Is There a Biological Relationship Between Autism and Suicide?

By Abbie Storan 

This article may be distressing for some readers due to its themes of suicide. If you are feeling suicidal, please visit here for help.

Around 800,000 people lose their lives to suicide each year. The World Health Organisation propose that for every person lost to suicide, there will be 20 more attempting suicide. Autistic people are 7.55 times more likely to die by suicide than the general population. Approximately 1% of the population is Autistic, but many will remain undiagnosed¹. 

When you consider a relationship between Autistic Spectrum Disorder, Mental Illness, and Suicide you will not fall short for evidence relating to the psychological nature of their connection, such as the JAMA network report published this January, which states that Autistic people have a “more than 3-fold higher rate of suicide attempt and suicide than neurotypical individuals, and that over 90% of people with ASD who attempted or died by suicide had another comorbid mental health condition². But what if we want to go deeper? Can we establish a biological explanation for why Autistic people are at such an exaggerated risk of mental illness, suicidal ideation, and death from suicide compared to the Neurotypical population? 

What is Autism? 

Autistic Spectrum Disorder [ASD] is a neurodevelopmental condition which affects how a person experiences the world around them, how they perceive others, and the way in which they communicate. With ASD, everything is different, and everyone is different. Due to the phenotypic heterogeneity as well as the accompanying differences in things like brain connectivity, it has been extremely hard for research to completely describe ASD neurobiology.  However, promising progress is being made with identifying the molecular pathways underpinning ASD³. With the increasing success in neuroimaging data and genetic analysis, it is likely we could see breakthroughs in the diagnosis and treatment of ASD and co-morbidities in the future.  

Before exploring the biology of ASD and Suicide, we should make note of the psychiatric evidence for relationships between ASD and Mental Illness. In 2017 AUTISTICA – the UK’s leading Autism research charity – partnered with the National Suicide Prevention Alliance. They produced a report wherein it was mentioned that depression is present in 30-50% of adults with Autism⁴. Meanwhile in a meta-analysis of 21,797 Autistic participants, 11.8% of were also diagnosed with Schizophrenia Spectrum Disorders⁵. Another large-scale meta-analysis of 26,070 people with ASD reported that the prevalence of co-morbid Anxiety Disorders was 42%. This same study also reported the lifetime prevalence of OCD within participants was 22%⁶.  

In the UK there are approximately 500,000 adults with Autistic Spectrum Disorder (ASD). Eight in ten of these adults will also suffer from mental illness⁷. From a study of 374 adults with ASD researchers found that 66% had experienced suicidal thoughts, and 35% had attempted suicide¹. 

Genetic links between Mental illness and Autism 

Thanks to a fascinating review of genetic associations with psychiatric disorders, from Andrade et al, we can now outline a direct biological relationship between ASD, Depression and Anxiety. This connection is facilitated by the dysfunction of genes encoding voltage-gated calcium channels (CaVs). CaV1.2 and CaV1.3 encourage neuronal firing and also couple excitation to gene expression; studies show this activity is linked to a number of psychiatric disorders. In particular CaV1.3 is encoded by CACNA1D genes, which have been associated with conditions such as ASD, Major Depressive Disorder, Schizophrenia, ADHD, and Bipolar Disorder. Andrade et al report that, “The non-coding SNP rs893363, located in the 3’ UTR of CACNA1D and the putative promoter region of the choline dehydrogenase gene was found in a genome-wide analysis of these five major psychiatric disorders”⁸. 

We can go on to consider the roles of Cortisol and the Hypothalamus-Pituitary-Adrenal axis (HPA) in relation to Autism and Suicide. Cortisol is colloquially referred to as the ‘stress hormone’, stress is a known biological and psychological response to experiencing threatening stimuli. The effect of acute stress is the Fight or Flight response, wherein the Hypothalamus stimulates the adrenal medulla to secrete adrenaline – which decreases activity of the parasympathetic nervous system while increasing activity of the sympathetic nervous system. Meanwhile chronic stress is regulated by the HPA axis⁹. Secretion of cortisol is controlled by actions of the paraventricular nuclei in the hypothalamus. Those nuclei secrete Corticotrophin-Releasing Factor to the pituitary, leading to the release of Adrenocorticotropic hormone into the bloodstream which stimulates cortisol synthesis and release from the adrenal glands. The HPA axis is under direct circadian regulation by the hypothalamic body clock, leading to diurnal rhythms in all components including cortisol¹⁰.  

Many studies on post-mortem brain samples from neurotypical people who died by suicide, and those who died by other means have highlighted higher concentrations  of corticotropin-releasing hormone¹²; suggesting that people who commit suicide biologically possess higher levels of cortisol, thus higher levels of stress. This has been supported by a particularly interesting study by McGowan et al in 2009, outlining the direct role of the HPA axis in suicide. From observations of the hypothalamus  in people who died from suicide they found evidence of hypermyelination as well as reduced expression of the NR3C1 gene – a glucocorticoid receptor responsible for weakening cortisol signalling – compared to their control group of people who had died by other means. Their work also revealed that early-life adversity can have lifelong detrimental effects on function of the HPA axis¹³. Autistic children are 63% more likely to suffer from bullying than neurotypical children; wider research confirms that 16.6-18% of Autistic children are physically or sexually abused¹⁴, and that autistic children are over 2.5 times more likely to be reported to child protection services for abuse¹⁵. So how is this relevant to ASD? The Diurnal Fluctuation of the HPA axis leads to a maximum concentration of salivary cortisol during the first half hour of waking, which decreases throughout the day¹⁰. We know that an increase in cortisol synthesis can dysregulate the HPA axis, and research states that children with ASD have elevated plasma and salivary cortisol concentrations, which we know to be associated with suicide. 

The Role of Serotonin 

We can now consider how serotonin plays a part in Autism and suicide. Hyperserotonaemia – elevated levels of whole blood serotonin – was the first biomarker identified from ASD in 1961, and it is present in more than 25% of autistic people. We can also note that elevated whole blood serotonin has been attributed to OCD too. Although we still do not completely understand how the serotonergic system contributes to ASD pathophysiology, neuroimaging and genetic research has concluded that the following clinical findings are related to both ASD and the serotonergic system: 

• Reduced platelet 5-HT binding, and reduced brain 5-HT binding. Since 5-HT is degraded by aromatic acid decarboxylase into 5-hydroxyindoleacetic acid (5-HIAA), this means reduced 5-HIAA levels are characteristic too.  
• Intensified by tryptophan depletion 
• A genetic linkage to chromosome 17q in males 
• Rare SLC6A4 amino acid variants leading to low expressions of the Serotonin Transport (SERT) receptor – associated with increase in cerebral cortex grey matter volume¹⁶ 

Post-mortem studies of people who died by suicide have revealed low levels of 5-HIAA in the brainstem, as well as in the prefrontal cortex. These low levels are also observed in suicide victims known to have depression and schizophrenia. Dysregulation of the serotonergic system predisposes individuals to suicidal and other self-injurious acts – The amount of 5-HIAA metabolite in the cerebrospinal fluid (CSF) is strongly correlated to current and future suicidal behaviour. So, we know that not only do low levels of CSF 5-HIAA predict a higher rate of suicidal acts, but also indicate more lethal suicide attempts. Most serotonin receptor studies focus on SERT, with results showing reduced amounts of SERT binding sites in suicide victims¹⁷. This information highlights more neurochemical evidence for the biological relationship between Autism and Suicide.  

