B I G B R A I N M O M E N T
Ah yes, the human body, the most complex thing mortals have ever seen. There are countless things that render people, even scientists, clueless. Heck, even I, as the writer here, can feel my brain cells screaming at the sight of such extensive knowledge and has to google everything that is being said down below. But we are here to learn, after all! What’s more fun than overworking your brain? (Please take proper rest.)
MHC (Major histocompatibility complex) is a complex on lymphocytes that can recognize specific antigens. Most of the time, when doctors use MHC for drugs, it’s about cancer treatment (immunotherapy). “MHC should recognize 2 signals,” Philip states, “Firstly, that would be antigens. Secondly, it would be your own cells. Since it is very specific to the patients, it is very hard to devise a drug that the patient’s MHC can recognize. The only way you can do it is by developing a drug that is eaten by an antigen cell. If you do lymphocyte manipulation, it’s theoretically possible but very difficult in reality to commonize.”
Moving on, immune cells in our body have low chances in meeting with pathogens. When asked whether or not there are any ways to increase such a chance, Philip replies that it will be quite challenging to do so. “When you begin to study immunology,” He says, “Earlier on, they will simplify the concepts. When a virus or bacteria enters your body, what happens is that immune adaptive cells will eat the bacteria or virus that has entered your bloodstream. Then they will migrate into the lymph node that will harbour these lymphocytes and maximize the chance of contact with the antigens. The body has already helped increase the chance of meeting with these antigens such as the migration into lymph nodes releases the chemokine and replication of the most favourable cell. Artificially, man-made vaccination can be created to juice up specific lymphocytes and create a faster response.” In addition, Philip also suggests the manipulation of the microenvironment, which is theoretically possible. “COVID has a cocktail therapy,” He mentions, “There is a medicine within this treatment called interferon. It is a chemical in the immune system that strengthens your immune response and is theoretically better than vaccination. You can add chemicals into your vaccination, conjugate it and add the virus’s protein into it.”
Sometimes, our immune system isn’t strong enough to defeat nasty bacteria by itself. Hence, various medications are prescribed to assist in this killing. One of these medications would be preferin. However, it is not advisable to use this on the patient. “Preferin is very dangerous,” Philip warns, “It can kill bacteria, but it will also kill pathogens and body cells, namely the patient’s own body cells. The pretty thing about preferin is that it relies on different pathways to activate its complement for effectiveness, normally, it is the antibodies specific to the pathogen bound to the pathogen and signify other cells to release preferin. Take assination as an analogy, the problem isn’t that we don’t have a sufficient amount of bullets, it is that we do not have enough assassins. More preferin will only increase the dangers the patient has to endure. Instead, we need more solutions that can specifically target the release of preferin into the right pathogens.”
Complement system may be something that no one wants to study when they are specializing in immunology, Philip jokingly remarks. “It’s just too difficult,” He complains, “ There are too many terms and names that are so random. I despise those especially with different numbers that are not consecutive, there are so many rules!” The Complement system was actually a hot topic in the past in which many people researched on. But now, its research is dying down because there isn’t anything to investigate upon. “It is simply very well-described,” As Philip explains, “Plus, the Complement system belongs to innate immunity. Adaptive immunity is the thing that we are more focused on, since this can specifically and hopefully kill or solve COVID. The Complement only needs a little adaptive response to guide its response. For infectious diseases, Complement is often left ignored; but when it comes to immunodeficiency, we will investigate it as the possibility of errors is very fascinating. For example, if you are born without C-4, or C-6, or C-1, the scenario you will be in completely differs from one another dramatically. It is quite interesting.”
C A N I T O L E R A T E Y O U
Food allergies in immunology are termed as “inappropriate responses”. The immune system plays a major role in food allergies, in the past, immunologists believed that every single allergy is a reaction from the immune system, but now, the loss of tolerance from the immune system is considered.
“Tolerance is very important,” Philip states, “When you eat a piece of bread, for example, your body is actually forcing your immune system to tolerate it. We believe in food dependent exercise induced anaphylaxis. The theory is that the patient, in their core, is allergic to wheat, but their body has tolerance to it. The body wants to have reactions against wheat yet there are certain barriers that prevent such reactions from happening and in turn increases the tolerance to wheat. So from a certain age, they will start to have reactions against wheat because the tolerance level decreases. Other factors that can reduce your tolerance to it include exercising, drinking alcohol or female hormones.”
