CHRONIC Steven Phillips/Dana Parish
MTHFR
You may have heard about these genes that are now mentioned in psychiartric circles. There are at least two genes that encode for the enzyme methylenetetrahydrofolate reductase, or MTHRF for short. These are frequently mutated in the population, and cause varying levels of metabolic disruption depending on how many copies of each mutated gene are present. Mutations of these genes contribute to increased levels of homocysteine, an amino acid, which is recognized to be a significant risk for vascular disease, dementia, psychiatric illness, and certain cancers.
The American College of of Obstretricians and Gynecologists, College of American Pathologists, American College of Medical Genetics, and American Heart Association do not recommend testing for MTHFR. Likewise, most medical societies do not recommend routine screening for homocysteinie levels. I (Dr. Phillips) have been very surprised by this, giving the following:
Studies show that certain B-vitamin supplementation resulting in lowered homoscysteine reduces the risk of stroke, which is confirmed by a metanalysis of many studies. Homocysteine reduction by vitamin supplementation also reduces retinal atherosclerosis in diabetic patients with high blood pressure, as well as brain shrinkage and cognitive decline in patients with early dementia. Other studies also demonstrate a significant treatment benefit to psychiatric symptoms in patients with depression and eating disorders.
Although studies of homocystiene reduction by vitamin supplementation demonstrate a reduced rate of recurrent blockage of the coronary arteries after balloon angioplasty, a procedure to open clogged arteries, most studies do not demonstrate a reduction of overall heart disease that meets statistical significance. This may be because the B-vitamin reigmens used in those studies were sub-optimal, as homocysteine levels were frequently only modestly reduced. I offer my patients with elevated homocysteine vitamin therapy to lower it. For most patients, methylfolate and methylcobalamin will markedly lower homocysteine. For some patients, additional therapy is required, such as vitamin B6, but it can cause heartburn in some patients, and if taken in excess, can damage nerves. Thus, it's always best to follow up with your doctor before starting any supplements. p133-134
Vaccines have a long and colorful history. They have eradicated many ills that used to debilitate, disfigure, or kill entire swaths of populations. The first vaccine was for smallpox, a common epidemic prior to the eighteenth century. In the late 1700s, a small-town doctor, Edward Jenner, noted that farmers and milkmaids exposed to cowpox, which was common among cattle at the time, never seemed to suffer from smallpox during its frequent outbreaks. They would have a brief bout with the illness, which was less serious and less deadly than smallpox, but retained their beautiful complexions. Others, who suffered immensly from the disease, would either die from it or be left with severly scarred skin. For Jenner, this was a huge clue. He began looking into whether or not these workers were being naturally vaccinated by exposure to the cowpox virus. (Interesting trivia tidbit: the word vaccine come from the latin word VACA, which means "cow.")
In 1796, Jenner met a young diarymaid named Sarah Nelms who had cowpox lesions on her hands. He carefully extracted material from her lesions and injected it into an eight-year-old boy, James Phipps, who was the son of a gardener. This was before the days of informed consent, not to mention parental involvement of consent, but it also speaks to the long tradition of medical researchers experimenting on the poor. Phipps developed fevers, chills, and loss of appetitie about a week later, but recovered thereafter. The real experiment came two months later, when Jenner injected Phipps with smallpox material. As he predicted, the boy stayed well, leading Jenner to conclude that Phipps was protected from the deadly smallpox. The boy was now "immune" to the disease. Better yet, two other children who shared a bed with Phipps did not catch smallpox from him either, further strengthing his evidence. His report of the events called for more vaccinations, and elicited skepticism. Jenner was not discouraged. He documented more vaccinations throughout the next year. By 1800 Jenner's work had been published in all major European languages and had reached Benjamin Waterhouse in the U.S., a respected physican and a cofounder of the Harvard Medical School. The rest as they say, is history. Other vaccines for many other disease would follow.
After decades of continuous worldwide vaccination and improvements in public sanitation and hygiene, in 1972 smallpox was declared eradicated in the United States; in 1977 a single case of smallpox occured in Somalia, the very last one.
By 1980, the WHO considered smallpox to be eliminated worldwide.