Hope For The Future 

There is a lot of work to be done to further our understandings of both Autism biology and the biological basis of suicide respectively. Therefore, primary research into the direct biological relationship of suicide and Autism is understandably lacking. From past investigations discussed here, we can be positive this work is underway, and remain hopeful that in the future we may have answers that could keep more autistic people alive. Unfortunately, Autistic people are more prone to experience discrimination throughout their lives from other individuals and even from services expected to keep people safe – undoubtedly having a severe impact on their mental health. There is also still not even enough resources or support specifically for Autistic individuals with mental health issues, which tells us that equally as much progress is desperately needed on a societal basis to reduce Autistic suicides.  

 

References 

1.  Cassidy S, Bradley P, Robinson J, Allison C, McHugh M, Baron-Cohen S. Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. The Lancet Psychiatry. 2014;1(2):142-147. doi:10.1016/S2215-0366(14)70248-2 
2.  Kõlves K, Fitzgerald C, Nordentoft M, Wood SJ, Erlangsen A. Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark. JAMA Netw Open. 2021;4(1):e2033565. doi:10.1001/jamanetworkopen.2020.33565 
3.  Ecker C. The neuroanatomy of autism spectrum disorder: An overview of structural neuroimaging findings and their translatability to the clinical setting. Autism. 2017;21(1):18-28. doi:10.1177/1362361315627136 
4.  Cusack J, Cassidy S, Spiers J. Suicide and autism. Published online 2017. Accessed March 23, 2021. http://www.nspa.org.uk/wp-content/uploads/2017/02/1b.-Suicide-in-autism.pdf 
5.  Lugo-Marín J, Magán-Maganto M, Rivero-Santana A, et al. Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Res Autism Spectr Disord. 2019;59:22-33. doi:10.1016/j.rasd.2018.12.004 
6.  Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol Med. 2019;49(4):559-572. doi:10.1017/S0033291718002283 
7.  Baron-Cohen S. Vulnerability – Autism. Autistica. Published 2020. Accessed March 23, 2021. https://www.autistica.org.uk/our-research/research-projects/why-are-autistic-people-more-vulnerable 
8.  Andrade A, Brennecke A, Mallat S, et al. Genetic Associations between Voltage-Gated Calcium Channels and Psychiatric Disorders. Int J Mol Sci. 2019;20(14):3537. doi:10.3390/ijms20143537 
9.  McLeod S. What is the Stress Response. Simply Psychology. Published 2010. Accessed March 23, 2021. https://www.simplypsychology.org/stress-biology.html 
10.  Sharpley CF, Bitsika V, Andronicos NM, Agnew LL. Further evidence of HPA-axis dysregulation and its correlation with depression in Autism Spectrum Disorders: Data from girls. Physiol Behav. 2016;167:110-117. doi:10.1016/j.physbeh.2016.09.003 
11.  Knapp S. HPA Axis – The Definitive Guide. Biology Dictionary. Published 2020. Accessed March 23, 2021. https://biologydictionary.net/hpa-axis/ 
12.  Offord C. What Neurobiology Can Tell Us About Suicide. Sci Mag. Published online 2020. Accessed March 23, 2021. https://www.the-scientist.com/features/what-neurobiology-can-tellus-about-suicide-66922 
13.  McGowan PO, Sasaki A, D’Alessio AC, et al. Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci. 2009;12(3):342-348. doi:10.1038/nn.2270 
14.  Mandell DS, Walrath CM, Manteuffel B, Sgro G, Pinto-Martin JA. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse Negl. 2005;29(12):1359-1372. doi:10.1016/j.chiabu.2005.06.006 
15.  ScienceDaily. Children with autism more likely to face maltreatment, study finds. Published 2019. Accessed March 23, 2021. https://www.sciencedaily.com/releases/2019/02/190215135837.htm 
16.  Muller CL, Anacker AMJ, Veenstra-VanderWeele J. The serotonin system in autism spectrum disorder: From biomarker to animal models. Neuroscience. 2016;321:24-41. doi:10.1016/j.neuroscience.2015.11.010 
17.  Wassink TH, Hazlett HC, Epping EA, et al. Cerebral Cortical Gray Matter Overgrowth and Functional Variation of the Serotonin Transporter Gene in Autism. Arch Gen Psychiatry. 2007;64(6):709. doi:10.1001/archpsyc.64.6.709 

Coffee with Caroline

Programme Lead Dr Caroline Topham has been hosting “Coffee with Caroline” drop in sessions for students to discuss their wellbeing. In this article, Caroline answers some of your queries. Have more? Email c.h.topham@salford.ac.uk

1. How do I maintain a healthy work-life balance?

This is so important and getting into good habits now will help to set you up for a healthy work-life balance for the rest of your life. There will always be times when we need to work late or have a particularly busy period, but this should be every now and then, and not the norm if you can help it. Not everyone has the luxury of being able to choose a good work-life balance all the time – at the end of the day we all have to pay the bills – but if you find yourself spending a lot of time working, but not actually getting a lot done, then maybe your work-life balance is something you need to address. 

For me, a good work-life balance is partly about good planning, and partly about respecting your own wellbeing. Planning well helps you to use your time efficiently; instead of spending a week twiddling with an assignment, set yourself some deadlines. For example, spend an hour on your literature search, 4 hours of reading time (with a break!) then the next day you can crack that essay question. Planning little rewards and downtime can help you to stick to the plan. 

Now for the second part: respecting your own wellbeing. When you have a lot to do it’s easy to fall into the trap of thinking there is no time for breaks or relaxation, but this is a false economy. If you feel overwhelmed with work, this is a sure sign you need to take a good break and focus on your wellbeing, even just an hour off can help. Take a walk, call a friend, cook a meal, spend some time doing anything that you find calming. Investing in your wellbeing this way will pay off, as you will be able to be more productive when you do choose to work.  

