The Individual Cells of Your Immune System

In this week’s excerpt from Lessons from the Miracle Doctors, Jon Barron details all of the individual cells that make up your immune system.

“In the following paragraphs, I’m going to summarize the function of the immune system. While a full discussion would take several volumes, I would like to provide a brief overview, a sense of how this marvelous system works.

All blood cells, both red and white, begin as stem cells in your bone marrow. These undifferentiated cells begin to assume individual characteristics and become either red cells (the oxygen carriers) or white cells (the cells of the immune system). Further differentiation divides the white cells (also called leukocytes) into four main types of cells: lymphocytes, phagocytes, granulocytes, and dendritic cells.”

immune cell taxonomy





“Lymphocytes are white blood cells that serve as the key operatives of the immune system. In a healthy body, not under attack, they number about one trillion. There are three main classes of lymphocytes.

  • B-Cells—Each B-cell is programmed to make one specific antibody to defend against a specific invader. An antibody is a soluble protein produced by B-cells that’s capable of binding to and destroying or neutralizing a foreign substance (antigen) in the body. Antibodies belong to a particular family of nine proteins called the immunoglobulins. So, one B cell produces an antibody to defend against a particular strain of flu, whereas an entirely different B-cell produces the antibody for the strep bacteria, and so on. B-cells work primarily in the fluids of the body, defending against “foreign” invaders and toxic molecules. They are not capable of defending against the body’s own cells that have “gone bad.” Once a B-cell encounters the particular invader that it is built to defend against, it produces many large plasma cells, “factories” that produce millions of specific antibodies and release them into the bloodstream. Once the invader has been eliminated, the B-cells stop production of the plasma cells.
  • T-Cells—Although B-cells are capable of recognizing invaders on their own, primarily that function falls to the T-cells. T-cells are smarter than B-cells; they’ve been to school, as it were. After being produced in the bone marrow, T-cells make their way to the thymus gland, where they are educated in how to distinguish between the cells of the body and invading cells, and how to distinguish between normal healthy cells and mutated rogue cells. T-cells that cannot make this distinction are eliminated so that they do not make their way into the body and begin attacking it. Every T-cell carries a marker (T-3), a distinctive molecule on its surface that affects how it behaves.In addition, some T-cells carry a T-4 marker. These are known as the helper T-cells, which serve the purpose of identifying foreign invaders, then activating B-cells, other T-cells, natural killer (NK) cells, and macrophages to attack the invader. And some T-cells carry a T-8 marker. These are cytotoxic T-cells (also called “suppressor cells”), which identify rogue mutated cells in the body or cells that have been invaded by viruses and compromised. Once they’ve identified the enemy, cytotoxic T-cells attack the cells that have been infected or are malignant and destroy them. This process is often referred to as the cell-mediated immune response.
  • Natural Killer (NK) Cells—Unlike cytotoxic T-cells, NK cells do not need to recognize a specific invader to act. They attack a whole range of microbes in addition to tumor cells. Also, they kill enemy cells on contact by delivering lethal bursts of potent granular chemicals that “burn” holes in target cells, causing them to leak and burst.

Phagocytes are the large white cells that eat and digest invading pathogens, primarily through protease enzyme activity. There are several kinds of phagocytes: monocytes, neutrophils, and macrophages. Macrophages have a number of functions in the immune system. Not only do they attack foreign invaders, they also play a key role as scavengers by ‘eating up’ worn out cells and other waste in the body. Once macrophages have ‘digested’ an invader, they then present the key identifying molecules, or antigens, to the T-cells to initiate the immune response. Macrophages play a key role in fasting. When you are not eating and creating new metabolic waste in the body, macrophages get a chance to get ahead in terms of cleaning up debris. Fasting time becomes ‘spring cleaning’ time for macrophages.

Granulocytes include eosiniphils, basophils, neutrophils (neutrophils are classed as both phagocytes and granulocytes), and mast cells. Granulocytes destroy invaders by releasing granules filled with potent chemicals. Dendritic cells have long threadlike tentacles that are used to wrap up antigens and expended lymphocytes and carry them to the lymph nodes for removal from the body.”

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Another Great Video from Dr. Mark Rosenberg: What You Should Know About Cancer and Your Immune System

Another Great Video from Dr. Mark Rosenberg: What You Should Know About Cancer and Your Immune System

Health Economics and Outcomes Research Medical Unit Medical Resource Management

Here is the scope of work of one of our consulting assignments. The project involved streamlining and optimizing HEOR personnel deployed in a therapeutic area by a large pharmaceutical firm.

