2005 Biomedical Nobel Prize - A realm goes back to bacteria

Two Australians selected for the 2005 prestigious award: Digestive System Specialist Barry J. Marshall (54) and pathologist Dr. J. Robin Warren (68, quit) retirement). The medical world seems surprised at the Nobel Prize in 2005, because in recent decades it has been awarded to American and European scientists, and also focused on basic research. But this time the prize was awarded to two Australian scientists and a relatively simple study.

Both Dr. Marshall and Warren work at a ' anonymous ' research institute at the University of Western Australia in Perth, Australia. Neither are scientists in Australia's top category or internationally. However, their research is of great importance and importance to the world : they discovered Helicobacter pylori (H. Pylori) is a component of peptic ulcer or gastritis. thick and some cancers . Assessing the importance of this discovery, the Swedish Academy of Science Council wrote: 'Discovering bacteria is the cause of peptic ulcer disease, one of the most common diseases of humans, has opened. a new research orientation to find other bacteria that can cause chronic inflammatory diseases. '

Helicobacter pylori (H. Pylori) (Photo: fondef)

In fact, Marshall and Warren's discovery rewrites medical textbooks, and the journey to the pinnacle of glory is bitter and tough. For hundreds of years, one of the ' teachings ' of medicine is that nothing has sprung up from the stomach. Medical textbooks have so far maintained that gastrointestinal ulcers or ulcers (a very painful disease for patients) are diseases arising from eating, such as eating too much spicy food, high in acid. , or in a stressful situation. Indeed, opening almost any medical dictionary, we can see a few explanations of peptic ulcer disease as follows: a puncture in the lining of the gastrointestinal tract due to pepsin and digestive acid; this can occur when pepsin and high concentration acids are unusual or when there are several other mechanisms that reduce the normal mechanisms of mucosal protection; There may be a role of bile salts especially in stomach ulcers.

But in the early 1980s, Dr. Warren noticed the presence of bacteria in the lining of the stomach of about half of patients with biopsies. Later, Dr. Marshall, then a young physician, practiced at Warren's lab, participated in the study, and successfully cultivated a bacterium he named Campylobacter pyloridis because he thinks it belongs to Campylobacter family. But later, the bacterium was known to be of the Helibacter family , so it was named H. pylori. However, there was no one in the medical world who believed that bacterial theory was the cause of peptic ulcer disease! When Dr. Warren and Marshall submitted a report at a medical conference in Australia, the conference president did not publish, because he believed that the ' paradox ' theory was a mistake!

Barry J. Marshall

J. Robin Warren

In 1982, to convince his colleagues, Dr. Marshall (then 32 years old) decided to do experiments on his own body . He swallowed the gastroscope into his abdomen so that fellow Warren could see his stomach and biopsy to prove that he was not infected with H. pylori. (Again, readers who are not familiar with medicine or biopsies are a small surgery to cut a small part of a certain organ, such as the stomach, liver, cervix, etc.). Biopsy is generally safe, but there are cases that can be dangerous to the patient's life) . Dr. Marshall had to wait until 10 days later, when the stomachs (biopsy) were healthy, he took H. pylori into his abdomen. Three days later, he fell ill, vomited constantly, always felt full, and his breath was stinking. Ten days later, he again swallowed the stomach tube so that Dr. Warren could do a biopsy, and proved that H. pylori was the culprit in peptic ulcer disease . After being treated with antibiotics, he became ill. This unique experiment convinced Marshall and Warren that stomach ulcers were caused by bacteria, not acidic or stressful moods like textbooks.

To date, through thousands of studies, the medical community knows that H. pylori is indeed the culprit of about 80% to 90% of gastric ulcers, and these cases can be treated in a way Quick and easy with antibiotics. (However, many people - maybe 50% - of us are the ' landlord ' of H. pylori, but only 10% to 15% of these suffer from ulcers). Thanks to the discovery of Marshall and Warren, peptic ulcer disease is no longer a chronic disease.

The medical community knows that H. pylori is indeed the culprit
of about 80% to 90% of gastric ulcers

The role of inflammation

The discovery of Marshall and Warren is not only meaningful and potential for the treatment of peptic ulcer, but also makes us think more about the role of inflammation in other chronic diseases such as Stomach cancer and heart disease . Indeed, there is a promising factor explaining some cases of heart disease, but not many people believe it, if not many people oppose it: inflammation. Try giving a hypothesis: the starting point of the process of generating heart disease is arterial inflammation caused by infection.

Scientists have long recognized that arteritis is the first step in the development of atherosclerosis, but they believe this damage is caused by cholesterol. But maybe arteritis happens first, then the cholesterol builds up later. There is some evidence that seems consistent with this view. In rabbits, it is discovered that once the coronary artery ruptures, there is no plaque, even though they have very high cholesterol. Of course, arteritis can arise in many ways, such as through chemicals from cigarettes

Chlamydia pneumoniae bacteria attacks and circulates in humans through coughing, and sneezing

(Smoke is a stimulant in the blood). French scientists once proved that in mice, when placed in polluted air, the circulatory system was damaged. This 'damage' appears in the form of patches very similar to atherosclerosis. In addition, there are genetic factors: the array usually occurs in mice without protein IL-10. Mice that were unable to produce IL-10 had 30-fold blocked arteries (and the risk of coronary artery rupture was four times higher) than mice with IL-10. About 10% of people lack IL-10 and it is possible that these people are susceptible to bacterial infections.

