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Hi Reddit! I'm Dr. Ellen Vitetta, biomedical scientist and professor of immunology. I design vaccines. AMA!

Apr 14th 2014 by DrEllenV • 48 Questions • 337 Points

Hi Reddit, My name is Dr. Ellen Vitetta. I’m a biomedical scientist and professor of Immunology at the University of Texas Southwestern Medical Center. I’m a past president of the American Association of Immunologists, a member of the National Academy of Sciences, the Institute of Medicine, and I was elected to the Texas Women’s Hall of Fame. I teach and mentor both medical and graduate students, and one of my former graduate students received the Nobel Prize in Physiology and Medicine in 2004. I’m very interested in women in science/medicine, the current state of federal science funding, and in novel ways of communicating the importance and excitement of research and science in general. In recent years I have been concerned with ethics in scientific endeavors and in reproducibly of scientific studies. My current work involves the targeted therapy of cancer and the development of vaccines (e.g. my lab developed the ricin vaccine and tested it in humans). I’d be happy to talk about women in science, scientific ethics, the importance of increasing federal funding for scientific research, immunology, and vaccines, but Ask Me Anything!

SIGNING OFF;12:15AM APRIL 15, 2014. PLEASE CONTINUE TO SUPPORT SCIENCE AND DON'T FORGET TO COMPLY WITH THE VACCINE GUIDELINES. BYE ALL!

Q:

How close do you think we are using immunotherapy to effectively treat cancer? Thanks!

A:

We're already doing it! and there are 100's more immunotherapies in clinical trials. The challenge is not treatment but cure, of course. And that is going to involve better methods for early detection.


Q:

I'm an immunologist as well. Antibodies recognize very very specific portions of pathogens or pathogen parts. So if two dissimilar pathogens, let's say bacteriums, both possess this tiny similar portion then that's all an antibody needs to tag it, even if they look and behave completely different.

A:

Agree!


Q:

Thanks for doing this!

If you had to pick one of the current bleeding-edge projects in immunology as being the one most likely to lead to knocking another killer disease out of mass circulation, which one would you pick and why?

A:

My crystal ball is at the cleaners, but I think that personalized medicine in all fields of disease will have the biggest impact on human health and well being in the near future. There is no longer any reason to believe that one-size-fits-all when it comes to treating or preventing disease. Many of the breakthroughs will come from understanding genomics, proteomics, and harnessing this information to determine how to handle each individual based on his or her risks, predispositions, and responses to therapeutics.


Q:

What makes viruses so much more difficult to find a vaccine for?

A:

Their high rate of mutation and rapid spread through our highly geographically-mobile society. Also, isolating the causative virus to MAKE a vaccine in the first place can take time, while the virus continues to mutate.


Q:

Do bacteria not mutate? Or just not as fast as a virus?

A:

Most bacteria mutate less often and in a different way than viruses. Most often, they develop drug resistance. However, if you are able to vaccinate against them in the first place (against bacteria, which CAN be vaccinated against), drug resistance would become a non-issue. This is part of what I find so exciting about vaccines! If you prevent the infection, you don't have to deal with all kinds of downstream problems!


Q:

So with HIV/AIDS being a virus how are we able to combat it so well now? Does it not mutate like other viruses?

A:

Left unchecked, all viruses mutate. The biggest problem with HIV is that it grows in the very immune system that you need to combat it, and therefore is more devastating. We still cannot vaccinate against HIV because of the many mutations and different substrains that exist. This is true of many different viruses. With regard to HIV, what we CAN do is treat somebody who is already infected and thereby turn this into a chronic as opposed to an acute disease. This has happened because of the many anti-viral drugs which have come onto the marketplace over the last 20 years. Did I interpret your question correctly?


Q:

And the flu, how do we have a flu vaccine. Isn't it a virus?

A:

Yes, it is a virus. Each annual flu vaccine in fact contains 3 flu strains. however, you have to give this vaccine every year because next year the strains may be different or may be the same with additional mutations. Therefore this year's vaccine may not protect against next year's virus.