All vaccines work the same way: they prime the immune system to recognize and attack a particular pathogen, or in the case of a toxoid vaccine, a pathogen's toxin, if it shows up in the body in the future. This can be done in four main ways: inactivated virus, live attenuated vaccines, toxoids, and subunits/conjugates. Inactivated vaccines do not contain live viruses or bacteria, but either whole killed germs or simply parts of these organisms. (The development of a vaccine against parasites continues to be elusive - deeply troubling, given the breath of their presence and toll that they take on global health.) These microbial parts are either DNA, protein, or specific molecules on the germ's surface. They allow your immune system to identify this as the enemy and obtain advance notice if that virus or bacterium were to invade. Immune system cells then have memory to be able to recognize the organism when they next encounter it, in order to produce antibodies to fight it. The immune cells remain circulating in your blood on guard, ready to stop an infection in its tracks if you body is later exposed to the real thing. However, these antibodies often don't remain for your whole lifetime or aren't strong enough to protect you after just one shot, which is why booster immunizations are recommended, for example for whooping cough or rabies.
The smallpox vaccine wa a live attenutated vaccine, but it was given in much smaller concentrations than the original, Jenner-like smallpox vaccine. These types of vaccines often confer a lifelong immunity after one or two doses. But people with compromised immune systems are usually not able to recieve these. Examples of live attenutated vaccines include the measles vaccine, the rotavirus vaccine, and the yellow fever vaccine. There's a vaccine for tuberculosis that's given in several countries around the world, known as BCG, which is also a live bacterial vaccine, but the CDC recommends that it should not be given to those with weakened immune systems.
A toxoid is a form of vaccine that is an inactivated bacterial toxin. Examples of this include toxoids against diphtheria and tetanus. These types of vaccines enable the body to render the real toxin harmless if it were to show up in the future. Tetanus is exceedingly rare today (fewer than thirty cases per year occur in the United States) and most doctors have never seen a case. Tetanus is not like other infections that can spread between people. It's a spore forming soil bacterium and is transmitted by entering an open wound. Its spore can survive on surfaces, like a rusted nail, for long periods, only to start replicating in the unsuspecting person who steps on the nail. The spore produces a toxin that causes powerful and life-threatening muscle contractions, unless of course that person has been vaccinated.
Like inactivated whole-cell vaccines, subunit/conjugate vaccines don't contain live components of a pathogen, but rather small fragments of its outer surface protein, which stimulates a protective immune response. Some examples of subunit/conjugate vaccines are those for influenza, hepatitis B, HPV, and some for shingles.
At a time when many infectiou diseases have been brought or kept under control with global vaccination efforts, one has to wonder why it has taken so long to develop a vaccine for lyme+. There are several reasons for this. Lyme is the only one in the family that has gotten any significant attention by the medical community, and that attention has been fraught with controversy. BARTONELLA is an emergency infectious disease that has only been recognized in earnest since the 1990s. Before that, only two species were known - one that was restricted to the high Andes Mountains and caused Carrion's disease, and the other that caused trench fever. Over the past twenty years or so, about forty-five more species of this bacterium have been discovered. In sum, we're dealing with a tribe of infections, all of which are poorly understood, and all of which have been mismanaged by the medical community.
Moreover, these are complex germs that behave in crafty ways in the body. A good analogy is to consider the human immunodeficiency virus, or HIV, for which we still do not have a vaccine after decades of research. Not only are there many different types, subtypes, and strains of HIV, each genetically distinct, but the virus also mutates frequently. These characteristics make the prospect of a vaccine practically impossible - there are too many rapidly moving targets. The Lyme+ family of infections suffers from similar complications. It's like trying to shoot a gun at a swarm of flies.
Not that vaccines for Lyme haven't been developed and tried. SmithKline Beecham (now GlaxoSmithKline) developed the first and only liscenced vaccine against Lyme disease. It was called LYMERix and it was rolled out in 1998. Given in a three-dose series, the vaccine had an unusual method of action: it stimulated antibodies that attacked the Lyme bacteria in the tick's gut as it fed on the human host - before the bacteria were able to enter the body. More specifically, it was a recombinant vaccine containing an outer surface protein (OspA) from BORRELIA BURGDORFERI, the Lyme bacterium. A recombinant vaccine is one that's been engineered using recombinant DNA technology, whihc means inserting DNA into bacterium. The bacterium then produces a specific antigen, in this case the surface protein from BORRELIA, which is then purified and used as the vaccine.