In physiology, there is an antibody called IGE, it sticks to the mass cell that produces many chemicals, thus causing the patient’s food allergic reaction to be triggered; but nobody knows what the tolerance consists of. “Some have theorized that maybe certain enzymes help break down the IGE, but during exercise, this enzyme’s activity decreases;” Philip suggests, “Others think that the tolerance itself is actually controlling the mass cell. The barrier protects the food and the immune system cannot recognize it, but once you exercise, the barrier is gone. Nobody really knows and people all over the world are competing with one another to find out who is the first that can discover what the tolerance is.”
Ethically speaking, when conducting allergy tests with the desire to find out the truth, a patient is necessary in following follow instructions to test out the validity of the hypothesis, but as a doctor, it is impossible to ask a patient to do such thing knowing that certain activities can be fatal to them, hence the research becomes very difficult. “But we also have managed to find 2 solutions,” Philip assures, “We can withdraw blood from the patients, downgrade it into stem cells and transform the stem cell into a patient’s cell to conduct the experiment on. Or we can find small animals, like rats and mouses that have similar conditions to certain patients to do experiments on.”
“But immunology is difficult, we have to face so many obstacles.” He also concludes, “Firstly, it’s rare, and secondly, even if we are doing research, it is hard to find test subjects as we cannot break through our moral ethical dilemma.”
T H I S O R T H A T
Some people tend to take Chinese medicine daily, believing in concepts such as rejuvenating your body,
but from an immunologist’s perspective, the saying that Chinese medicine is helpful to our immune system is debatable. “ I would be very biased since our fundamental systems are very different from one another,” Philip reasons, “From my limited knowledge in Chinese medicine, their understanding of health is very different in regards to the functioning of organs. Thus if they use certain herbs to boost their functioning, in the Western perspective, it doesn’t make sense. But that’s because we are using our own perspective to comment on the other perspective. In the other way round, the Chinese medicine doctors would think that Western medicine is full of toxins and harmful to the body, since they are using their own system to interpret our treatments.”
Hence, Philip advises patients to ‘decide on a lane’. If the patient chooses Western medicine, then from this perspective, Chinese medicine will have no effect nor evidence nor linkage in improving your immune system. If the patient happens to still hold faith for Chinese medicine, they are allowed to proceed but with caution. This also applies to Western medicine as the development of Western medicine is younger than Chinese medicine, in addition, certain herbs or antibiotics or even concepts in the Western medicine industry is common in the Chinese medicine industry and vice versa. But never combine both!
B U S Y B E E
During the interview, Philip has also expressed his interest in researching different diseases, with a particular few that struck something within him. Firstly, it would be Hereditary Angioedema, in which he has diagnosed approximately thirty patients and set up an organization. Secondly, he has also taken an interest in Anaphylaxis. The reason for his curiosity towards this disease is because of a special phenomenon in Hong Kong. “If you go around asking your relatives or friends,” Philip explains, “The majority of people will admit that they have allergies to different types of food. Hong Kong people like saying that they are allergic to certain things but in most cases, that is not the truth and they can eat them. They can be supported by traditional Chinese medicine beliefs, such as ‘beef is toxic’. However, there are actually numerous patients that have fatal allergic reactions and are constantly hospitalized with no idea of their food allergies. It’s just that after they eat, they will faint and CPR treatment is necessary. They just cannot figure out what they are allergic to.”
Recently, Philip and other immunologists have come up with a survey targeting Queen Mary Hospital, the data they received concludes that ⅛ patients that come to receive immunology treatment have no idea what they are allergic to, with 60-70% of them having a very particular allergy. “It’s not just eating the food, it’s the aftermath of it.” Philip deciphers, “It can be exercise, or it can be indulging in alcohol. These are all factors that trigger the patients’ allergic reactions. It’s quite strange that many Chinese have this disease. And the majority is allergic to wheat! But you can still consume wheat everyday via eating oatmeal and you will be fine. Yet on a particular day, if you happened to eat a bread bun and run to school, you will immediately find yourself fainting. And this is fatal.”
Other than researching diseases that are rare and shrouded with an air of mystery, Philip also spends his time in decoding medicine allergy. “Lately, we have published a journal,” He announces, “It’s the world’s most extensive paper on penicillin allergy. In every 50 Hong Kong people, there is 1 who claims they are allergic to penicillin. Yet after conducting experiments and tests, 9 out of 10% of these claims are fake. This may seem to be insignificant, but in a doctor’s perspective, it is really important to know which medication you are allergic to because when you are hospitalized, we have to take into account the allergic reactions you have to certain medicines and prevent applying such medication on you. If you are allergic to particular medicine, your rate of survival instantly decreases and the duration of hospitalization increases; and if you abuse antibiotics, your body will grow to reject certain medications. Thus, we are aiming to reduce Hong Kong people’s incorrect claims of allergic reactions and we are investigating in a method to decrease the rate of misconceptions in regards to medicine allergies.”
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