“Simplicity is the ultimate sophistication”, Leonardo Da Vinci used to say. I can hardly start an article extolling the virtues of simplicity with a complex quote, so I will quote myself. “Stupid simple is not stupid but simple. Simple."
There are multiple vaccine candidates for the Sars Cov 2 novel corona virus. A few are looking promising. Moderna vaccine is mRNA and one of the 4 vaccines Pfizer is working on is also mRNA.
mRNA vaccines are supposed to be safer, easier to make, easier to mass-produce, quicker to develop and will likely stimulate a robust all around immune response. The rub is, there hasn’t been any mRNA vaccine yet for an infectious disease. Plenty for cancers in precision medicine.
I wanted to explain that concept in overly simplistic fashion to the point of absurdity. It is not only for lay people but in the era of specialization, where a left eye doctor wont treat your right eye, my physician colleagues will likely enjoy a brief simple refresher.
Munis means service, for example municipal government. Immune literally means free from service. (Exempt from service or obligation.) A joke about municipal governments is warranted here but we will graciously move on.
The immunity is in form of cells and proteins (antibodies) secreted by the immune cells. We have 2 types of immunity. Innate, the one with which we are born and Acquired, which we acquire as we move along and learn after fighting infections.
So both innate and acquired immunity will have cell-mediated component and antibody mediated component.
There is also a Passive immunity, where you literally borrow antibodies from someone else, your mom from her breast milk or a recovered Corona patient as a plasma donor .
The goal for any vaccine is to give the human body a small dose of infection, in the hope that, dose will be too small to cause sickness but big enough to stimulate bodies immune system, so next time the body encounters that infection, it can fight it off.
The dose of disease could be inactivated germ, or live attenuated particle or a protein/antigen that the organism makes. Starting from Edward Jenner’s variolation in 1796, the world had great success fighting Small pox, polio, measles, mumps, rubella, varicella, tetanus, rabies, to name a few.
mRNA is the messenger RNA ( ribonucleic acid), a strand with genetic information that gives instructions to the cells in the body to make specific proteins. A lot of work is done already on this platform. This concept was literally born, when Paul Ehrlich was trying to stain the infected cell so they can stand out from the normal cells, when he would look at them under microscope. If I can make these cells take a dye to light them up, why can’t I make them take up a chemical that will selectively kill them, without harming the normal cells. Bingo. Chemotherapy was born.
The exciting cancer work is done when body is made to consider cancer cells as foreign and body attacks them using immunity. So an mRNA carrying the information about cancer cell is slipped in and it makes the body makes proteins that hopefully will destroy only the cancer cells without any collateral damage. To sweeten this thought further, same cancer may have different type of mutations in different peoples, so this cancer vaccine can literally be made person specific on the mRNA platform, thus discarding the older “ one size fits all, clumsy and ham handed approach.” mRNA is also easy to package and a small dose can be instructed to replicate and make a stronger immune response. It literally treats the body as the hard drive, itself functions as software.
We haven’t had an mRNA vaccine for an infection. Thoughts are that it could be spectacularly good. Well, this Sars Cov 2 virus has had its way with mankind till now. Wouldn’t it be something to look forward, that the thing that kills of this novel virus is a novel vaccine?
Will the immune response be lasting, like chicken pox or will it require a yearly dose, like flu? Playoffs. Don’t talk to me about playoffs. Let us just kill it for this year and then worry about the next.
(Ravi Godse is an internist based in Pennsylvania.)
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