Q:

Yes, you did. How do these antivirals work? And do they have antiviral concoctions for other viral infections as well?

A:

They target different pathways in the cell necessary for viral replication and production. By using mixtures of these agents you avoid the problem of a single mutation in one pathway getting around the drug, because there is a backup inhibitor in another pathway. This is why we call HIV drug-regimens "cocktails." Cocktails are finding their way into treating other viral infections as well. My guess is that just like mixed chemotherapies for cancer, we will soon be using cocktails for all chronic viral infections.


Q:

One last question regarding this an I'll be done. With the flu vaccine we give people flu viruses I'm assuming to try and boost the immune system to be able to fight it. Why can't something similar work with other viruses like HIV?

A:

It would likely work against that one strain. However there are so many strains of HIV out there all at once that the one you encountered probably wouldn't be the one vaccinated against. In contrast the annual flu strains are more limited and therefore vaccine will protect against this year's strains.

As an aside, trying to convince the FDA to immunize people with dead HIV took a long time.

If you could make a cocktail of ALL possible HIV strains on the planet, kill them thoroughly, and use that as a vaccine, it could work. Theoretically. The holy grail in this field is to find a molecule that is shared by ALL strains of HIV so that one vaccine would protect against all of them.

Finally, if you ask 100 immunologists this question, many would argue that you need something called "T-cell immunity" and that no combination of dead viruses will ever do the job.


Q:

In your career and field, what kind of progressions would you like to see by the end of your career?

A:

Two things. First, I would like to see more interactions between basic and clinical scientists and far less time-sucking compliance. By the end of my career, I would like to see many things, but the first that comes to mind is to promote science more--locally, nationally, and internationally. We are wasting too many hours and too many dollars on administration, compliance, politics, and egos, and not spending enough time solving problems.


Q:

What do you think will be the next big breakthrough with vaccines?

A:

With all humility, I think I may be working on it. The idea is to make vaccines that are broadly protective against all strains of a pathogen (e.g. a vaccine against ALL strains of influenza or HIV) by using entirely safe synthetic structures.


Q:

How much of a risk is it that viruses are becoming more resistant or immune to vaccines?

A:

Virtually any virus can mutate in the population to evade a previous vaccination. The key will be to develop vaccines against conserved structures that cannot mutate. I don't think the problem is necessarily getting worse, but that we are becoming more aware of it as we develop more and more sophisticated vaccines.


Q:

How long do you think it will be before we have this type of vaccine?

A:

It all depends on funding (and how well it continues to work). Right now I'm trying to raise money for my broken mass spec! Go figure.

However... if I had all the money in the world AND it continues to work, I believe I could have it done and in clinical trials in 6-8 years. That said, these predictions are very difficult to make. Sometimes things take longer than you think... occasionally you have sudden breakthroughs.


Q:

When might we get to see needle-less vaccines?

A:

We already have them in the form of nasal sprays (influenza) and sugar-cubes (polio). Trans-dermal patches are not far away. It may be possible in the future to put vaccines in food!


Q:

Have you always wanted to make vaccines?

A:

No. My interest in vaccines is a fairly recent one, based on connecting the many dots of immunology into a bigger picture. The more you see the big picture, the more you realize what we are missing in terms of developing effective new vaccines (broad immunogenicity, relationship between auto- and useful-immunity, etc). As I realized this in my own field, I decided to get involved in this very translational type of research. It's terribly tedious and complicated but it's exciting and has a HUGE payoff if you get it right. I'm trying!


Q:

Dr. Ellen Vitetta, SOMETHING IS WRONG WITH THIS SYSTEM! Do you think many scientists could be persuaded to join an institution with less prestige but more opportunities to do science rather than management?

A:

Yes it is. In my view (and just about everybody's) we need MORE Federal funding, a serious paperwork reduction act, fewer compliance courses and more scientists than administrators. When I entered this profession, administrators worked for scientists... Now it's the reverse. We scientists are terrified of litigation... And lawyers are getting rich.

