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The drug Stelara is a FDA monoclonal antibody that is used to primarily treat Crohn’s disease, ulcerative colitis, psoriasis, and psoriatic arthritis (1). Monoclonal antibodies are made by identical immune calls that are all clones of a unique parent cell (3). These will bind to the same part of an antigen as its parent cell to elicit inhibitory actions against the infectious organism.

Stelara works via injections that suppresses the immune response chemicals (IL-12 & IL-23) that cause damaging inflammation. Stelara will not cure the disease it is used to treat, but only produce less symptoms in affected individuals (the reduced inflammation). Stelara effects the innate and acquired immune system by inhibiting IL-23 and IL-12. IL-23 and IL-12 are produced by some antigen presenting cells. IL-23 facilitates the transition of naive T helper cells into Th17 which will secrete several inflammatory cytokines such as IL-17 and IL-22 (4). IL-12 promotes the differentiation of Th1, this will secrete interferon gamma and TNF (tumor necrosis factor)(4). These responses are essential to the inflammatory response, during these chronic diseases inflammation becomes a problem because the immune system goes into over drive and the system doesn’t shut off.

Overall Side effects of Stelara

• malignancy
• Reversible posterior leukoencephalopathy syndrome (one case reported)
• Infections from the following vaccines
  • mycobacterium
  • salmonella
  • bacillus calmette-guerin

Patients with psoriasis:

• Nasopharyngitis
• Upper respiratory tract infection
• Headache
• fatigue
• diarrhea
• back pain
• dizziness
• pharyngolaryngeal pain
• pruritus
• injection site erythema
• myalgia
• depression

Patients with psoriatic arthritis:

• Arthralgia,
• nausea
• dental infections

Patients with Crohn’s disease

• nasopharyngitis
• injection site erythema
• vulvovaginal candidiasis/mycotic infection
• bronchitis
• pruritus
• urinary tract infection
• sinusitis
• vomiting

Due to the increased risk of developing a serious infection from many kinds of bacterium, patients considering Stelara should be screened for a latent TB infection if TB status is unknown. Patients with TB are not recommended to take Stelara as their immune system is already too compromised to out weigh the risks.

References

1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/761044lbl.pdf
2. https://www.stelarainfo.com/
3. https://en.wikipedia.org/wiki/Monoclonal_antibody
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158482/

Click to access 761044lbl.pdf

Our immune system is the top notch defense against bacteria and viruses trying to invade our bodies everyday. We have so many cells within our immune system all with different roles but all equally as important. Dendritic cells are part of the first line defense, when PRRs are activated the dendritic cells become professional antigen presenting cell. They move into the lymphatic system and show the T- cells the corresponding pathogen, activating the T-cells. T cells then proceed to either kill infected cells or to induce B-cell activation.

Researchers and scientists have taken advantage of this system and have modified it for immunotherapy against many cancers. In one example, CAR- Tcell therapy is when a sample of a patient’s T cells are collected from the blood, then modified to produce special structures called chimeric antigen receptors (CARs) on their surface. When these CAR T cells are reintroduced into the patient, the new receptors enable them to latch onto a specific antigen on the patient’s tumor cells and kill them (Cellular Therapies Program). Recently new therapy methods have emerged in the article Engineering dendritic cell vaccines to improve cancer immunotherapy they are working to provide a blueprint for the rational design of optimized dendritic cell vaccines for personalized cancer medicine. Also, in another article Dendritic Cells Loaded with Heat Shock-Conditioned Ovarian Epithelial Carcinoma Cell Lysates Elicit T Cell-Dependent Antitumor Immune Responses In Vitro they are targeting ovarian tumors with a similar dendritic cell vaccine.

Ovarian carcinoma is a very aggressive tumor and so many new immunotherapies have been considered as a combination therapy alongside traditional methods like chemo and radiation. It has been demonstrated that effector T cells move into the tumor site, the prognosis and survival is much better. the article says that in their laboratory they have developed an autologous DC-based immunotherapy directed against advanced malignant melanoma, called TAPCells (tumor antigen-presenting cells), which consist in ex vivo-generated monocyte-derived DC, loaded with an allogeneic heat shocked melanoma lysate that is able to activate the immune system and induce a specific antitumor response in cancer patients. They are seeing promising results and very little side effects. The cost of dendritic cell vaccine preparation was € 20,450 per patient making it quite expensive for the average person.