Peer pressure has role to play here too: if your friends are pulling ‘all-nighters’ or your colleague is always the last to the leave the office it can be tempting to think that you should be too. However, this style of working is often a result of bad planning and procrastination, and in ten years you will be very glad you took the time to look after yourself when you see your colleague is off work with stress and burnout. No one is going to tell you to look after yourself, so learn do this for yourself! It’s important. 

If you think you might fall into the procrastination trap (we’ve all been there!), have a go at these training sessions from the university for some practical advice on how to use your time efficiently: https://www.salford.ac.uk/library/skills-for-learning/personal-skills 

 2. How do I relax when stressed about assignments?  

A good starting point is to try and identify what exactly is causing the stress. Having to complete assignments doesn’t have to be stressful, so maybe there is an underlying issue which is causing the stress. For example, is it a topic you feel under-confident about? Have you run out of time? Do you feel like you don’t know how to start? If you can identify what the barrier is before your stress levels get too high, then you can take action to fix it.  

Without exception, getting started with assignments as soon as they are set will always work in your favour as it gives you time to identify the gaps in your skills or knowledge and then take steps to work on them. I really recommend these tutorials from the library when preparing for your assessments; they have some practical hints and tips to help you do your best: https://www.salford.ac.uk/library/skills-for-learning/assessments 

3. How do I manage my time when I have multiple deadlines due at the same time?   

The best way to manage deadlines that are close together is to set yourself a false deadline. For example, if you have 2 weeks to complete two assignments, spend a week on one and set yourself a ‘pretend’ deadline 1 week earlier than the actual deadline. Then when it’s done, leave it alone! Now you have a week to work on the next assignment. See the link below for a nice tutorial about ‘owning your learning’ which can help you to take control in situations like this: 

https://www.salford.ac.uk/library/skills-for-learning/personal-skills

From Syria to Salford

By Hussam Almawal

I started my career in Syria in 2007 as a laboratory scientist. Shortly after this, I was promoted to manager of the general laboratory and IVF laboratory in 2009. My role grew quickly at the hospital, and it wasn’t long before I was overseeing the laboratory activities across seven floors, managing 40 laboratory staff – until 2013.  

When the war started in Syria, in the blink of an eye I had lost everything you can imagine. Members of my family and friends, my house, and my job. My family and I crossed 14 countries just to find a safe place to live.  

I arrived in the UK in 2014 speaking zero English. I started to learn the language and worked in a coffee shop at the same time. I also started my study at the University of Salford because I had been told: 

 You will never be able to work as scientist again.  

Since then, I’ve been on a mission to prove to the world that I’d be able to not only learn English, but also make my life a success story once more, so that my daughter would be proud of me. It’s hard to believe I’m now in my final year. I would be lying if I said it has all been sunshine and roses. I cried and slept in pain, feeling confused, lost and exhausted. There have been times where I have questioned myself, thinking, ‘why am I putting myself through this?!’ But at the end of the day, I wouldn’t trade it for anything in the world.  

First day at university

First day at University 

Today, I’m a Bioscience lead at one of the largest UK testing centres. I am so proud to be a part of the fight against COVID-19 with the Department of Health and Social Care and Lighthouse laboratories. 

I’m responsible for overseeing a lab-based team from sample receipt through to RNA extraction and delivery of PCR data. This includes troubleshooting and solving problems with PCR machines and supervising scientists carrying out their lab activities. I have had the opportunity to complete a portfolio of training activities including health and safety, manager essentials, and performance and improvement courses. Together with my team, we have delivered 7 million COVID test results to patients.  

2020 at #Lighthouse labs – COVID-19  responders Department of Health and Social Care 

I could say so much more about my experiences and journey so far. I can honestly say that I have always appreciated the support that has been provided to me by the University of Salford and that I wouldn’t be here without it. My journey at the University of Salford is not yet over, as I intend to study an MSc in Biotechnology after I graduate from my BSc in Biomedical Sciences.  

Through my educational journey at the University of Salford, I have learned four major lessons that I think other people may benefit from:  

1. It’s NOT too late, never give up.  
2. To finish any great endeavour, you must first start.
3. If you want happiness, help other people.
4. Failure and mistakes make you stronger.   

Tahmina Hussain on the IBMS and Securing Placements

By Tahmina Hussain

Tahmina shares her tips as a BMS Team Manager and Blood Sciences Training Officer at Christie Pathology Partnership, for securing IBMS placements and getting involved with the IBMS as a student.

About me

I completed a degree in Applied Biomedical Science at Manchester Metropolitan University, which involved a 12-month sandwich year placement in my third year which was an amazing opportunity to complete my IBMS Registration Portfolio to gain the IBMS Certificate of Competence, and also opened up the pathway for me to secure a job. Since then, I have completed the IBMS Specialist Diploma in Haematology and Hospital Transfusion Practice, and a Master’s degree in Haematology and Transfusion Science. Completing these qualifications has enabled me to expand my skills, knowledge and experience and have contributed massively towards my professional development and career progression. I have also completed the IBMS Certificate of Expert Practice qualifications in Training and in Quality Management. My particular interest is within Training and Education and developing students, trainees and colleagues and help them to grow in confidence.  

Advice on placements 

Based on my experience, the uptake of placements is highly competitive, therefore it is extremely important to apply for a placement if the opportunity is available. Without this, I would not have been able to complete my training and become a HCPC-registered Biomedical Scientist. The benefits of undertaking a placement are huge, as you will gain experience working in a laboratory while developing your knowledge and skills, as well as significantly improving your opportunities for employability. If you are unable to secure a placement via university, try and contact local laboratories to ask whether there are any work experience opportunities, connect with your local IBMS Branch and search for vacancies advertised for medical laboratory assistants or assistant practitioners.  

When you are searching for a placement or applying for a position as a Biomedical Scientist, you should include key points in your CV that stand out to the employer. Your CV should be about selling yourself and increasing your chances at being shortlisted for an interview. Include your qualifications, how many years’ experience you have, what skills you have developed and what training you have previously completed. Make sure you include your roles and responsibilities in a particular job and relate them to the position you are applying for. Employers will be looking for skills that relate to Biomedical Science so keep your CV clear and concise and make sure it flows well. If you have attended other courses such as mentorship or been involved in other extracurricular activities that add to your skills, make sure you include it in your CV. If you take part in or contribute to any conferences or events as a speaker or write articles, these are all valuable skills and experience to add.  

If you have been shortlisted for an interview, make sure you prepare well. Remember to sell yourself with the qualities and skills that you have highlighted in your CV and relate it to how it would fit the job criteria. Think about your strengths and weaknesses and how these can be used to your advantage. Most importantly, employers will want to know why you want the job but also what benefits you will bring.