Before licensure by the FDA, 6,478 people recieve a total of 18,047 doses of the vaccine during clinical testing. It was reported to be about 78 percent effective in protecting against Lyme after all three doses of the vaccine had been given (note that what constitutes efficacy is subject to interpretation, since we're talking about BORRELIA BURGDORFERI only - notany of the myriad other virulent infections included in the Lyme+ family such as RICKETTSIA,EHRLICHIA,ANAPLASMA,BARTONELLA,F.TULARENSIS,COXIELLA, the Powassan Virus, and BABESIA, just to name a few.) Between the time of its licensure in 1998 and July 31, 2000, about 1.5 million doses of the vaccine were distributed. It was intended for use in individuals between fifteen and seventy years old living or working in areas with high rates of Lyme diease.
By 2002, SmithKline Beecham had withdrawn LYMERix from the market. Report of sobering side effects were accumulating, some of which were serious - resulting in life-threatening illnesses, long hospital stays, or severe disability. The vaccine was followed by crippling arthritis in some and neurologic disorders, including cognitive issues, in others. It was a cruel twist of irony, given that Lyme itself can cause all of those conditions. But people couldnt' get an active Lyme infection from the Lyme vaccine, as it contained no live bacteria. That's true, but it's also true, and indeed well known among Lyme researchers, that asymptomatic or minimally symptomatic Lyme infection is common. What if Lyme was widespread in the general population but the narrow CDC surveillance laboratory criteria adopted by IDSA for its diagnosis missed a large portion of those infected? Well, it turns out thta Lyme IS common in the population - 11 percent of healthy people without symptoms turned antibody-positive by the CDC criteria. Although it wasn't admitted by the CDC at the time the vacine was released, in 2013 the CDC admitted that the true number of Lyme cases is approximately ten times higher than the number reported to them. This means that the true infection rates with Lyme are alarmingly high. So what happens if the Lyme vaccine is give to a patient with asymptomatic Lyme infection? Since the symptoms of Lyme are caused largely by the immunse system going after the bacteria, can vaccinating someone with hidden, undiagnosed Lyme turn that asymptompatic infection into a symptomic one?
During a heated meeting with the FDA, Donald H. Marks, MD, phD eviscerated LYMERix and its makers. Dr. Marks was the director of the Lyme vaccine program for the pharmaceutical giant Aventis Pasteur, previously called Connaught, and had been brought in as a consultant to independently review the reported adverse events of LYMERix. He accused SmithKline Beecham of using "confusing" language to mislead physicians administering the vaccine. His strong words:
"SKB (Glaxo) has acted in an unreasonable manner by marketing LYMERix without adequate warnings about the risks of severe rheumatologic, neurologic, autoimmune, and other adverse events, and by failing to caution and educate physicians about these dangers."
"In my opinion," he told FDA officials, "there is sufficient evidence that LYMERix is causally related to severe rheumatologic, neurologic, autoimmune, and other adverse events in some individuals. This evidence is such as to warrant a significantly heightened degree of warnings and possible limitations or removal from marketing of LYMERix."
With that, LYMERix was hasitly pulled from the market, though the offical PR story from its maker was that it was yanked due to lack of demand. Many individual lawsuits followed, as well as a class-action lawsuit from vaccine recipients who became ill after vaccination. We continue to hear from patients who say they have still not recovered from their LYMERix injuries.
Vaccines are enormously expensive to develop, often costing more than $1 billion, as was the case with the rotavirus vaccine - a vaccine for a condition whose seriousness doesn't compare to what Lyme+ can do. Federal institutions and global organizations have already spent more than $9 billion trying to develop and HIV vaccine. At this expense, it is hardly believable that a drug company would pull an approved vaccine due to a relative "lack of demand."
Today drug companies are trying to develop vaccines for zoonotic infections, among them some that target multiple tick-borne pathogens and some that target tick saliva, but this area of medicine continues to be fraught with challenges. Lyme+ presents unique difficulties that make developing a vaccine a very onerous, if not impossible, task.
(The same is true of malaria, which has its own unique complexities and no commericially available vaccine despite more than fifty years of trying.) There needs to be a major leap in vaccine technology and a cleanup of the industry; otherwise, it's an enormous waste of resourses, with so many different strains of Lyme and with so many other pathogens that can be transmitted with Lyme, or on their own, there may never be a single vaccine to cover this extensive territory. And a "Lyme vaccine" could give people a false sense of security since it will not prevent any of those other infections from taking hold. The hurdles are formidiable, just like those for testing and diagnosing. p148