As a senior having to give up pretty much every senior tradition AND graduation, needless to say, I am pretty damn bummed about it. I feel even worse for the senior athletes, senior club members, senior researchers etc. because they are giving up so much more than traditions and graduation. Trying to adapt to virtual learning has been pretty painless but kind of irritating. As a senior, my learning style is pretty much full developed and let me tell you online learning is not my preference. There is just something about having a routine and structure in your learning environment that permits optimal learning (at least for myself). I am a little worried that without the structure and the distraction of being home will affect my learning but I am trying to overcome this fear by taking it one day at a time.

On another note, something else that this virus is effecting is my wedding on May 24th! Me and my fiance have been together for over 7 years and have been engaged for almost 3. So we have been planning this wedding for a long time and it now, less than 2 months away we have no idea what the global situation will be like. ALSO the register of deeds in every county pretty much has closed to the public so I have no idea if we will be able even to obtain our marriage license!!! HOW STRESSFUL! We do have a plan B set in place to have a small ceremony and then a postpone our large reception for our one year vow renewal.

During this mess right now my biggest fear or anxiety is caused by the unknown. We don’t when what or how anything is going to happen and I think that is very unsettling, especially for a graduating senior stepping out into the world. To cope I am of course binging on movies and TV shows, cuddling with my cute dog sue and trying to get outdoors for walks as much as possible with my fiance. While everything seems uncertain I know that everything will go back to normal eventually.

Penicillin was discovered by Fleming in the 1920s and used on patients 20 years later and completely revolutionized patient care (MedicalNewsToday). Antibiotics are miracle drugs allowing patients to survive from what could have been potentially lethal. Now less than a century later our world could be facing a life, again, without the use of antibiotics due to- intense global antibiotic resistance. Why? How? Can we stop it?

Antibiotic resistance is due to an evolutionary arms race between us and bacteria but we are to blame for how quickly this has emerged. Unfortunately antibiotics have been misused for decades (MedicalNewsToday). Doctors have been overprescribing, prescribing for illnesses not caused by bacteria, and patients have not been taking the antibiotics responsibly. All of these misuses have lead to an unfortunate reality that we are now having to deal with. In the article The rise of superbugs: Facing the antibiotic resistance crisis states that more than 2.8 million people in the US experience an infection from antibiotic resistant bacteria each year. What makes matters worse is that we are not just facing bacteria that are resistant to one antibiotic but rather multiple, these are Superbugs. For example bacteria from the enterobacteriaceae family, antibiotic-resistant gonorrhea and clostridioides difficile are being referred to as Nightmare bacteria in the article The ‘post-antibiotic era’ is here: Drug-resistant superbugs sicken 2.8M and kill 35K each year. The bacteria’s conjugative abilities of moving their R-plasmids (plasmids which contain multiple resistant genes that can be transferred from one bacteria to another.)

The future of antibiotic use looks a little more careful as we are now understanding the harmful effects of misuse and overuse. So how do we confront this? of course the development of new drugs is the obvious answer to this question, but resistance to any drug is inevitable- that is just how evolution and biology works!(MedicalNewsToday). So the answer to avoiding resistance lies outside of making new antibiotics and pushing for more research in preventative measure like vaccines or combating the infections with bacteriophages and antibodies (MedicalNewsToday). I think with acceptance of vaccines worldwide we could make a huge difference. I am also excited and interested about fighting bacterial infections with viral bacteriophages but of course we would have to figure out how to manipulate the interaction between the virus and the bacteria to make sure the therapeutic window stays high. The present situation with antibiotic resistance is scary and uneasy to anyone who is educated, but with uneasiness brings change and innovation, and so I am hopeful for the future.

The first polio vaccine was created in the 1950s known as the inactivated polio vaccine. This had to be administered via injection (Britannica, 2017) . Then in the 60s the second kind of vaccine was developed, the Oral Polio vaccine, a weakened live virus that can be given orally (Britannica, 2017). This made the vaccine much more available worldwide. These two vaccines along with other global interventions have changed the story about polio.

Polio is a life threatening disease causing paralysis, but with the emergence of a polio vaccine the number of cases related to the wild polio virus has shown a significant drop. In the article Sequential inactivated (IPV) and live oral (OPV) poliovirus vaccines for preventing poliomyelitis, they indicate the increasing number of paralysis from one of the two types of vaccine, the Oral Polio Vaccine. The problem being that it is a weakened live virus unlike the Inactive Polio Vaccine. Though with the understanding that the OPV and the IPV have their benefits and such they conducted an experiment to review the efficacy of giving the IPV and the OPV together. From their data and results I believe that it could be beneficial in decreasing the number of OPV related paralysis. I am curious if we could move to make an oral version of the IPV to make it more easily available to everyone around the world.