For Biomedical Scientist jobs, most employers will ask specific competency-based questions, so be prepared to answer using past experiences. Examples of questions can be talking about your biggest achievement and why you are proud of this or how you might have handled a difficult situation. You may also be asked questions that are very specific to the discipline. For example, you may be given a scenario where a sample has been processed and an abnormal result is detected, what might the cause of this be? What condition might it be related to and what would you do? By preparing well and researching the common tests performed in the laboratory you will have a better chance at answering the questions well.

Don’t forget, although you may not have worked in a laboratory before, you can still demonstrate your knowledge in the interview, this will indicate your eagerness to learn. Take your time to answer the questions and don’t be afraid to ask your own questions. Examples of questions might include shift patterns or opportunities for career progression. When the interview has ended, thank the interviewers for their time, ask when you are likely to hear back from them and ask if they are prepared to provide feedback at the end of the process. 

Tahmina’s advice on getting involved with the IBMS 

There are other ways of getting involved with the IBMS which will help you develop new skills. Biomedical Science Day (24th June 2021) is the IBMS annual celebration of biomedical science. This day celebrates our profession and the work we do. You can get involved by promoting Biomedical Science and raising awareness to the public of our role in healthcare.

Prior to COVID-19 many of us celebrated by hosting events and exhibitions so that patients and staff in the hospital were able to come and ask questions; we also gave a tour of the laboratories! However, since the global pandemic, we were not able to celebrate in the usual way. But that did not stop us! The social media platform has become increasingly popular for promoting our profession so there’s always an opportunity to get involved and take part in increasing awareness.

National Pathology Week (4th-9th November 2021) is also an annual celebration of pathology to highlight the important roles we play and the contributions we make to healthcare. Again, there’s lot of ways to get involved! Public engagement activities such as delivering careers talks to schools and universities are great opportunities to engage people of all ages.  

The IBMS Chats also take place on Twitter on the first Wednesday of every month at 8-9pm. You can join in the chat and ask questions and network with other professionals. The IBMS Support Hub also deliver free online sessions on various topics such as completing CPD, portfolios and professional development.  

The IBMS mentoring program has been launched recently and is available for any IBMS member who would like some support in gaining skills and knowledge for career development.  

If you are looking to connect with the IBMS, there are plenty of resources available on their website which are useful for obtaining information on the different qualifications, CPD and networking with other members. For more information, visit https://www.ibms.org/home/

For the Love of Global Health: Ongoing University of Salford Microbiology Research in Uganda

By Prof. Richard Birtles 

In late 2015 I got an email from Louise Ackers, a Professor in the Health School, asking if there were any microbiologists at Salford University. I told her, yes, there were a few, including me and my colleague Dr Chloe James. Looking back, this was yet another moment of serendipity that changed my life – another “bit of luck out of the blue” that serves to remind me that just when you think life is getting predictable, there’s always a surprise just around the corner. Louise was looking for some help with a project she was planning in Uganda focused on educating hospital staff to improve antimicrobial stewardship.  

Six months later, Chloe and I were in Fort Portal, the biggest town in western Uganda, washing our hands like fury in front of groups of doctors and nurses to illustrate a good way of controlling transmission of Staphylococcus aureus infections. By this point we had learnt a lot about the appalling impact of infection (particularly sepsis) on maternal mortality in Uganda and we wanted to try and do something to help.  

We arranged for the regional hospital to collect S. aureus clinical isolates for us and, with the help of a new PhD student, we set about characterising these to see how they were related to one another and the extent of their resistance to antibiotics – hoping to get a better understanding of where mothers pick up infection from and how best to treat  infections. This work involved sequencing bacterial genomes and, with the help of my colleague Dr Ian Goodhead, we were able to do this in collaboration with microbiologists at Makerere University in Kampala as a way of transferring expertise in genomic techniques that are well-established in the UK to Uganda.  

Staff at Fort Portal Regional Referral Hospital use VR developed by Chloe and others at Salford University to learn about antimicrobial stewardship. 

We used our free time in Fort Portal to explore some other avenues – I’m interested in tick-borne infections of livestock, so we had a day-trip to nearby farms to pull ticks off cows (later tested by an MSc student) and Chloe had us collecting chicken poo as part of a project on the epidemiology of the food-borne zoonotic pathogen Campylobacter jejuni.  

Chloe’s PhD student, Paz, collecting faecal samples from Ugandan chickens to screen for Campylobacter jejuni and other zoonotic pathogens. 

Fort Portal is also the “home” of a UK/Uganda charity called Knowledge for Change (K4C). K4C has been offering placements for Salford University nursing and midwifery students for several years and we were very keen that they expand their offering to include Biomed and HBID students. It took a while to get things sorted, but the first group of BMS and HBID students went out to Fort Portal with Chloe in June 2018 and had a wonderful, life-changing month-long experience embedded in local microbiology, parasitology and haematology services. Here’s what BMS student Adrian Beck said: “This placement had a very positive impact on my personality. The most important thing I noticed is Ugandans have so little [materially] but are still so happy; I am grateful now that I have roof over my head and my good health!”. 

Our work on S. aureus as a cause of maternal sepsis and other hospital-acquired infections started to yield results (https://www.biorxiv.org/content/10.1101/2020.11.20.371203v1), and Chloe returned to Fort Portal in January 2020 to share these results with hospital and public health staff. She used virtual reality kits to help her deliver messages about antibiotic resistance and how it develops. Through continuing collaboration with Louise Ackers this work also contributed to improved antimicrobial stewardship both locally and nationally. 

An infectious control ( hand hygiene) class at Kibiito Health Centre.  

In late 2017 we were chosen to showcase the work we’d been doing in Fort Portal to a delegation of academics from the University of Gulu who were visiting Salford University. Gulu is in northern Uganda, a region devastated by civil war in the 1990s and 2000s and now accommodating hundreds of thousands of refugees from South Sudan and the Democratic Republic of Congo. The University in Gulu is new and very keen to establish collaborations with Institutions that have strong global health research, thus in January 2018 Chloe, Ian and I made a reciprocal visit to Gulu aiming to develop these collaborations. 

We had an amazing, exhausting trip, which included me addressing prisoners in a remote jail about body lice and the infections they transmit, and encounter with children suffering from the terrible “nodding disease”, the cause of which remains a mystery. Ian and one of his PhD students were able to carry out field work collecting tsetse flies, which transmit sleeping sickness. We established links with scientists working on black flies that transmit river blindness and are now working together exploring the microbiomes of black fly guts and their possible impact on Onchocerca volvulus transmission.  

