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Comparing parts of UK & US Healthcare systems, IgG explained

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NAC consultant Eavan Muldoon introduces herself as our new medic and talks a little about her background, part of which was spent at Tufts Medical Centre, Boston, USA. Then Graham Atherton talks about ...

NAC consultant Eavan Muldoon introduces herself as our new medic and talks a little about her background, part of which was spent at Tufts Medical Centre, Boston, USA. Then Graham Atherton talks about IgG, what they are and how they work.

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    Comparing parts of UK & US Healthcare systems, IgG explained Comparing parts of UK & US Healthcare systems, IgG explained Presentation Transcript

    • LED BY GRAHAM ATHERTON SUPPORTED BY NAC CENTRE MANAGER CHRIS HARRIS EAVAN MULDOON CONSULTANT THE NATIONAL ASPERGILLOSIS CENTRE NATIONAL ASPERGILLOSIS CENTRE UHSM MANCHESTER Support Meeting for Aspergillosis Patients & Carers Fungal Research Trust
    • Aspergillus meeting – Friday 20th September 2013 Eavan Muldoon Consultant in Infectious Diseases
    • Tufts Medical Center
    • Differences between the USA and UK • Differences in healthcare provision – Funding – Structure of medical teams – Clinics – Number of doctors • Differences in Management of Aspergillus disease
    • Aspergillus outbreak USA 2012
    • Programme  1.30 Eavan Muldoon– NAC Consultant  2.00 Graham Atherton – Your subject (IgG)  2.30 Patients Discussion (Break)  3.00 Group discussion/Requests for information  ICAAC : A ‘sniffer’ for Aspergillosis  Patients survey  3.20 Q & A from the floor or online
    • Suggest a subject Can be on any relevant subject you would like to hear our opinion or get our help with Send suggestions to admin@aspergillus.org.uk Pass notes to me at clinic or at the meeting Phone them in (24 hrs) at 0161 291 5866
    • IgE Immunoglobulin E (IgE) – an antibody Also have IgA, IgG, IgM – each plays a different role IgE main role – defence against parasites! Normally very low levels IgE is released as soon as an infection is detected – the hypersensitivity response. Gets all immune cells ready for action – allergy!
    • IgE/IgG All look the same!
    • Role in disease Secondary Immune response (IgE Is part of the Primary Immune response) All happens in our Lymph nodes The most abundant Ig in our bodies – making up 75% of all Ig molecules circulating Made by B cells Controls infection – bacteria, virus, fungus
    • Highly specific Ends are HIGHLY variable so can recognise millions of different molecules on the surface of foreign bodies entering our bodies
    • Recognition & replication Once attached the other end of the antibody becomes very attractive to B cells, which will stick to it. This stimulates the production of more B cells producing that specific antibody and each B cell produces lots more antibody. This quickly produces vast numbers of specific antibodies All this activity is one reason why your lymph nodes swell up when you have an infection!
    • Recognition & replication Interestingly, the better the ‘fit’ (recognition) of the antibody to the foreign particle (virus, bacterium, fungus) the more intense the production of that antibody, so the best antibodies quickly dominate. Clever!
    • Vaccines Once B cells go through this process they can become ‘memory’ B cells with a long life – this is why vaccination works. In vaccined individuals, IgG appears about 24–48 hours after infection.
    • How do antibodies work? Multiple mechanisms IgG-mediated binding of pathogens causes their immobilization and binding together via agglutination; IgG coating of pathogen surfaces (known as opsonization) allows their recognition and ingestion by phagocytic immune cells; IgG activates the classical pathway of the complement system, a cascade of immune protein production that results in pathogen elimination; IgG also binds and neutralizes toxins
    • Protection of new born child IgG is small in size allowing it to easily perfuse tissues. It is the only isotype that can pass through the human placenta, thereby providing protection to the fetus in utero. Along with IgA secreted in the breast milk, residual IgG absorbed through the placenta provides the neonate with humoral immunity before its own immune system develops. Colostrum contains a high percentage of IgG, especially bovine colostrum.
    • What do your tests mean? If you have large amounts of IgG circulating in your blood, you probably have an ongoing infection (not allergy!) If we can identify the specific type of antibody as being one that attaches to a specific bacteria, virus or fungus then it tells us which organism is causing the infection. Useful!
    • Other uses Screening blood or other tissue
    • Other uses: Detection Specific detection
    • Other uses: detection Can link antibody to colours This is an image showing where 3 different proteins are in a single cell.
    • Other uses: detection Highly convenient, disposal tests (very simple to use)
    • Other uses: detection/purification Great for detection Used to try to use this to get purified protein – limited in scale and purity
    • Other uses: purification Magnetic beads
    • Any other Immunoglobulins? IgM – very large, found in spleen. Good indicator of very recent infection. Good at binding infecting particles even if no prior immunity! Blood agglutination is mainly caused by this Ig IgA – Important in the mucosal lining of our organs, the main immunoglobulin found in mucous secretions, including tears, saliva, colostrum and secretions from the genitourinary tract, gastrointestinal tract, prostate and respiratory epithelium. Highly resistant to breakdown in gut. IgD – found in small amounts in blood.
    • ICAAC 2013: Aspergillosis ‘sniffer’ An Aspergillus fumigatus (AF)-Specific Breath Volatile Organic Compound (VOC) Profile is Diagnostic of Invasive Aspergillosis (IA) Sophia Koo, MD; Brigham & Women’s Hosp., Boston, MA Poster Session 023, Presentation M-219 The suggestion is that this research will enable us to diagnose invasive aspergillosis by testing the breath of the patient. This would be a useful tool (if reliable and accurate) as diagnosis of IA is currently slow and difficult, and even more importantly all delay in the diagnosis of invasive aspergillosis has the effect of increasing mortality rates. The sooner we are able to start treatment the better!
    • Patients Survey
    • Patients Survey
    • Patients Survey
    • Patients Survey Of those that answered no, 32% of them do not have a computer or use the internet. Anything we can do to improve this?
    • Patients Survey
    • Patients Survey Can we fix this in any way?
    • Patients Survey Can we improve this?
    • Has the move to Friday Meetings worked? 8 months prior to move - 32 patients/carers attended 8 months after move - 42 patients/carers attended (32% increase) Total numbers of visits have also risen 15 - 20% =Success! Any other ideas? Over the whole history of the meetings (3 years), over 150 patients/carers have attended.
    • Patients Survey Can we improve this?
    • Thank You “The best chance we have of beating this illness is to work together” Living with it, Working with it, Treating it Fungal Research Trust