Anti-Inflammatory/Anti-Aging Strategies
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As of this writing, the Centers for Disease Control (CDC) in Atlanta is strongly recommending that pregnant woman postpone travel to many countries across the world, including the popular Caribbean islands.  The CDC is taking these steps due to the possibility that these women may become are infected with a mosquito borne virus called Zika.  The World Health Organization (WHO) Director General Dr Margaret Chan, has said that Zika had gone “from a mild threat to one of alarming proportions” and expects the virus to spread through the Americas and affect between three million and four million people.

Eighty percent of individuals who are infected with Zika do not show symptoms.  However, when symptoms do occur, they can last up to a week or so and include fever, rash, pink eye, and joint pain. Some clinicians suggest that Zika virus infection may result in the autoimmune [against oneself] condition,  Guillain-Barre syndrome (GBS).  This is rare disorder where too much inflammation damages the nerve cells, causing muscle weakness and may lead to paralysis.

The greatest concern however right now is that health agencies “strongly suspect” that when a pregnant women is bitten by a mosquito that is carring the virus, that even if she does not experience symptoms, that her offspring may develop brain malformations.

This latest outbreak adds to concerns that infectious diseases are one of the top threats challenging our world—a major topic on the agenda of last week’s World Economic Forum world leader attendees.  Until vaccines or treatments are developed, viral infections such as Zika, Ebola, SARS (severe acute respiratory syndrome), and MERS (Middle East Respiratory Syndrome) remain a threat to the world’s population.

Currently, there are no commercially available vaccines or treatments for Zika.  Until recently the cost to develop a successful vaccine was far greater than what the manufacturers would recoup in vaccine sales.  However, development of a vaccine for Zika will likely now escalate since Zika has spread so widely, infecting over 1.5 million individuals and its being linked to neurological problems, especially in newborns.

In addition to a lack of vaccines and treatments for a multitude of viral diseases, another significant health-care crisis we are facing is treatment of infection by anti-microbial-resistant pathogens. As Dr. Keiji Fukudaof the World Health Organization has stated:  “We really hope to pull the world back from the brink where antibiotics don’t work anymore”.

When bacteria are stressed, for example by a killer antibiotic, their genetic material may change, mutate, so that they can tolerate and become resistant to such compounds.  The bacteria can then replicate easily and outgrow bacterial strains that were not resistant to the antibiotic.

Fifty percent of antibiotic prescriptions written by U.S. physicians are of no benefit to the patient, and when used to fatten livestock and poultry it gives bacteria even more opportunity to acquire antibiotic tolerance.

It is our immune systems that identify, destroy, and remove invading pathogens.   When our body recognizes that it has been invaded by foreign agents, a strong inflammatory responses is triggered to meet the onslaught of the pathogens.  White blood cells accumulate in the area to combat the invaders.  These immune cells release cytokines and other immune messages  recruiting more white blood cells in an attempt to “burn out” the infection. Without a powerful inflammatory response, we cannot limit or survive infections.

In the absence of drugs or treatments that prevent and control the growth of viruses and other microorganism the immune system must be optimized to protect the body against them.

 

www.cdc.gov/mmwr/index.html
www.scientificamerican.com/article/who-extremely-alarmed-by-zika-cases-could-reach-4-million/?WT.mc_id=SA_DD_20160128
www.wsj.com/articles/health-threats-spur-vaccine-hunt-1453337493
ecdc.europa.eu/en/healthtopics/zika_virus_infection/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx
www.vox.com/2016/1/20/10795562/zika-virus-cdc-mosquitoes-birth-defects
www.wsj.com/articles/SB105768561135341800
www.cdc.gov/features/antibioticresistancethreats/
www.cdc.gov/media/dpk/2013/images/untreatable/img2_sm.jpg
www.bbc.com/news/health-35427493

Mutating cells and invasion by pathogens triggers inflammatory responses in the body.  Inflammation consists of a series of events involving cytokines (immune messages), other immune factors, and circulating white blood cells. Uncontrolled levels of inflammation damages healthy tissues and organs.

Excessive inflammation of the eyes may result in sight-threatening condition.

Uveitis
Uveitis describes a group of eye inflammatory diseases.  Symptoms can develop gradually over a few days, or occur suddenly. Symptoms may include: photophobia (sensitivity to light), cloudy or blurred vision, increased floaters, difficulty in vision focus, headaches, “red eye” with pain ranging from a mild ache to intense pain, and loss of peripheral vision (ability to see objects at the side of one’s field of vision). Severe uveitis may lead to permanent damage to vision.

Many cases of eye tissue inflammation are “idiopathic”, i.e., without a known trigger.  Some clinicians suggest that uveitis is caused by:  a) autoimmune responses in which the body’s immune system mistakenly targets and attacks its own eye tissues, b) infections or cancer, c) trauma to the eye, or d) exposure to toxins.  Uveitis is more likely to occur in individuals that have other immune and inflammatory conditions.

Ebola and Uveitis
Two months after an American physician was treated for Ebola, and despite the fact that the virus was no longer detectable in his blood, there were high levels of Ebola virus in his eye. His eye infection was accompanied by an intense inflammatory reaction, uveitis. After much effort, the physician was successfully treated and thankfully  did not lose his sight.

In a study of 85 Ebola Virus Disease survivors in Sierra Leone, 40% reported that they had some sort of “eye problem”. (It is not known whether they also had uveitits.)