I really don't think that the institution matters. There are just too many government agencies making too many rules. Ther are too many expensive and time- sucking lawsuits. We need to infuse some common sense into our government and into our science policy. Scientists have little time to THINK and be creative these days. Personally... I think that the tail is wagging the dog. Our government works for US , not the reverse. If you agree with me, contact your reps in Congress. Our constitution starts with "We the people"...


Q:

Aside from cancer, what major ailment/disease seems the most daunting from a research perspective?

A:

Alzheimer's and other brain disorders. In general, as we live longer, and are not as susceptible to infectious diseases because of vaccinations, we will be dealing more with "diseases" of the elderly. i.e. wear and tear on organs, degeneration of mental capacity, etc.


Q:

Hi there, thanks for taking the time to do this AMA and for all your thorough answers. What sort of ethical considerations/limitations do you take into account when developing a new vaccine?

One more question, and I'm sure you'll get asked about this more than a few times since it's a hot button issue on reddit, but what can be done about the resurgence of diseases in the wake of the claims of people like Edward Hooper or Jenny McCarthy? Obviously we need to simply keep educating people and continuing to push forward with vaccination programs, but is there anything else that you think we should be doing?

A:

Most of the ethical considerations involve the clinical trials in humans. You must acquire enough safety data in animals to be convinced that you are not going to cause unacceptable side-effects in humans. You must also be willing to design your trial whereby you start with very low doses and gradually escalate, watch every vaccinated individual carefully for a period of time (usually a month) and make sure you are DILLIGENT about following your protocol.

Second question--How to answer that? You are right, education is everything. We all know that people love conspiracy theories or feel that the medical profession is hiding things from them. I think it becomes the responsibility of every scientists to COMMUNICATE effectively with the population, rather than hole up in our labs and ignore the fact that people are social creatures and need interaction. By building trust amongst researchers, physicians, and the population at large, I hope that this problem will... go away...


Q:

Thanks for your answer. It seems that effective science communication is really vital skill, yet remains one that's sorely undervalued by far too many scientists. Vaccine researchers, climate scientists, evolutionary biologists, (list continues forever!) would all benefit significantly, and so would society, from more effectively being able to communicate the importance of their work the general public.

I think what's really lacking isn't the 'science' part of the communication, rather it's the ability to frame the information in an emotional context that deniers and naysayers find palatable.

A:

I agree. Just because you're a good scientist doesn't mean you're a good communicator, or have time to communicate. However, as the federal funding for science decrease, scientists are going to have to make the importance of their work more understandable to the general public. The public is ALSO responsible to make their priorities known to their legislators so that more of the federal budget is allocated to scientific research.


Q:

How deep is the crisis in the lack of federal funding for scientific research?

A:

The crisis is enormous. We are losing a whole generation of new scientists and we are shelving an entire generation of seasoned mentors. Our government needs to get its act together before our profession goes down the rabbit hole.


Q:

many hospitals have mandatory flu vaccination policies to protect patients. what do you think about health care workers who refuse vaccination because it conflicts with their religious beliefs? from 1-10 how stupid do you think that is?

A:

I think if it conflicts with their religious beliefs, that is their belief and should be respected, but they should find another profession which does not conflict with their religious beliefs. Remember that if they get the flu they will spread it through an entire hospital population of already sick patients. A key feature of religious freedom and tolerance is not to force the consequences of your religious beliefs on others.


Q:

How would a vaccine for a Biosafety level 4 pathogen go through human trials?

I don't know a lot about vaccines or whatever, but would that just not happen?

A:

The FDA requires safety testing of the vaccine in humans, and efficacy testing in 2 species prior to approval. It is not necessary for one of those species to be human for the challenge tests when it comes to the types of pathogens and toxins you are talking about.


Q:

What was your dream job coming out of college?