According to The U.S. Government and Global Polio Efforts Polio has been infecting the world since ancient times, but in 2018, due to the vaccine efforts, there were only 33 reported cases! (thats pretty good!!). With efforts to continue to eradicate the virus from more countries and have it completely wiped off the earth in 3 years! If accomplished this would be the second infectious disease eradicated ever. Another interesting point that the article above mentioned is that The U.S. government has been the second largest donor to the Global Polio Eradication Initiative and as a supporter of developing countries’ efforts. From previous studies in global health I know that the US does give a large sum of money to developing nations but what it does’t include is that number divided by the GDP of the country. With that factored in we fall along one of the lowest contributing nation.

The microbiome is an incredible system of organisms living amongst us all over our bodies and inside! These organisms play an essential role with how our body functions and our overall health. In many cases we predict that when the microbiome is compromised disease arises. in the article The Dynamic Interplay between the Gut Microbiota and Autoimmune Diseases describes how autoimmune diseases could be linked with the dysbiosis of the microbiota in the gut. The microbiota also maintains nutritional activities, metabolic functions in nutrient digestion, detoxification, vitamin synthesis, and immunologic homeostasis in the host. Specifically, the gut microbiota disease could influence an immune response causing an inflammation disease. In the article they give a specific example that describes how “high levels of Prevotella copri correlate with low levels of the gut microbiota previously associated with immune-regulating properties.” All of which continues to show the importance between the commensal relationship of the microbiome and our immune system. In another article Revisit gut microbiota and its impact on human health and disease it describes how disruption of the microbiome can play a role in causing obesity, hypertension, cardiovascular disease, IBS, and even mental health illnesses like depression.

I think that it is important to understand how these organisms can impact your health so that you can strive to obtain a healthier lifestyle. I believe that people who find themselves in a continual cycle of health problems more than likely have a poor microbiome health. Maybe they have taken too many antibiotics and it has removed a lot of the good bacteria from the gut. Maybe when they were an infant they didn’t receive the nutrients necessary to build a healthy adult microbiome and have been predisposed to illness all their life. What was also described in the Revisit gut microbiota is how with more research on the microbiome we could tailor therapy to an individuals personal microbiome to ensure better outcomes.

In 1998 Andrew Wakefield and several colleagues published an article to the Lancet stating the risk of the MMR vaccine to young children developing autism. Since then the article has been recounted and removed from the Lancet for the many problems underlying the “scientific” discovery. Shortly after publication other epidemiological studies were produced; all refuting the causal link between the vaccine and autistic behavior. Which lead to the series of refutation of Wakefield’s bogus study.

In the article Vaccines and Autism: A Tale of shifting hypothesis by Jeffrey S. Gerber and Paul A. Offit it is stated that Wakefield and his team had a very small sample size of 8-12 individuals (this alone should be enough to shake your head on how the paper got published in the first place). The cohort of individuals were also self referred by Wakefield and it did not include control subjects. Then to continue, evidence arose that they all had financial interests in mind which lead to falsifying the results. They did so by picking and choosing the evidence that confirmed their hypothesis instead of presenting all of the findings.

From Wakefield’s study a fearful response to the MMR vaccine surged throughout the world and really sparked a distrust in vaccines as a whole. Repercussions of this fear is now being seen through increased measles/mumps/rubella related deaths worldwide. WHO says that there has been a 30% increase of Measles cases and in 2018 alone more than 140,000 died from Measles globally. The US had over 25 cases as well as four countries in Europe lost their MMR elimination status! The CDC posted a graph showing the years of Measles outbreaks in the US and what stands out to me is that they are not from the beginning of the century but rather 2013, 14, 15, 16, 17, and 18. For this number of people to be dying from a vaccine preventable disease speaks volumes on what the fear of vaccines are doing to our world.

I am a SENIOR here at UNC, I will be graduating with my BA in Biology with a minor in Archaeology. I am originally from Salisbury, NC and now I live in Hillsborough with my fiancé Alex and my cute pup Sue. I will be getting married this May #marryingamyers. My future career plan is to work in women’s health as a Physician Assistant. Something fun that I was able to do two summers ago was visit Portugual for 3 weeks with a program called Atlantis! There I was able to shadow health professionals during the week and of course experience the wonders of Portugal! It was BEAUTIFUL, the food was fantastic, and the people are a delight!