The one person we didn’t meet in Gulu was Dr Richard Echodu, the Director of Gulu University’s new multifunctional research laboratories, who was away in Kampala. However, in early 2020 yet another moment of serendipity led to our working together on the biggest Salford-Uganda collaboration to date. Richard and I were talking about a grant application to support the black fly microbiome work mentioned above, when I mentioned COVID-19.  Richard spoke passionately about how unprepared Uganda was for the pandemic and we both agreed to look out for funding that might give us the opportunity to contribute the country’s response to the virus. A week or two later, Ian found a call for the UK Government through its Global Challenges Research Fund that seemed to fit the bill. What followed was pandemonium as Ian, Richard and I raced to submit our application (at the same time as converting all our teaching to online and teaching students as befuddled by all the changes as we were), but submit we did, and a month later we got the surprising news that we’d been funded.  

The project started last August and under the management of the magnificent Dr Judy Mwangi (who just completed her PhD at Salford University) with fantastic support from Louise Ackers and many other people, we are now six months in and still standing. Working in two countries during the pandemic has thrown up many barriers but this week our diagnostic laboratory opened for business with the approval of the Ugandan Ministry of Health. We now aim to test at least 25,000 people for SARS-Cov2 infection in the next few months and to compliment this with genome sequencing by the summer.  

Me playing a rather passive role in collecting ticks off local cattle. Doing most of the work is my ex-Phd student Jess and Philip (right), a Regional Veterinary Health Officer. 

We’re particularly interested in the impact the virus is having on refugee communities and how the epidemiology of infections might be shaped by risk factors quite different to those recognised in the UK, such as age and obesity. Most Ugandans are young and not fat, but they are far more likely to be carrying parasites or be malnourished than Salford residents. Hopefully, this time next year, we’ll have some answers and we’ll also have helped Gulu University establish itself on the national stage as a centre of molecular microbiology research excellence because the need for such expertise will not go away with COVID19.                   

So, as far as this story goes, we’re nowhere near the end, but maybe we’re at the end of the beginning. There will undoubtedly be many opportunities for oldies like me, Ian, Chloe and Louise, who have loved global health for many years, but there are also opportunities for those just starting out; those who recognise that the relevance of biomedicine and bioscience extends way beyond the boundaries of Salford, or Manchester, or the north-west, or the UK. There’s a big world out there waiting!  

K4C placements are available (again) from September 2021 and are open to all, regardless of whether you are still a student or not. For more information, check out their website, www.Knowledge4Change.org. 

Can Fight or Flight Turn hair White?

By Bruce Veloso

An old tale going back to the 1789-1799 French revolution says that Marie Antoinette, the last queen of France, was sentenced to the guillotine after being accused of treason, it is said that her hair turned white overnight. It is believed that the stress caused by being sentenced to death resulted in the change of Marie’s hair color.  Although the story may seem farfetched, research suggests that high levels of stress can indeed change the hair to a white color.

Recently, a team of researchers led by Bing Zhang from the Harvard University Stem cell institute, identified a mechanism that links hyperactivation of the sympathetic nervous system and a rise in norepinephrine to a reduction of stem cells that specifically regenerate pigment in the hair follicles of mice. It was clearly noted this linkage turns hair white¹.

“For the longest time it’s been said that stress makes the hair turn white, but until now there was no scientific basis for this belief. Our study proved that the phenomenon does indeed occur, and we identified the mechanisms involved. In addition, we discovered a way of interrupting the process of hair color loss due to stress” 

Co-author, Thiago Mattar Cunha. 

When the researchers involved in this study first tried to figure out why acute stress can cause gray hair, the stress hormone cortisol was expected to be the main causative factor for the loss of hair colour, because stress elevates levels of the hormone cortisol in the body. But it came as a surprise to the researchers that once the adrenal gland from the mice was removed so that they could not produce cortisol, the hair still turned grey under stress. This suggested that cortisol was not a main causative factor in the hair turning gray.

Figure 1. Stress turns hair white: Comparison of representative control mouse with black fur (left) to a representative mouse subject to sustained stress for several months (right)¹. 

How does stress change hair color? 

When the researchers involved in this study first tried to figure out why acute stress can cause gray hair, the stress hormone cortisol was expected to be the main causative factor for the loss of hair color, because stress elevates levels of the hormone cortisol in the body. But it came as a surprise to the researchers that once the adrenal gland from the mice was removed, so that they could not produce cortisol, the hair still turned grey under stress. This suggested that cortisol was not a main causative factor in the hair turning gray. This then led to the researchers to expand the focus of the experiment to the entire sympathetic nervous system (SNS), which directly impacts the fight or flight response in both humans and mice. The experiments involved the use of a dark furred mouse and it was noted that the SNS can touch every mouse hair follicle. When pain-induced stress was applied, it triggered a fight-or-flight response from the mice in the autonomic nervous system that caused a rise in norepinephrine levels. This rise in norepinephrine then disabled the pigment-regeneration ability of the stem cells present in the hair follicle. 

“Acute stress, particularly the fight-or-flight response, has been traditionally viewed to be beneficial for an animal’s survival. But in this case, acute stress causes permanent depletion of stem cells.” 

Lead author, Bing Zhang. 

This research paper was widely praised within the scientific community in 2020. The significance of this findings can be expanded past hair follicles and allow scientists globally to better understand how acute stress can impact other tissues and organs within the human body. This, perhaps, allowing for different treatments of known conditions, treatments that can reduce the impact of stress on our bodies. 

References: 

1.  Zhang B, Ma S, Rachmin I, et al. Hyperactivation of sympathetic nerves drives depletion of melanocyte stem cells. Nature. 2020;577(7792):676-681. doi:10.1038/s41586-020-1935-3 

The Emerging Role of a Physician Associate: Interview with a PA

BY PATRICIA MEDEIROS

Dr Eugene Stead (the US chairman of the Department of Medicine) founded the physician associate (PA) profession in 1965. There was a prominent shortage of physicians and other medical providers, resulting in a higher demand for healthcare professionals¹. As a response to this, Dr Stead initiated the PA course; a 2-year medical masters with a fast-paced curriculum, similar to the 3-year medical curriculum used to train doctors in World War II². However, due to the knowledge required, potential candidates could only matriculate if they had previous health-related training. Following the graduation of the first PA cohort, other US universities incorporated the PA course in their medical schools. Numerous countries around the world have since developed their own versions of the course, including the UK.

The UK formally introduced the PA profession in 2003. The Faculty of Physician Associates (FPA) defines PAs as medically qualified professionals with a generalist healthcare background³. PAs are an emerging role in the NHS and an integral part of the multidisciplinary team. They are dependent practitioners, working in liaison with medical supervisors, these commonly being consultants and surgeons. However, with the appropriate training, PAs can work autonomously.