Retinitis Pigmentosa
Retinitis pigmentosa is a genetic disorder in which the light-sensitive retina, the “screen” at the back of the eye that captures images, becomes damaged .  Its photoreceptors,  rods and cones, begin to die off resulting in a  loss of vision.  This condition may end in blindness.

There are conflicting opinions as to whether inflammation plays a major role in this disease.

One study that support the contention that immune responses are involved in retinitis pigmentosa measured the levels of TNF-alpha.  TNF-alpha is a cytokine, that among other functions, helps regulate immunological responses. Depending on when and how much of the cytokine is produced , TNF-alpha may be pro-inflammatory (initiate inflammation), or anti-inflammatory (inhibit inflammation).   In animals with uveitis-like conditions, the levels of TNF-alpha in the eye are  increased between 5-10 fold over control animals.

Also,  in retinitis pigmentosa, immune white blood cells are attracted to the retina, perhaps to clean up debris from dying cells. Some investigators suggest that when these immune cells are overly stimulated, they initiate an autoimmune response, destroying other light-sensing centers in the retina.

Immune Homeostasis, Immune Balance
Immune inflammation is essential to defend the body against cancerous cells and invading microorganisms.  However, the appropriate levels of  “protective” cytokines are needed to balance the “destructive” cytokines produced in the eye so that it can maintain immune homeostasis, immune balance. Unchecked inflammation results in tissue damage and an inability of the body to mount stable and proper immune responses in the face of various challenges.

Dr. Hellen is available at 302.265.3870 for discussion on the role of inflammation and immune homeostasis in one’s health.  There is no charge to speak with her.  She may be contacted at: drhellen@drhellengreenblatt.info, or use the contact form.  Thank you.

 www.sciencedirect.com/science/article/pii/S0014483502003329
www.ncbi.nlm.nih.gov/pubmed/24174679
www.ncbi.nlm.nih.gov/pubmed/24639355
www.ncbi.nlm.nih.gov/pubmed/23608634
eyewiki.aao.org/Retinitis_Pigmentosa
www.ncbi.nlm.nih.gov/pubmed/22986109
www.ncbi.nlm.nih.gov/pubmed/21787221
www.nhs.uk/conditions/Uveitis/Pages/Introduction.aspx
www.nei.nih.gov/health/uveitis
www.nejm.org/doi/full/10.1056/NEJMoa1500306#t=article
www.nytimes.com/2015/05/08/health/weeks-after-his-recovery-ebola-lurked-in-a-doctors-eye.html?smid=tw-nytimes&_r=0

 

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. As of this post, the virus has spread through many African nations, and is the worst Ebola outbreak every recorded. The virus has infected over 1200 people and abuot 60% of these individuals have died from the disease.

Health practitioners have put themselves at great risk caring for those who have become infected. According to the BBC, one hundred health workers have been affected and half of them have died. At least three high-profile physicians in the forefront of care have succumbed to the virus, and three nurses who worked in the same treatment center as one of the physicians, are believed to have died from the virus.

Two Americans working to battle Ebola in Liberia, one a physician, have tested positive for the virus and are undergoing intensive treatment and workers from Doctors without Borders and the Red Cross are “overwhelmed” for the virus that has no cure.

Depending on the type of Ebola virus, up to 90% of those infected can die a rapid and difficult death. The onset of symptoms may be characterized by a sudden spiking fever, headache, joint, muscle, and stomach pain, diarrhea, vomiting, and in some cases, uncontrolled internal and external bleeding. Infected individuals die from failure of multiple organs in the body such as the nervous system, liver, and kidneys.

The disease is characterized by abnormal immune responses in which the Ebola viruses appear to evade attack of immune cells; dramatic immune imbalances occur in response to infection. There is evidence that the immune system responds with a “cytokine” storm during which certain immune cells “dump” large amounts of pro-inflammatory molecules, cytokines, into the body. Other biological compounds are released as well that contribute to the confused immune response.

Additionally, specialized cells produce insufficient amount of anti-viral cytokines, while at the same time, there is a significant increase in death of other types of immune cells. Scientists at the National Institute of Allergy and Infectious Diseases call this “a mixed anti-inflammatory response syndrome (MARS)”, and suggest that this “catastrophic uncontrolled immunological status contributes to the development of fatal hemorrhagic fever”.

Perhaps some of the symptoms that patients experience are due to autoimmune responses against individual classes of lymphocytes. This would account for the loss of certain immune cells, such as CD4 and CD8 cells. If they were available in higher numbers, they might be able to help the body fight the infection.

Many immunological factors contribute to Ebola virus fatalities. It is my contention that if  individuals were able to achieve immune homeostasis, immune balance, they would be better equipped to mount  controlled inflammatory responses which might help control the course of the disease.

 www.cdc.gov/vhf/ebola/pdf/fact-sheet.pdf
www.cdc.gov/media/releases/2014/t0728-ebola.html
www.who.int/mediacentre/factsheets/fs103/en/
www.nasw.org/users/mslong/2010/2010_09/Ebola.htm
www.vox.com/2014/7/23/5930311/ebola-virus-disease-outbreak-africa-facts-guinea?utm_medium=social&utm_source=facebook&utm_campaign=voxdotcom&utm_content=Sunday
www.ncbi.nlm.nih.gov/pubmed/20957152
www.ncbi.nlm.nih.gov/pubmed/21987781
www.ncbi.nlm.nih.gov/pmc/articles/PMC368745/

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