The Infectious Etiology of Chronic Diseases Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary (2004) / Chapter Skim
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4 Opportunities to Prevent and Mitigate the Impact of Chronic Diseases Caused by Infectious Agents
4 Opportunities to Prevent and Mitigate the Impact of Chronic Diseases Caused by Infectious Agents
Pages 174-186
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From page 174... ...
Among therapeutic possibilities, vaccines hold a special attraction, given their unique record of totally eliminating or eradicating several target diseases. Recent advances in molecular biology and genetics have provided powerful new methods for vaccine development.
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From page 175... ...
Helena Mäkelä described the recent advances that are raising promise for the development of vaccines to fight chronic diseases, either by preventing acute infection or by curing established persistent infection. The possibility of developing a vaccine to fight cardiovascular disease, one of the major killers in the United States and worldwide, served as an example.
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From page 176... ...
Vaccination is an exciting novel concept for intervention in chronic diseases arising from the realization of a link of many chronic conditions with infectious agents. A second aspect that sets vaccination apart from other interventions is that it is based on acquired immunity, the powerful defense system of the mammalian body.
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From page 177... ...
Nevertheless, it is also true that no animal experiments can replace final clinical trials in which the vaccine is evaluated in its real target population. Of the problems listed, the question of persistent infection requires special attention as a feature not considered in the context of conventional vaccines.
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From page 178... ...
An effective vaccination program reaching a high coverage rate would also be likely to reduce the transmission of the infectious agent and thereby lead to herd immunity further enhancing the overall effect of the program. Vaccination of this type would seem very attractive for prevention of infections that lead to the chronic disease relatively early in life, e.g., for juvenile diabetes, if the connection to the infectious agent is established and a vaccine available.
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From page 179... ...
pneumoniae after infection: it has been identified in peripheral blood mononuclear cells and in vascular plaques of individuals with other osclerotic disease. The role and mechanisms of action of the persistent bacteria in the pathogenesis of cardiovascular disease is open -- potential mechanisms suggested include local reactivation of the bacteria with resulting local inflammation, activation of the blood coagulation system, and induction of various cytokines either directly by the bacteria or their components (especially lipopolysaccharide)
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From page 180... ...
. These experiments have shown that the cure of the acute infection did not require antibodies or either CD4+ of CD8+ T-cells; however, in more severely deleted mice lacking both types of T cells cultivable bacteria continued to be present in the lungs in relatively high numbers.
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From page 181... ...
. This is an entirely novel mechanism of immune evasion by pathogenic microbes, and certainly presents a formidable challenge for vaccine development.
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From page 182... ...
1999. Depletion of CD8+ cells abolishes memory in acquired immunity against Chlamydia pneumoniae in BALB/c mice.
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From page 183... ...
Strategies that use collaborations to enhance the productivity of independent investigators, integrate rigorously executed laboratory techniques into welldesigned epidemiologic studies and surveillance systems, and complement short-term studies with long-term follow-up can overcome the hurdles to create new prevention and intervention opportunities. Balancing research on potential infectious links for common chronic conditions, in which the contribution of microbes to overall burden could be minor, with that on less common diseases, perhaps likely to have a primary infectious cause, could benefit many.
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From page 184... ...
Therefore, just as vital will be a parallel investment in epidemiology that emphasizes: · Linking of databases -- for infection-chronic disease associations, infectious diseases, and chronic syndromes -- designed or modified to be compatible; · Observational epidemiology to identify clusters and trends; · Application of validated pathogen discovery technology to further describe the epidemiology of infections and identify potential infection-chronic disease links; · Achieving balance between cross-sectional studies and longitudinal cohorts of individuals affected and unaffected by a chronic disease, including those infected and uninfected; · Longitudinal follow-up of infectious exposures through surveillance systems (e.g., state-based FoodNet surveillance) and cohorts of recently infected people; and · Banking specimens for analysis with future technology and to study newly proposed etiologic associations.
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From page 185... ...
As the field expands two additional, crosscutting issues call for continuous consideration: · To capitalize on the benefits afforded by confirmed and newly discovered infection-chronic disease links, medical education (training and continuing education) must improve recognition of known and potential links, the attendant intervention opportunities, and the cautions against inappropriate therapies; and
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From page 186... ...
186 THE INFECTIOUS ETIOLOGY OF CHRONIC DISEASES · The potential changes that population migrations and individual travel impart on the distribution and character of even established associations create an ongoing need for surveillance. Although the links between infectious diseases and chronic diseases can be complex and multifactorial, they can be characterized, and beneficial interventions against infection designed.
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