to prevent further tissue damage by binding to TNF alpha and inhibiting its action. With the reduction of inflammation, the reduction of its symptoms also follows. This allows the recipient to have lessened pain, swelling, and discomfort.

Like most drugs, there are several side effects to Humira:

• headache
• rash
• nausea
• stomach upset
• swelling, redness, pain or itching at site of injection
• hypersensitivity reactions
• reduced levels of platelets and red blood cells in the blood.

There are a few conditions that if a patient has these they should not be given Humira. These conditions include tuberculosis, sepsis, and fungal infections. If this drug is taken by a patient with a nervous system disease, the patient may see worsened symptoms and it is also associated with the development of cancer. However, the connection between Humira and cancer has not been fully researched or supported yet. Some patients have seen the reactivation of Hepatitis B after taking the drug as well. The reason why a patient should not take this drug if they have any of these conditions is because this drug is inhibiting the immune response, specifically the innate immune response of inflammation. As stated previously inflammation is a necessary part of the healing process, especially in the diseases listed above. Interference with the immune response to these diseases could lead to worsening of the disease that the patient already has and prevent the body from healing and fighting the infection.

I think that it is extremely important to become educated on the medicine a patient is given before they take it. There are so many things that I would not know without doing research that I would want to know.

Before doing any research on this topic, I used my own knowledge about antibodies to make predictions about what the tests results would mean in a medical setting. I know that when testing for antibodies, it cannot be determined whether the patient currently has the virus, but it can determine if the person has had the virus in the past. If the test is done and only the COVID-19 IgM antibody is found, I would predict that the patient could still be showing symptoms or their immune system quickly killed the infection. This is because IgM is the first antibody to be released after an antigen is detected and it has a shorter half life, so the presence of this antibody would mean that the body was recently fighting the Corona antigens. If both the COVID-19 IgM and IgG antibodies are present then the patient is later in their infection because the body has had time to release the second responding antibodies, IgG. If only the COVID-19 IgG antibody is present then the body has been fighting the infection for a while and the patient has probably recovered from the disease. IgM would not be present because if the infection is stopped, then they will not be released any longer and they will not be present in the blood because they have a shorter half life. IgG will be present because it has a longer half life so they will remain circulating in the blood longer then IgM. Finally, if no COVID-19 antibodies are present, the patient has not been infected. This is my predictions for what information the test will provide to the medical providers who are administering them.

One article discusses the importance of testing, when to test, and what each available test provides for the patient and provider. The only two tests that are being used currently are the RNA tests where a person is diagnosed positive or negative for the disease and the antibody testing where it can be determined whether a person has had the disease or not. The article states that a person will begin producing antibodies 7-11 days after initial exposure. Because of this, antibody testing is not very useful during the acute stage of disease when the patient is not showing symptoms. The main use for this type of testing is to determine whether a patient has been exposed to the disease in the past. Although the level of protection the formed antibodies provide after a patient has recovered has not yet been determined, there have been tests that have had promising results that people who have had the disease and recovered will have some protection. Whether it is partial or full protection is unknown. This test has played a role in testing to determine the level of protection provided by COVID-19 antibodies.

Another article describes an interesting use of this test where they researched how the virus moves from an infected pregnant mother to the child. The study observed six mothers who showed symptoms and tested positive for Corona virus. All of the mothers had cesarean births and their infants were immediately isolated from them. Blood samples were taken from the mother and the infants and the samples were tested COVID-19 antibodies. There were both COVID-19 IgM and IgG antibodies present in the infant and elevated levels of both in the mother. The infant showed no symptoms of the virus. I enjoyed reading this article because it seemed to add some component of positivity in a subject matter that is largely negative and scary. While it is sad that the mothers are suffering from the virus, their children were born healthy and may have further protection if they were to get that virus giving them a higher chance for survival

T cell therapy is a treatment that is intended to allow the body to detect harmful cells in the body and identify them for destruction by the immune system. This is achieved by genetically altering T cells into CAR T cells and growing them in large numbers outside of a human host. These are then injected into the patient. This therapy is used in cancer treatment and specifically in the articles discussed in this blog, leukemia, which is cancer of the blood. The CAR cells mimic T cells and send signals in the body that provoke a similar response. This method of treatment has shown an large response rate from patients and has proven to be very effective in destroying cancerous cells. However, this treatment is not completely effective in curing leukemia. One article discusses some of the drawbacks of the treatment. One of the main issues is that upon relapse of the disease, the CAR cells are no longer effective against the new cancer cells because the cancer cells do not present the correct antigen. This same study set out to find the best way to alter this therapy to make it more effective against a wider variety of antigens in antigen presenting cells. By the end of the study they managed to find a CAR T cell to be effective against a larger variety of antigens while also being as least toxic as possible to the patient.