During the course, PA students attend a series of clinical placements in primary care (GPs) and secondary care (hospitals). These placements include a variety of medical specialties, such as, paediatrics, GP, general surgery, obstetrics and gynaecology, mental health and more. After qualifying, PAs can choose to reside in a single area of medicine, but they also have the option to move between specialties. As part of the multidisciplinary team, PAs have become increasingly prevalent within the world of medicine and more widely recognised in the healthcare sector. PAs are not doctors; the PA role was designed to develop generalist clinicians as opposed to a specialised healthcare professional. For example, Drs commonly train to become ‘specialists’ in one area of medicine and PAs train to become ‘generalists’ in many areas of medicine. PAs have obtained a previous health-related degree, whereby certain areas of that degree incorporate key components of medicine. Therefore, providing them with a subsequent generalist medical education, develops competent individuals with the ability to work in varying areas.  

There are, approximately, 30 universities in the UK offering the physician associate course. To become a qualified PA, applicants are firstly required to achieve a 1^st class (or a 2.1 honours) in a 3 to 4 year undergraduate degree. This degree has to be in a science or health-related subject. Examples of these include, biomedicine, pharmacology and medical sciences. Following this, an additional 2 years of the PA masters (MSc) or the postgraduate diploma (PGdip) is required (or alternatively, a 4 to 5 year MPAS). PAs are also required to complete a series of university exams, a national exam, assessments, OSCEs, and more in order to qualify⁴. After qualifying, PAs are then further trained in a specialty of their choosing, with many completing internship years or, alternatively, rotational posts. As with many other medical professionals, PAs must also sit a recertification exam every 6 years. This exam encompasses all areas of medicine, regardless of the area the PA is currently working in. This ensures that all PAs maintain a general knowledge of medicine for patient care and safety.   

As physician associates study postgraduate level medicine, once they qualify, they are able to: diagnose and treat their own patients; formulate management plans; perform surgical procedures; run clinics; take medical histories; carry out physical examinations and more. Currently, PAs in the UK do not; sign off prescriptions, request ionising radiation or have licenses to work in certain countries. However, PAs in other countries, such as the US, do not have these limitations. This is mainly because the PA role in the UK is newly established and currently not regulated. However, in 2022, the General Medical Council (GMC) will become the official new statutory regulator for PAs. This means that the current limitations are being re-evaluated with plans for prescribing rights, licenses to work abroad and a clear progression pathway for the role⁵. 

AN INSIGHT INTO THE PA PROFESSION: 
PA THOMAS SMYTH IN CONVERSATION WITH PATRICIA MEDEIROS 

With guest editing by Afnan Housein and Nabiha Ahmed

WHAT DID YOU DO YOUR DEGREE IN?    

“I did my undergraduate degree in sports rehabilitation at the University of Salford and graduated in 2015. Then, I completed the PA course at the University of Manchester and I did the PGdip, not the MSc, so I didn’t need to do an additional thesis at the end of the course.”  

DID YOU HAVE ANY WORK EXPERIENCE BEFORE APPLYING?

“I was in the very first cohort, in the northwest, back in 2016. As the course was quite new, I didn’t know what experiences were applicable, so I tried to make everything as relevant to healthcare as possible. Luckily, with my sports rehabilitation degree, I already had placements in the NHS setting, like working with orthopaedic surgeons in hospital. Unfortunately, a lot of students now won’t have as much experience due to COVID-19, so universities are being slightly more lenient. We do have a mentor scheme at Salford Royal called the PA Academy and there’s also the North West PA Forum so people can get in touch for an insight into the role. We understand that students are doing their best under the current circumstances.”   

WHAT TIPS WOULD YOU GIVE ON WRITING A STRONG PERSONAL STATEMENT?    

“A useful tip that I was told, was using a ‘SEE’ approach, which is a ‘skill’, then an ‘experience’ relating to that skill, then an ‘elaboration’ on that and how it applies to everyday needs. Also, always link experiences to healthcare, even if they are not directly in a healthcare setting.  Try not to waffle – whoever is reading your personal statement is trying to gain an understanding of your knowledge and experiences from a short-written piece.”

WHAT WAS YOUR INTERVIEW LIKE AND WHAT ARE INTERVIEW PANELS LOOKING FOR WHEN SELECTING A PA?

“I actually interview applicants at Manchester and the process now is different from when I applied. Back then, we had to go to Hayfield Racecourse because I think there were 500 of us and only 140 places, spread between 3 universities. We had MMI (multiple mini interview) stations and if you got through, then you got a place at one of the 3 universities based on what you scored. It was very intense, but I think interviewers are looking for students that can understand and distinguish the PA role from other allied professions. It is also good to be knowledgeable on the NHS and its core values, data protection and more.”   

WHAT MADE YOU CHOOSE THE PA ROLE, AND DID YOU EVER CONSIDER MEDICINE?

“Yes, I always wanted to study medicine and I did a lot of research into it and found the PA course which, honestly, really resonated with me. I did a sports rehabilitation degree, so I already knew a lot about the human body and how it functions, but I wanted to know more. I think that a key factor in studying medicine to be a Dr. and studying medicine to be a PA, is that the course itself is 2 years, but it’s a postgraduate masters, so you need knowledge from another 3-4 year degree. After that, you can then still go into any specialty whilst maintaining a generalist approach. So because we are generalists, we can transition between specialties, without restarting our training, so I really liked that flexibility.”  

WHAT SPECIALTY ARE YOU CURRENTLY WORKING IN AND WHAT WAS YOUR MOST INTERESTING CASE ?

“The apple didn’t fall too far from the tree; I went back and did trauma and orthopaedics and I just fell in love with the role at Salford Royal hospital, especially the surgical element to it. So, I think the most interesting case I’ve had was a bone transportation surgery. Unfortunately, a patient had a high trauma road-traffic accident and a large portion of the bone in their leg was missing. We have a phenomenal team of specialist surgeons called the limb recon team. So, we did a bone transportation where we physically cut a segment of the bone and transported it millimetre by millimetre each day, and you could actually see the bone regrowing, it was amazing.”

Physician Associate, Thomas Smyth (Instagram-@Thomasthepa) 

WHAT IS YOUR FAVOURITE PART OF BEING A PA AND ONE THING THAT YOU WOULD POTENTIALLY IMPROVE?   

“For me personally, it would have to be the flexibility and the work-life balance. I’m in many different places throughout the week. I’m a PA ambassador and a guest lecturer too. I’m also in theatre for surgery a lot and I run my own clinics, so I enjoy that. But I think if I was to improve anything, it would be the recognition of PAs. There are a few misconceptions about the role and it’s undervalued at the moment because it’s quite new in the UK and people don’t always know what we can do.”  

WHAT DO OTHER HEALTH CARE PROFESSIONALS THINK OF YOUR ROLE AS A PA?