A:

To do exactly what I'm doing now, but with lots more funding and lots less compliance!!


Q:

Where can I send funding to?

A:

It depends on what you want to support. Virtually every disease has a society that collects donations for research. For example, the American Cancer Society. You can also give money to a University or a specific investigator. But in my own view, the best thing Americans can do to make sure that science is funded is to contact their representatives in government and tell them that this is a priority! Until our government's funding priorities get untangled, science funding will continue to be an enormous problem. We scientists MUST get better at communicating our needs to the American Public; that's why I'm sitting here, typing on reddit! Go SCIENCE!


Q:

How closely do you work with pharmacists, if at all?

A:

In the aspect of my work that involves clinical trials in humans, I work closely with them. In my basic science research, rarely.


Q:

Could you elaborate on the clinical trials? I am going to be a pharmacist, and this sounds pretty interesting to me.

A:

When new experimental drugs or vaccines are being tested, it is very important for the scientist to have strong interactions with the pharmacy to make sure that the storage and use of the drug follow protocol and if any strange things happen that they are communicated to the entire clinical trials group. Sometimes a simple observation by a pharmacists about the appearance of a drug that has been stored or thawed prior to administering it to the patient can change an entire clinical trial.


Q:

Where did you go to undergrad at? Favorite fruit? What did you want to grow up to be, when you were 10?

A:

I graduated from Connecticut College. My favorite fruit is Rock Hudson. A scientist or vet.


Q:

Hi, I am female and want to be a Professor in Conservation Biology. Just finished my undergrad and about to head of to grad school. What's the best way to make a positive impact on this world with this career goal? Sorry for the vague question, but any advice would be appreciated!

A:

Try to ask important questions and to design thorough and well-controlled experiments. Interpret the data honestly and objectively and make sure that you can and DO repeat everything. Write your papers carefully and clearly, and send reprints to every living person you know. Finally, realize that things fail 9/10 times, so suck it up, move forward, and enjoy your successes when they come!


Q:

Hi, I'm 15 and still unsure of what I'd like to do after school, but creating vaccines is something that has always interested me. What made you want to develop vaccines? What subjects should I study in school that would help me to pursue such a career?

A:

Hi Clara! Vaccines are exciting because they prevent diseases, which is much better than having to get sick and then try to cure being sick. To me, as an immunologist, this is a great thing to study because it has immediate benefits for the Human Race. It also combines my interests in medicine and basic science!

As far as your future is concerned, take whatever courses fascinate you and develop your brain. Obviously you'll want to take a variety of science and math courses, but don't let that become your whole life. The key is to study hard, do as well as you can, be enthusiastic, and go well beyond the minimum requirements. Try to interact with your teachers, read lots, and stay healthy. Good luck!


Q:

Thank you for doing this, and for your patience in answering all that you have.

A:

You're most welcome... now I'm back to grant writing and rebutting reviewers!


Q:

How close are we to a treatment for multiple myeloma? I've read that immunologist in Australia have been developing a monoclonal antibody treatment with great success in the lab, could this be a viable cure?

A:

Advanced MM is indeed a difficult disease to treat but life can be prolonged with steroids, thalidomide, and bone marrow transplants. Several monoclonal antibodies are being tested now and results are encouraging but early.

Lets hope that a cure is not far away.


Q:

Dr. Vitetta:

A bit of a hypothetical question for you, concerning diseases of molecular mimicry. I must preface this by saying I am not an anti-vaxxer. I believe strongly in the use of vaccines in pediatric and adult settings for prevention of disease.

If a disease like reactive arthritis (Reiter's syndrome) is the result of a reaction with bacterial proteins, and there are other diseases that are recognized as being the result of molecular mimicry (rheumatic heart disease, possibly ankylosing spondylitis, at least H1N1 narcolepsy, possibly multiple sclerosis, and several other fascinating autoimmune diseases-

-is it possible that the use of adjuvants in vaccines could inspire autoimmune reactions, and therefore disease?