  • Provide expertise/strategic leadership of key initiatives within the US General Medicine and Health Economics and Outcomes Research (HEOR) functions
  • Responsible to provide direction, oversight and coordination of complex activities within HEOR portfolio(s) and functions including budget & strategic resource management support to VP/Heads within US Medical teams
  • Partner with HEOR Head and provide project management & operational expertise
  • Drive annual strategic planning process across the specific portfolio including coordination of communications across the teams
  • Responsible to lead budget planning & management including strategic resource management recommendations in partnership with Head of HEOR
  • Accountable for summary of all HEOR spend changes & assumptions to clearly communicate budget forecasted vs. actual and actions/decisions required with defined accountabilities for budget owners
  • Challenge budget owners on assumptions & ensures documentation
  • Requires rationale and appropriate level of detail from all budget owners to assess implications and decisions required on a monthly basis
  • Responsible for maintaining external spend and forecast accuracy within 5% of budget on a quarterly basis
  • Facilitates monthly pre-alignment meetings and Medical Budget Alignment meeting & coordinates with Project Budget Managers role to facilitate data accuracy within tracker tool & meeting minutes 
  • Drive and facilitate 2016 Tactical Plan completion in preparation for 2016 (seasonalization of tactics by month) ~Oct 2016 
  • Able to facilitate and work amongst entire HEOR team and amongst all therapeutic areas (CV/Resp, Imm/Derm, NS, Early Development, and HEOR non-brand) 5 trackers with 4 Project Budget Managers and consolidate this information into a summary for the Budget Alignment meetings 
  • Able to understand and track HEOR contracts and HEOR tactics (analyses, models, data analytics, etc.) ongoing (working with Strategic Sourcing and tactic owners) 
  • Work with tactic owners to consolidate business needs for new tactics for Ethics and Compliance submission Comparative Effectiveness Review (CER) responses project management of this process and coordination between internal stakeholders to consolidate response and provide in the time requested 
  • Project management support for complex projects facilitate internal and external stakeholders communications and provide high level timeline tracking and budget management 
  • Project management as key component of role 
  • Excellent, proactive stakeholder management skills 
  • Excellent interpersonal communication skills and customer service orientation 
  • Strong cross-functional collaboration skills 
  • Demonstrated ability in strategic thinking and strategic planning, resource management and budget management 
    Understanding of the FDA, OIG, HIPAA and other guidelines relevant to the pharmaceutical industry 

Immunotherapy: Using the Immune System to Treat Cancer

Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor.
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Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. Source: National Institute of Allergy and Infectious Diseases (NIAID).

The immune system’s natural capacity to detect and destroy abnormal cells may prevent the development of many cancers. However, some cancers are able to avoid detection and destruction by the immune system. They may produce signals that reduce the immune system’s ability to detect and kill tumor cells, or they may have changes that make it harder for the immune system to recognize and target them.

Immunotherapies are treatments that restore or enhance the immune system’s ability to fight cancer. In just the past few years, the rapidly advancing field of cancer immunology has produced several new methods of treating cancer that increase the strength of immune responses against tumors. These therapies either stimulate the activities of specific components of the immune system or counteract signals produced by cancer cells that suppress immune responses.

The journal Science designated “immunotherapy of cancer” as its Breakthrough of the Year in 2013 to recognize the progress made in this area. These advances are the result of long-term basic scientific research on the immune system.

Additional research is underway to:

  • increase our understanding of what enables immunotherapy to work in some patients but not in others who have the same cancer
  • expand the use of immunotherapy to more types of cancer
  • better understand how to use immunotherapies in combination with targeted therapies and other standard treatments, such as chemotherapy and radiation therapy

What is Immunotherapy?


Immune Checkpoint Modulators

One immunotherapy approach is to block the activity of certain proteins that limit the strength of immune responses. These proteins normally keep immune responses in check to prevent overly strong responses that might damage normal cells as well as abnormal cells. In cancer cells, these “checkpoint” proteins may be abnormal and may help tumors to evade the immune response.

Blocking one of these checkpoint proteins could lift the brakes on the immune system, enabling it to destroy cancer cells. The first immune checkpoint modulator to gain Food and Drug Administration (FDA) approval is called ipilimumab (Yervoy). This immunotherapy drug, a monoclonal antibody, blocks the activity of a checkpoint protein called CTLA4 and has been approved to treat advanced melanoma.

Immune Cell Therapy

An experimental form of immunotherapy is adoptive cell transfer (ACT). In one form of ACT, cytotoxic T cells that have invaded a patient’s tumor, called tumor-infiltrating lymphocytes (TILs), are harvested. The cells with the greatest antitumor activity are selected, and large populations of these cells are grown in the laboratory and activated with cytokines. The cells are then infused back into the patient.

The idea is that TILs already have the ability to target tumor cells but may not be present in sufficient amounts to exert an antitumor effect. If the activity of the TILs is being suppressed by the tumor cells, it may be possible to overcome that suppression by exposing the tumor to massive amounts of activated TILs.

In another form of ACT, often referred to as CAR therapy, a patient’s T cells are collected from their blood and genetically modified to express hybrid proteins called chimeric antigen receptors (CARs) before they are expanded and infused into the patient. The CAR allows the cells to attach to specific proteins on the surface of cancer cells, which activates the T cells to attack those cells.