Another study examines many other issues presenting this type of therapy. One of those issues is making the CAR T cells specific enough to only target cancerous cells while also making them general enough to target a wide variety of cancerous cells. The article does emphasize that this therapy is a breakthrough in cancer treatment and has improved the life expectancy and the survival rate for those with leukemia. Down regulation to the CAR T cells is also a concern. Down regulation is when a receptor becomes less sensitive to a substance that binds to it because there is so much of that substance there. A natural example of this in the human body is a negative feedback loop. When enough of a neurotransmitter or hormone binds to a receptor the production of that substance is ceased. With my understanding of the article (which could be wrong) when this occurs during T cell therapy the body will stop supporting and sending the CAR T cells to the cancerous cells, which stops the killing of the cells before all the antigen presenting cells can be destroyed, and therefore causing the cancer to return.

While this therapy has a large success rate in the killing of cancerous cells there are still some problems facing patients who choose to go through this therapy. The major on is that the therapy can cause other diseases and side effects because it leaves the patient immunocompromised. One disease caused by this therapy is cytokine release syndrome which causes flu-like symptoms. This being said, I think that this an amazing break through in cancer treatment. I think it is amazing to use this as an alternative to chemotherapy because T cell therapy uses natural responses in the body to kill mostly harmful cells while chemotherapy kills both harmful and healthy cells in the body. I like this treatment because it feels more natural to the body rather than invading the body with harmful rays and substances. T cells are very familiar to the body and even though it can cause side effects for the patient that are uncomfortable, it is better than some of the side effects for chemotherapy. Overall, I am hopeful for this method of treatment for cancer and I hope of see advances into different types of cancer.

Corona virus truly has me shook to say the least. Before Spring break I had no idea how big of a deal the virus was. It seemed so far away and even the school sending out an email about travel restrictions and self quarantine, I thought was going to be the end of it. I never expected that the entire semester would become online and I would be forced to move home away from my life in Chapel Hill. Events like this are something that you hear about in the news occurring in some distant country or read about in a history book. I never imagined that something like this would reach my world. It feels like the situation in America keeps becoming more severe as more and more restriction are being put in place. I had never thought that toilet paper would become such a luxury. One thing that is pretty cool about this hard time is that the whole world is going through it together, which rarely ever happens. It almost feels good to be united under one big problem that effects all of us and that we are all working to solve.

When I first realized that I was not going to be at school for the rest of the year and I was going to move back to Charlotte, I was devastated. My whole life is in Chapel Hill and I absolutely love it there. I miss my friends, I miss the campus, having freedom, having a schedule. I was worried what the lack of structure and obligation was going to do to my mental health. I find that staying busy and having a balanced routine keeps me happy and mentally healthy. I was and am worried that the lack of social interaction and structure in my day will increase my anxiety and decrease my productivity. Along with being disappointed about all the memories I wouldn’t get to make at school, my summer plans have also all been cancelled. I was going to go backpacking through Spain for a month and then go live in Nicaragua for the rest of the summer working as a translator at a medical clinic, but both of these incredible opportunities and experiences have been cancelled. At times I feel i am grieving the loss of these experiences.

I personally do not feel afraid to contract the virus myself because I know I am likely to survive from it. However, my mom and dad both have conditions that make them immunocompromised especially in the respiratory system. This makes me more afraid to contract the disease because I am living with them and if I contract it then they also will most likely get it and there is a much lower chance of them surviving the virus. While there are many things that are hard about this time, I have really been trying to look at the positives. While this has been a time of stress with so many changes happening, it has also somehow been a time of rest for me personally. As a Chapel Hill student, my life is always very “go, go, go” and I usually do not have extended periods of time that I have nothing planned. I love living that lifestyle but this time at home without much to do has made me feel more well rested than I have in a while. I have been able to take the time to do things that I enjoy that usually would not get to do normally like cook, paint, do a puzzle, etc. I have decided that I want to use this time to be productive and work on myself. There are a few things that I struggle with that I tend to push to the side because I do not have time to focus on them. In the midst of this crazy and hard time, I am thankful for this opportunity to work on me.