This is to say: if the immunologic adjuvants in vaccines are added to increase the immune response to the proteins in the vaccine, is it conceivable that the introduction of an adjuvant at the wrong time could increase the likelihood of developing a disease?

To wit: Would someone who was given a dose of adjuvant coincident with, say, Salmonella or Campylobacter in the gut, run a greater risk of developing reactive arthritis than someone who was not having problems with one of those bacteria?

A:

Molecular mimicry has both positive and negative sides. Obviously, one could end up mimicking a self protein...this is always a problem with both vaccines and infections. I think that many autoimmune diseases have both a genetic component and a trigger. The trigger could be an infection, or a wound that releases self-antigens.

There are many immunologists who worry about this effect of certain adjuvants. In answer to your to wit: yes this is possible, immunologically speaking. BUT, I do not know of any data that bear directly on it. This is just the kind of thing that we immunologists/vaccinologists/cancer-immunotherapists think about all the time.


Q:

How close is the medical community to actually finding a cure to cancer

A:

There are many, many types of cancers, and so the challenges with treating them are also diverse. There are several cancers that we can already cure, and many that we can treat effectively to prolong life. However, until we understand all the causes of different cancers and can detect all of them very early, it remains a difficult problem. THIS IS WHY WE NEED TO INVEST IN SCIENTIFIC RESEARCH!


Q:

But you can't CURE cancer. You KILL it.

A:

Yeah! If it's dead, you're cured!

However, in all seriousness, what normally happens is that you don't eliminate every last cancer cell, so the goal is to have the patient "outlive the cancer." That is, have them live long enough that they die of something besides cancer. One of the things we scientists are interested in is creating a state of cancer-dormancy where the few cancer cells remaining are kept in check by either your immune system or other mechanisms.


Q:

Or nanites. Nanites could just detect cancer cells and eliminate them. Also, it's not that far off - nanites have been used to deploy medicine in a cockroach! Just a few more years, BOOM! A plague of nanites that cure all diseases!

Well, that's a little optimistic but I'd imagine that it'd be amazing. SPREADING immunity! Imagine!

A:

Sounds cool. When it works, let me know!


Q:

Hi Dr. Vitetta. You were my wife's mentor a few years back (Kimberly). She still speaks highly of you. But I need dirt. Do you any good stories about her?

A:

Oh yes. The first time she went into the mouse room, she fell off the chair and fainted! Her partner carried on and the experiments got done! Say "Hi" to Kim for me. I hope you are both well! :-)


Q:

Ha! She told me that, but we have friends reading this. She's doing well. I'll tell her to drop you a note to update you.

Now tell everyone about your epic Halloween costumes!

A:

Okay! Trinity in the Matrix. Dorothy in the Wizard of Oz. A Prisoner of Compliance (with a bona-fide striped prison suit from Huntsville)... and others not appropriate for mixed company. :-P


Q:

What do you think of the idea going around that research should be less hypothesis-confirming and more discovery-driven? This concept came up in a research course and I am wondering how that shift would impact immunology.

A:

Hypothesis and discovery are, in my view, equally important. Many times we hypothesize X and find Y. Sometimes Y leads to Z and Z refutes, agrees with or totally changes X. The key is to think hard, test hypotheses rigorously and be OPEN to discovery even if it is the opposite of what we hypothesized in the first place. Scientific research is a life-long work in progress.


Q:

I'm very excited by the advances being made in DNA Origami. What type of nanostructures/devices do you think would be most helpful in vaccine development?

A:

Don't thank me...call your reps. In Congress to keep us funded! Spread the word.


Q:

I've always wondered about this. How many antigens and T cells and APCs are present in our body? How is it that our body creates a sense of self antigen or how does it determine what to create a response against and what not to? There are so many things coming inside our bodies, do we really have that robust of a response?