“When I first started, they weren’t quite sure on what the role was, so I was often having to explain. I was also trying to fit in this huge, already well-established, medical team. But as soon as I got past that, there was a huge gap to be filled. Me and the other PAs don’t really rotate around; we’re there to offer patient continuity so we know the system. Since we’ve been there for 3 years, we’re able to teach the junior doctors that come in and get them into the system very quickly.  We can free up the ward time for the juniors, so that they can go into theatre and into clinics and get all these extra experiences, so actually, we do work very well together.” 

WHAT DO YOU THINK THE GMC REGULATION MEANS FOR PAs?

“GMC doesn’t really change my role, but it would make it slightly easier. I work in a profession where I need both ionising imaging and to prescribe, but the doctors are there for support and vice versa.  But equally, I am a bit sceptical because with the GMC regulation, PAs may become more prevalent on the wards without much support from the doctors. But overall, I think it’s a great thing because PAs can expand their scope of practice.”   

WHAT ADVICE WOULD YOU GIVE TO PROSPECTIVE STUDENTS?  

“Personally, I had a great experience, so choosing to be a PA was a success story in itself, I definitely recommend it. I would say though, students need a clear distinction as to which medical model they want to study, whether that’s a PA medical model or a Dr. medical model.  Any aspiring PAs are welcome to look at our mentor scheme or contact me on social media with any other questions!”

Find Thomas on Instagram:
@ThomasthePA
To find out more about the mentor scheme, visit thepaacademy.co.uk

Students at the University of Salford can join the Graduate Entry Medicine, Dentistry and Physician Associate Mentoring Scheme for guidance and mentoring with PA applications. For more information on this, please contact S.Namvar@salford.ac.uk.

References

1.        Longmire D. The Use of Physician Assistants for Health and Wellness in Aging Population.; 2020. Accessed February 18, 2021. https://scholarscompass.vcu.edu/uresposters/325/
2.        Brady MI. A Survey Assessing Patient Satisfaction with Physician Assistant Care at the Maple Street Clinic.; 2004. Accessed February 18, 2021. https://core.ac.uk/download/pdf/48843937.pdf
3.        Reynard K, Brown R. A clinical analysis of the emergency medicine workforce crisis. Br J Hosp Med. 2014;75(11):612-616. doi:10.12968/hmed.2014.75.11.612
4.        Murphy DC, Harvey A. Jeannine Watkins is a physician associate. BMJ. 2020;371:m3858. doi:10.1136/bmj.m3858
5.        Ghadiri SJ. Physician associates: an asset for physician training and a 21st-century NHS? Futur Healthc J. 2020;7(3):e9-e10. doi:10.7861/fhj.teale-7-3

My Journey to Salford: Charles

My journey to Salford brings you inspiring stories each issue from students who have overcome adversity to reach their current destination at the University of Salford

BY CHARLES MIDDLETON

My journey to Salford has not been an easy ride. There have been many challenges I have had to overcome, am yet to overcome and still face in everyday life. As we know, life is tough and struggles are a part of daily life. Maybe for some more than others. 

So, I am a student on the autistic spectrum. Autism, for me, means that some things can bother me, even the littlest of things, that maybe others do not think about often. It can be hard to socialise, particularly when I do not always pick up on body language and facial expressions. This has been tough during online lectures, but I am gaining confidence with getting opportunities to take part in extracurricular activities, such as the Biomed Society. Societies are a great way of socialising and practicing understanding social cues. Sensory processing can also be a challenge for me, such as with loud noises and food textures. Because of this, my journey to Salford has been a never-ending mountain of obstacles that I have had to tackle. Kind of like when you first learn to ride a bicycle and you fall off and get back up and try again, but continuously. It can be hard, trying to fit in, trying to succeed, trying to get to your destination. 

Throughout my school years I found it difficult to make friends and mostly preferred being on my own. I wasn’t like everyone else – I didn’t use much technology, I didn’t do fashion trends, or have an interest in being part of a friendship group What I did do was have a routine, do extra studying at home and even a paper round job. These things helped me and still do. 

Being on the autistic spectrum can have some advantages too. For me, I am determined, I pay attention to close details and I am good at identifying patterns. In fact, autistic individuals have great attributes and qualities which can contribute to unique talents, ideas, and innovations. I tend to think outside the box, then outside again, and then further outside; I like to solve a problem when it arises, and I ensure that I am always prepared to.

One thing I do enjoy is learning. However, I process things differently to some of my peers and see the world as something perhaps I do not understand, yet information processing is a a part of daily life and vital to academia. I did not think I would get into college, or even get onto the course I am doing at Salford. 

Throughout this year, I have had even more challenges throughout the pandemic. Not only with becoming a new student at Salford, but socialising. It can become lonely, stressful and tiring at times. Changes that I am not used to or are not part of my pre-planned routines have been a struggle. What helps is discussing these with my lecturers and support staff and doing my best to plan for any changes that will occur further along in the course. 

What I am grateful for is how different my experience at Salford has been: I have been supported throughout my time here so far, have made some great friends who are understanding and patient, and most of all, I feel like I am part of a community. 

Charles Middleton is a first year undergraduate student of BSc Human Biology and Infectious Diseases.

Want to share your inspiring story of overcoming adversity in your journey to Salford? Visit our contributions page.

Biomedicine Careers Hub Launched on Blackboard for Salford Students

By Dr David  Greensmith 

I’m sure that for most of you, to enter a career related to your degree — and thus realise your ambitions — is of the upmost importance. Indeed, it’s probably why you chose your particular degree in the first place! In an increasingly competitive employment landscape, choosing a career path that is right for you, then making yourself as employable as possible, has never been as important. 

To facilitate this, the Biomedicine leadership team has launched a brand new “Biomedicine Careers Hub” located within the communities section of Blackboard. It’s important to stress that the hub does not replace existing dedicated and personal mentorship schemes such as Biomed Soc, the Research Careers Working Group and GEMMS/PA. Rather, it will support and expand those schemes by providing a permanent and centralised repository for resources related to careers and employability 

At the top of the hub’s landing page, you will see a video (see “Welcome to the Biomedicine Careers Hub”) that provides more general information but briefly, you can use the hub in two ways: 

(1) To research career options

On the hub, you will see activity spaces for fundamental career groups. We have kept those groups relatively high level (representing a considerable breadth of distinct pathways in some cases) and the list certainly isn’t exhaustive. Indeed, if you feel a certain career group isn’t represented, let us know. Nonetheless, you can casually browse the hub to get an idea of the sort of careers that are aligned to your degree. If you decide you wish to pursue a given career, the associated space will provide specific information that intends to help with your own endeavours. For example; career-specific job advert sites, CV-enhancing opportunities and application / entry routes. 