Gonorrhea is a sexually transmitted infection that has no current vaccine. It is easily spread because it is usually asymptomatic, especially in women. However, with the right treatment it can be cured. The amount of cases of gonorrhea is rising quickly in various countries and with the exponentially increasing amounts of antibiotic resistance, treatment is becoming more difficult. One study sought to find a new method for the prevention of the spread of the disease through means of a vaccine. There are several possibly options for new vaccines, but the effectiveness and the length of time that each of these vaccines last has yet to be determined. Through controlled experimentation, this study was able to determine that one of the vaccines was effective in reducing the incidence of gonorrhea by 90%. This vaccine provides protection from this STD for over six years so it does not provide immunity for a lifetime, but can protect if vaccines are given regularly.

While the previous study discusses the growth in the incidence of gonorrhea, another study hypothesizes that this increase in diagnoses of gonorrhea could be caused by in increase in testing for the disease. This study investigated specifically incidence of testing among men. They found that there was in increase in diagnosis of the infection in men who had more than one screening done in 2010, however in 2017 there was a lesser difference in diagnosis between men who had only one test in comparison with those who had more than one test. There was also a large increase, however, in tests being given in 2017 in comparison with 2010. This increase in the administration of tests could be caused by an increase in reporting of the disease because of an increases awareness of STDs. Another possible cause could be that medical providers are screening more patients multiple times for be sure of their condition. The results of the study attribute the rise in incidence of gonorrhea to both an increase in the prevalence of the disease in a community and an increase in the administration of tests for the infection.

I have not had any kind of first hand or second hand experience with this disease before, however, in regard to the first study mentioned, I think a vaccine could be a huge step in the prevention of the spread of the disease as it would contribute to herd immunity. I think that with regard to a bacterial infection such as gonorrhea, a vaccine is the best focus for further research for many reasons. It would protect people from getting the disease in the first place but more importantly it would slow down antibiotic resistance in the population. Antibiotic resistance, in my opinion is an extremely important issue that should be a focus for the health care community, making sure to only prescribe antibiotics when they are needed. As for the second study, i think it is important to test for an infection several times in order to ensure that antibiotics are being given to patients who definitely need them.

Antibiotic resistance is a global crisis that is of great concern today because if it continues, antibiotics will be essentially ineffective in the coming years leaving the world with no treatment for bacterial infections. This crisis has largely been caused medical providers prescribing antibiotics for infections that they should not have killing off all of the normal microbiota and leaving the resistant bacteria to replicate further. Personally, I have even fallen into this line of ignorant thinking as a patient because I had not been educated on the purpose of antibiotics. I would imagine that most patients that seek medication are unaware of the science behind antibiotics and the microbiome which is why they insist on being prescribed an antibiotic. I think that a good way to get started on slowing down the progressing of this crisis in order to give science the time to find a stop to it would be to educate the public in simple ways. The detailed science behind bacteria and antibiotics is no necessary for informing the public, but teaching basic ideas would be extremely helpful in my opinion. For example, how antibiotics only work on bacterial infections and without testing it is hard to tell if the infection is bacterial or viral, or stressing the importance of not missing a dose of antibiotic. If I had been taught simple things like that earlier, I probably would not have been so quick to ask for medication.

While education is a good method to slow down the crisis, scientists are considering a few new methods to prevent total antibiotic resistance. One method that is currently being used is the combination of antibiotics so lessen the likelihood of the bacteria developing resistance. However, while this may slow resistance down, it is not totally effective in preventing it. One article provides details about how the combination of drugs can select for bacteria with tolerance genes. The study found that these tolerance genes also lead to resistance genes. Through experimentation, results showed that tolerance promotes resistance in a new way. Experiments with different antibiotics and strains of bacteria revealed that this is a general finding and can occur with any type of antibiotic or bacteria. The article concluded that an important factor to consider when combining antibiotics is tolerance.

Another study is researching the possibility of using integrons as a means of finding new scientific discoveries. Integrons allow for the reassortment of genes within a bacterial chromosome. In the past, this has been a possible contributor to antibiotic resistance, but with the use of biotecnology scientists are trying to rearrange the DNA to facilitate new enzyme discovery and possible new biochemical pathways. Because this is an on going study, the use of these new enzymes has not been established yet, but there is a wide range of possibilities with the manipulation of integrons. One of the main tested uses of integrons is that they provide a path for molecular cloning that does not require a vector or antibiotic selection. This occurs through the integrating of natural genes into a cell chromosome that an existing integron acquires. While this article did not detail if this could be used to prevent antibacterial resistance, it does use integrons which were originally the cause of the issue and have found new possibilities to make new scientific discoveries.