A:

The answer to your question of self-tolerance is LONG and complex and requires knowing quite a bit of immunology. The short answer is that our cells are educated NOT to attack self tissues since APCs present a universe of self antigens. There are also suppressor cells that prevent these responses in "uneducated" cells. Recently it has become appreciated that cells of the innate immune system have receptors for conserved structures on pathogens. Once these cells recognize these structures, inflammation occurs. Inflammation= danger. The immune system then wakes up and goes on the warpath. As you know, when this whole system gets messed up, autoimmunity occurs. That's a very oversimplified answer, but the best I can do in 3 minutes.!! You might want to read about self-tolerance...its really fascinating.


Q:

What kind of diet do you eat? I never hear or know what doctors eat.

A:

Don't assume that doctors eat any better than anyone else!! Some do and others live on donuts and peanut butter. I happen to be a vegan and chocoholic who occasionally indulges in seafood. I rarely drink alcohol..perhaps 1-2 glasses of wine a times a month. Most importantly I exercise and try (usually not very successfully) to keep my stress levels low....that is my biggest challenge.


Q:

Thank you for the response, Doctor. Are stress levels important to keep low primarily for the inflammatory response - or is it a different factor that adversely affects you?

A:

Stress causes MANY problems. Immunologically speaking, it raises our cortisol levels. Cortisol suppresses the immune system so you become more susceptible to infections. It also shortens your telomeres so you age faster. The list goes on. In general stressed-out people have many health problems. If you can avoid or decrease the stress in your life it is a GOOD thing!


Q:

I know Lyme disease, especially spirochetes a are difficult to vaccinate due to their extremely adaptive enzootic cycle. As someone who lives in a Lyme prevelant area...how close are we to developing this vaccine?

A:

Read this: http://www.historyofvaccines.org/content/articles/history-lyme-disease-vaccine There WAS a vaccine and it was withdrawn from the market. Most people think that there will be little impetus for a new vaccine. I am not so sure.


Q:

I have heard that, since they have found a way of treating HIV, they have considered giving it to cancer patients so the HIV kills the cancerous cells and doctors can then treat the HIV. Is this true?

A:

Its a work in progress using HIV as a "vector". Thats all I know about it. I seriously doubt that anyone is giving an infectious virus!!


Q:

Hi, hopefully this AMA is still ongoing:

I'm due to graduate with a degree in Biomedical Science in July this year and was wondering if you had any tips to possibly help break into my career? Everywhere seems to be asking for experience, but I firstly have to get registered with the HSPC (uk). Also, what's a typical day on the clock like for you?

Thank you :)

A:

My advice would be to get as much training in the best settings that you can. Interact with lotsa people and read until your eyeballs fall out. My typical day? Think endless....lots of hours.. Maybe 80 per week....Some tedious, some fun. I deal with experiments, funding issues, personnel issues, (increasingly with ) lawyers and administrators, students, fellows, faculty, teaching, writing, reading, committee meetings, traveling,lecturing, etc. Now and then I eat, sleep, see my family, play with my cats and water my plants. The one thing that is sacrosanct is exercising! I am also compliant with my annual physicals and COMPLETELY up on my vaccinations.


Q:

What do you think about the FDA making 23andme stop their genetic health risk info and their new requirements for them to start it back up?

A:

I liked 23and me and hope that they will start it up again. However, I do understand the concerns that some people have. Its a complicated ethical issue...at least for some people. When they have hashed out all the objections, it will likely return in some guise.


Q:

I understand some people misread it but since I only have half of my familial history it would like to know things to look out for, but I can see how it would cause some hypochondriasis and over sensitivity.

A:

Exactly!


Q:

I hear a lot about the next coming pandemic, like spanish influenza back around 1918. How likely do you think there will be something like this and what time frame? Also, do you think the world is ready for something like this and its effect?

A:

Highly likely. Scientist now accept this fact. The question is how to best deal with it. Identifying new and "recycling" pathogens in the world's population in real time is key. We must also speed up the way we generate protective vaccines as quickly as possible. I hope that we are up to the challenge!