(2)  To make yourself more employable

To facilitate entry into any career, the richer your CV the better; you must stand out from the crowd.  To this end, we will also place CV-enhancing opportunities on the hub. If you engage with as many opportunities as you can, your CV will improve consequently. As most opportunities have wide scope (i.e. will support many degree-related careers), they will appear in the “CV-enhancing opportunities (for all careers)” space. If an opportunity is career-specific, you will find it in the related career space. Remember, many opportunities are transient so you should check the hub frequently. 

The hub is a highly dynamic resource. It will constantly grow and develop with new content so do access it on a regular basis to see what’s new. And remember that while we created this resource to help you research careers, enhance your CV then go for the jobs, all we can do is provide the opportunities. It is up to you to engage with as many of those as you can to make yourself as employable as possible!  Enjoy the hub. Your programme team has invested a lot of effort in creating this for you, so we really hope you find it a useful resource. Feel free to send constructive feedback to d.j.greensmith@salford.ac.uk.

Pfizer-BioNTech COVID-19 Vaccine Explained

BY NADIA PATEL

With a variety of questions following its approval by regulatory bodies in the UK and US, many are focussed on communicating the precise mechanisms of the Pfizer-BioNTech mRNA vaccine to protect against COVID-19 or SARS-CoV-2. This piece aims to explore the contents of the vaccine and its exact effects upon injection into the muscle of the upper arm. 

The vaccine developed by Pfizer-BioNTech is different from other pre-existing vaccines: rather than using weakened or inactivated forms of the pathogen (disease-causing particle), it contains genetic information in the form of mRNA. To account for the effects of this, it’s important to acknowledge the body’s cellular machinery and the effects that the invading virus has: 

All cells contain  DNA. This is a very compact molecule that contains massive amounts of information encoded into its molecular structure. It contains instructions for your body on pretty much everything, from your eye or hair colour, to the exact details of chemical processes that take place in your digestive system. 

In order to mobilise (read and use) instructions in DNA, the cells convert DNA into  messenger RNA [mRNA] in a process called  transcription. 

This requires existing cell machinery called  ribosomes  to read the instructions in the  mRNA  molecules in a process called translation and use them to make proteins which are vital for all day-to-day function. 

The virus takes advantage of the cells’ existing processes, hijacking the structures to reproduce its own genetic information (also in the form of mRNA) rather than that of the original, functional cell.

Viruses hijack healthy cells’ existing machinery to produce  their own viral proteins  which then go on to help produce more of the virus. This is what disrupts regular function and causes disease¹.

Figure 1: Creative rendition of SARS-CoV-2 virus particles. Note: not to scale. Credit: NIAID 

The vaccine particles interact with the body’s cells, fuse with them and release the spike mRNA into the cells. The cell then uses its own ribosomes to construct the spike proteins which, on their own, are relatively harmless. (Figure 2, below) The inserted mRNA is eventually destroyed by the cell, leaving no permanent trace. 

What’s the effect of having SARS-Cov-2 spike proteins in the body’s cells? 

Once they are constructed, spike proteins (and fragments of spike proteins) migrate to the surface of the cell and stick out tips. This is recognised by the body, specifically the body’s immune system, and generates an immune response⁴. 

Figure 2: Creative rendition of interactions between vaccine particles and vaccinated cell. Shows how cellular machinery is used to synthesise spike proteins. 

How does the immune system react once recognising the foreign protein fragments following vaccination? 

Once the cell is recognised as foreign and infected, it is destroyed by the immune system, releasing its contents into its surroundings. The released spike proteins and their fragments are then collected by and displayed on the surface of an immune cell called an antigen-presenting cell. This can have several effects (Figure 3): 

Figure 3: Creative rendition of communications between immune cells involving antigen-presenting cells. 

The antigen-presenting cell activates a type of immune cell called the helper T-cell. Helper T-cells detect the fragments of proteins presented by the antigen-presenting cell and communicate with the rest of the body’s immune system to help fight the infection. 

Antigen-presenting cells also activate a type of immune cell called killer T-cells. These then seek out and destroy infected cells displaying spike protein fragments on their surfaces. 

Immune cells called B-cells then synthesise and secrete antibodies. These are protein molecules that the body produces in response to disease and uses to fight infections. Antibodies produced in response to the vaccine also have the ability to help fight SARS-CoV-2; they latch onto SARS-CoV-2 spike proteins, flagging them to the rest of the immune system to be destroyed. They also prevent further infection of other healthy cells by blocking the spikes from attaching to them (Figure 4). 

Figure 4: Transmission electron microscope image shows SARS-CoV-2, causing COVID-19, isolated from a patient. The spikes on the outer edge of the virus  give coronaviruses their name (corona = crown). The spikes act as a target for both immune response in disease and potential therapies. Source: NIAID-RML

The Pfizer-BioNTech vaccine requires two injections, given 21 days apart. It’s possible that in the months after vaccination, the number of antibodies and killer T-cells in the body will decrease, as researchers still aren’t sure exactly how long protection will last. However, the instructions to construct the disease-fighting antibodies are stored in the body’s bespoke ‘disease database’ managed by immune cells called memory B-cells and memory T-cells¹. 

The production of antibodies in response to vaccination gives the body’s immune system a much-needed ‘headstart’ in fighting a potential SARS-CoV-2 infection. This means that the body can recognise and fight the virus by producing antibodies much more quickly than if the vaccine was not given. On 18th November 2020, Pfizer and BioNTech reported that primary efficacy analysis of the BNT162b2 vaccine demonstrates 95% effectiveness against COVID-19 beginning 28 days after the first dose⁵.  

Whilst the exact logistics of its use within healthcare systems are still being determined, it is certain that the use of an effective and safe vaccine will prove invaluable in the first stage of global recovery from the pandemic. 

References

1.  Sadava, David, et al. Life: The science of Biology. 11th. Sunderland, MA : Sinauer Associates, 2016. 
2. mRNA vaccine delivery using lipid nanoparticles. Reichmuth AM, Oberli MA, Jaklenec A, Langer R, Blankschtein D. 5, 2016, Vol. 7. 
3.  Developing mRNA-vaccine technologies. Schlake T, Thess A, Fotin-Mleczek M, Kallen KJ. 11, 2012, Vol. 9. 
4.  Pierce, Benjamin A. Genetics: A Conceptual Approach. 6th. New York, NY : W. H. Freeman and Company, 2017. 
5.  Pfizer and BioNTech. Pfizer. [Online] 2020. [Cited: November 29, 2020.] https://www.pfizer.co.uk/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine-candidate-meeting-all-primary-efficacy-endpoints.