OPV and IPV are two types of vaccination for polio virus. OPV is given orally and is a live attenuated virus, while IPV can be given along side OPV in order to strengthen the immune response. It is a series of shots injected into the skeletal muscle. IPV is a form of inactivated polio virus. A study conducted in December 2019 examined the effectiveness of OPV alongside IPV versus each individual vaccine’s effectiveness alone. There was not substantial evidence to support that OPV with IPV was better for the prevention of WPV, however there is evidence to support the coupled vaccines have a greater effect in preventing VAPP. VAPP has been associated with the OPV vaccine, so this finding is important because it provides a way to be both vaccinated for polio while also not being at risk for VAPP. This seems to be the only visible effect of pairing the two vaccines together.

Polio has been a disease that the world has been trying to eradicate for a long time and they have almost succeeded. However, in 2019 the vaccine for polio had been linked to causing a different type of polio that caused paralysis (VAPP). This lead to an outbreak of this new form of polio that needed to be fixed with a different vaccine. This new version is called the IPV vaccine and should be given along side the original vaccine. One article points out that while this new vaccine will solve the long term problem, the short term outbreak still needs to be halted. Along with this observation, the author also points out that while there are effective vaccinations for polio, there are many countries, specifically in the middle east, that are not doing an adequate job of immunizing the children in their countries. A lack of herd immunity, as for any disease, puts more people at risk and greatly slows down the process of eradicating polio.

In my opinion, I think it is important that everyone receives this vaccination and that the vaccination itself is made widely available to anyone who will receive it. Herd immunity is so important for the safety of those who may not be able to receive the vaccination. One of my good friends has a condition where she cannot receive the MMRV vaccine and is therefore at a great risk of acquiring these diseases, however, because a large portion of people receive this vaccination at a young age, she has not contracted any of these diseases in her life time. Because of her condition, if she were to contract any of those diseases, it would be a lot more serious for her. Because I can see the benefit that herd immunity has for her, I know it is important to have worldwide for as many diseases as possible. Because polio is almost gone from the world, I think it is important to emphasize the importance of vaccination in those countries where it is more present.

There are many theories on how the microbiome enhances or effects the body. In one article, discussing whether allergies and autoimmune diseases were caused by the hygiene hypothesis or by something different. The study found that it was not a lack of healthy microbiota, but the effects that short-chain fatty acids were having on the body, which are things produced by the body’s microbiome. These bacterial metabolites have varying effects and impacts on the body including large effects on areas on the immune system including its homeostasis, its T cell production, and inflammation regulation. Metabolites from bacteria activate immune receptors that initiate inflammatory responses throughout the body. These metabolites are beneficial to the body because it prepares the body for any foreign bacteria that may come later. This study claims to have found that a diet that is lacking in variety and nutrients can lessen the gut microbiome, leading to allergies and autoimmune diseases because it limits the growth of healthy metabolites. This specifically could be the cause of disorders where inflammation activity is not normal and can cause problems. They hypothesize that some autoimmune diseases could be prevented with a change to a healthier diet.

In addition to autoimmune disorders, another study conducted research on how the microbiome effects depression. The findings were that inflammation in the brain caused my bacterial metabolites do have an effect on depression and its severity. Unregulated stress, immunity, and the microbiome are the biggest risk factors for depression based on the findings of this study. The three often work together and have interdependent effects. The way in which these three things interact can either create homeostasis in the brain or create an imbalance that leads to a greater risk for depression. The study focused on compiling research that had already been done and studying many different cases. The interaction is still not totally understood but there is supporting data that suggests that gut microbiota have an impact on the likeliness of depression occurring in an individual. This study shows another example of the importance of bacteria in the body.