Cancer Treatment Vaccines

The use of cancer treatment (or therapeutic) vaccines is another approach to immunotherapy. These vaccines are usually made from a patient’s own tumor cells or from substances taken from tumor cells. They are designed to treat cancers that have already developed by strengthening the body’s natural defenses against the cancer. Treatment vaccines may act in any of several ways:

  • to delay or stop the growth of cancer cells
  • to cause tumor shrinkage
  • to prevent cancer from coming back
  • to eliminate cancer cells that have not been killed by other forms of treatment

Developing effective cancer treatment vaccines requires a detailed understanding of how immune system cells and cancer cells interact. To be effective, cancer treatment vaccines must stimulate specific immune responses against the correct target. The immune responses must also be powerful enough to overcome the barriers that cancer cells use to protect themselves from attack by B cells and killer T cells.

Recent advances in understanding how cancer cells escape recognition and attack by the immune system are now giving researchers the knowledge required to design cancer treatment vaccines that can accomplish both goals.

In 2010, the FDA approved the first cancer treatment vaccine, sipuleucel-T (Provenge), for use in some men with metastatic prostate cancer.

Immune-Modifying Agents

Yet another type of immunotherapy uses immune-modifying agents, such as cytokines, antibodies, and growth factors, to enhance the body’s immune response against cancer. Cytokines are signaling proteins that are produced by white blood cells, and they help regulate immune responses. Two types of cytokines are used to treat patients with cancer: interferons and interleukins.

Dr. Steven A. Rosenberg, Chief of Surgery at the National Cancer Institute, developed the first effective immunotherapies and gene therapies for patients with advanced cancer.

Immune-modifying agents may work through different mechanisms. A type of interferon, for example, enhances a patient’s immune response to cancer cells by activating certain white blood cells, such as natural killer cells and dendritic cells. Recent advances in understanding how cytokines stimulate immune cells could enable the development of more effective immunotherapies and combinations of these agents.

Research at NCI

Immunotherapy research at NCI is done across the institute and spans the continuum from basic science discoveries to clinical research applications.

The Center of Excellence in Immunology (CEI) brings together researchers from across NCI and other NIH institutes to foster the discovery, development, and delivery of immunotherapy approaches to prevent and treat cancer and cancer-associated viral diseases.

“It doesn’t make sense to hire smart people and then tell them what to do; we hire smart people so they can tell us what to do.” — Steve Jobs

“In this business, by the time you realize you’re in trouble, it’s too late to save yourself. Unless you’re running scared all the time, you’re gone.” –Bill Gates

Clinical Trial Finds Moderate Cooling Improves Transplant Results

Global Value Dossiers (GVD)

Michael has worked on global value dossiers (GVD) for pipeline and marketed pharmaceuticals as well as medical devices in the cardiac surgery and wound healing space.  These value dossiers reflect detailed assessment of payer reimbursement levels, value propositions in terms of net savings to the payers, and competitive market assessments.  Normally, Michael is tasked as the Project Manager for the GVD and coordinates workflows from regulatory, clinical affairs, scientific and engineering, and commercial teams.  One reason he is particularly well-suited to manage cross-functional GVD development teams is that he understands how to construct persuasive value propositions as a Ph.D. economist, he understands the legal and regulatory aspects as a healthcare attorney, he has interfaced with numerous commercial and government payers and is sensitive to the financially constrained healthcare environments in which they operate, and he understands and interfaces well with medical affairs as an active researcher who publishes articles in peer-reviewed medical journals.  If outside vendors are part of the GVD development team, then normally Michael will play a pivotal role in vendor evaluation and selection and then serve as the point of contact for the vendors with the client firm.  The GVD is a key component of a successful market access strategy.  To that end, Michael performs the project planning, budgeting, work stream scheduling, interfacing with business units and franchises, vendor selection and oversight, monitoring, and quality assurance functions of a Project Manager.  At the conclusion of the GVD, Michael disseminates the information through internal and external presentations, including attending payer meetings as the Health Economics & Outcomes Research and Value expert.  Michael’s GVD experience is current.

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Chlorella – A Natural Detoxifier by Jennifer Good

Let’s explore the green algae known as Chlorella. The name is taken from the Greek chloros, which means green, and the Latin suffix ella, meaning small. This supplement is growing in popularity in the US, and in Japan it is already one of the most widely used supplements. In fact, chlorella use in Japan is more common than our use of vitamin C in the US. So, why is it so popular there?

This algae was first heavily studied as a possible mass food source to address food shortage concerns after World War II. It was believed that chlorella could serve as a potential source of food and energy because its photosynthetic efficiency can, in theory, reach 8%, comparable with other highly efficient crops such as sugar cane. It is also considered an attractive potential food source because it is high in protein and other essential nutrients; when dried, it is about 60% easily digested and utilized protein, 9% fat, 22% carbohydrate, 5% fiber, and 9% minerals, vitamins, and chlorophyll.