Before I did any research on this topic and before I took Microbiology, my understanding of the microbiome was very limited. Mostly, I thought that all bacteria is bad and that I should never touch anything and without washing my hands after. While this is true in the sense that the best way to avoid bad bacteria is to wash your hands, I think it is important for everyone to understand all the benefits that bacteria can have and how it has the possibility of harming our body, but more often than not, it benefits and helps the body. With specific regard to the depression study, I have had personal experience with how one’s diet can effect one’s mental health. My brother struggles with depression and with overeating. His depression has always been at its worst when his eating is out of control and all he is eating is fast food and sugar. Currently, he has gotten a life coach/personal trainer that has completely changed his eating plan. He has been on this eating plan that allows him to eat a variety of foods with lots of different nutrients and I have not seen him feeling so good as he has being on the new eating plan. I have no data, or scientific evidence to support that this is caused by the new eating plan but I have noticed a great change in his attitude and demeanor.

In an article published in 2020 relays the story of a family who contracted the infection together and how they spread it around to those near to them. This article provides a more personal story of the impact that the corona virus is having on families in China. The father of the family, who was immunocompromised from the start with various common diseases including diabetes, high blood pressure, and heart disease, came down with the corona virus. Before his symptoms began to show, he spent three days with his wife and son in a single hotel room. Because of the air conditioning and the close quarters that they were living in, the man’s son began to show symptoms of the disease shortly after his time in the hotel. The hospitals immediately gathered information on who else may have been in close contact to the family, however no new cases have come up in connection to the family. This study shows that the incubation period was three days or less in this particular case and that the disease is shared through extremely close proximity and shared air.

While the story provides a closer case study, there is still a lot about the disease that is unknown. Another study examined the first few hundred cases of the disease in order to conclude some important epidemiological characteristics of the corona virus in China. The study supported the theory that the disease was transmitted through human-human contact. There should be strong methods used in order to prevent further spread of the disease to the population and precautions taken in other countries where there is a possibility of an outbreak. This study also noted that a large portion of the cases were children or adults over the age of sixty, supporting the hypothesis that it has a stronger effect on the weaker members of society. In regards to the incubation period, in contrast to the case study in the previous paragraph, this study found that the incubation period for the corona virus is up to fourteen days which can be extremely problematic when trying to contain a disease.

Personally, this epidemic in concerning to be largely because of its ability to spread quickly with human to human contact and silently with its two week incubation period. While the disease has had a small effect on america so far, it is important to understand how to prevent the disease from beginning an outbreak if it were to find its way into the states. like Dr. Kramer always says, with this particular disease especially, washing your hands and not touching your face are the best ways to prevent spread and contraction of the corona virus. I hope that in China and in other affected countries have a plan in place and in action for stopping the spread of the virus so that the disease can be isolated and prevented from spreading to other people.

The influenza virus is an single stranded, RNA, enveloped virus that is responsible for seasonal epidemics in america. In the 2019-2020 flu season there has been a higher number of reported flu cases in America. There is a concentration of cases in the south and in the west. More specifically, a larger number of the cases have been caused by type B rather than type A, which is a generally good thing considering type A is the more serious infection and a higher number of type A cases would be a greater cause for concern. The symptoms of the influenza virus are typically similar among all age groups with the exception of nausea in younger children that is not seen in adults. the virus causes significant morbidity each year, however most people who die from the disease are immunocompromised, or who did not receive the vaccine.

Because quality scientific resources should be peer reviewed and published it was difficult for me to find an article on the effectiveness of the flu vaccine for this year, as we are still in the middle of the flu epidemic, and analysis of its effectiveness will take some time. However, I found an article written about the influence of the media on whether people received the vaccine this year and how it effected their overall perception of vaccination. Receiving the vaccine does not guarantee that one will no contract the flu, however, it aids the immune system in fighting off the infection more effectively and could save one from dying due the the virus. The study that the article discusses shows that 86.3% of adults felt that the vaccine was safe and 73% felt that it was effective. These are hopeful statistics, but the younger adult population when surveyed had stronger negative opinions towards vaccinations.

In my opinion, it is important to inform the younger population of the safety and importance of vaccination so that herd immunity may continue into the following generations. The best way to go about doing this is to get accurate information about vaccines onto platforms that the younger generation uses and identifies with, like social media or having a celebrity spokes person that could speak to the benefits of vaccination and ease the public’s mind about the dangers. While this public figure may not be the most scientifically reliable, they tend to have a much stronger influence over the larger younger population than an article in a scientific journal. This approach has been effective on other issues in the past. In reference to the effectiveness of this years vaccine, i am going to hypothesize that because there was a higher number of cases of the flu this year, that the vaccine may not have been as effective as in years past, especially against type 2 strains of the flu.