The most notable bacterium is Chlamydia pneumoniae , often called TWAR. This bacterium attacks and circulates in humans through coughing, and sneezing . Among those in their 20s, the probability of carrying this bacterium is about 50%. From the lungs, this bacterium can ' hitch ' the phagocytes to enter the arteries. In the 1990s, scientists noted that people with cardiovascular disease often had very high levels of TWAR antibodies, meaning they had been infected many times before becoming ill. In addition, the DNA and protein of this bacterium often appear in the outer plaques of the coronary arteries, even if live bacteria are also found there. In a Dutch study, signs of bacteria were found in about 60% to 79% of cases of blocked arteries, and rarely found in normal arteries. But, some other studies found no signs of this bacterium in blocked arteries!

The tendency to increase heart disease in the early 20th century and to decline recently has been described as an epidemic, because the process of developing this disease seems to follow a process commonly found in epidemics, But with a longer time than plague. It is possible that heart disease is actually a plague according to the common sense, rather than a stereotypical way of speaking. Bacterial infection may explain why the rate of death from heart disease drops rapidly, and that decline is not in our expectations. Antibacterial antibiotics such as tetracyline were introduced into public health at the same time as the mortality rate began to decline.

Similarly, H. pylori may also play an important role in treating stomach cancer. In fact, H. pylori has been considered a component of stomach cancer called MALT (mucosa-associated lymphoid tissue). This type of cancer is usually controlled by using antibiotics to kill H. pylori in the stomach. This disease was very common in the early 20th century, but after the 1950s it was no longer as common as before, although no one knew why. Perhaps the use of antibiotics is a factor in reducing the incidence of stomach cancer? It might be!

Journey on inflammatory disease

It can be said that this year's Nobel Prize in Biomedical Sciences is an expression of the journey to the source, returning to inflammation. In the past 200 years, diseases have been classified into three groups: infectious diseases, genetic diseases, and environmental diseases. Early in the 19th century, medical development revolved around conquering infectious diseases.

Emil Adolf von Behring
(Photo: gmina-ilawa)

During the early 20th century to the mid-20th century, when studies of infectious agents shifted from bacteriological studies to viral research, the concept of disease genetics began to stir. Until the discovery of DNA structure and then, the study of genetics has become a fashion fad in medicine. Following genetics are extraordinary developments in molecular genetics and cytology, leading to sophisticated studies of pathogenesis from DNA mutations and DNA interaction with the environment. .

The Nobel Prize for Biomedical Medicine has been awarded since 1901, so far over 100 years ago. Looking through these award-winning scientific works can also provide a concept of the progress of medicine according to the trend I just mentioned. From relatively ' sketchy ' clinical studies (compared to today's technical level), medical research has advanced into the most basic areas of humanity such as molecular and biological genetics. molecule. In 1901, Emil Adolf von Behring (German) won this award for his research and treatment of diphtheria . The Swedish Academy assessed that the project was very high, they wrote: '[through this study], he opened a new direction in the field of medicine, and in that way, gave the doctors a dance. effective air to conquer disease and death. ' In 1902, the award was given to a British scientist, Ronald Ross, for his research related to malaria. In the following years, the scientists were awarded awards for their work related to tuberculosis (1905; Robert Koch, German), fever (typhus) (1928; Charles Nicolle, French); blood classification (1930; Karl Landsteiner, American), infectious disease (1945; Alexender Fleming, American; Ernst Boris Chain, British; Howard Walter Florey, Australia), yellow fever (1951; Max Theiler, American), curing treatment of tuberculosis with streptomycin (1952; Salman Abraham Waksman, USA).

Robert Koch

Alexender Fleming

Charles Nicolle

Karl Landsteiner

Salman Abraham Waksman

Ernst Boris Chain

Howard Walter Florey

Max Theiler

Beginning in 1958, the study of genetics has caught the attention of the Swedish Academy through the award of prizes to three American scientists, George Wells Beadle, Edward Lawrence Tatum, and Joshua Lederberg, for It is also possible to discover an important rule in genetic recombinant.

George Wells Beadle

Edward Lawrence Tatum

Joshua Lederberg

In 1961, three Francis scientists Harry Compton Crick (UK), James Dewey Watson (USA) and Maurice Hugh Frederick Wilkins (England) won the Nobel prize for their famous discovery of DNA structure, making a premise for millions of studies. and progress on medical biology later.

Francis Crick

James Watson

Maurice Wilkins

Since then, the award has been researched on works with molecular and genetic biological nature.

In 1978, the Swedish Academy awarded awards to three scientists Werner Arber (Switzerland), Daniel Nathans (USA) and Hamilton O. Smith (USA) for their discoveries of enzymes and applications. Genetic research.

Werner Arber

Daniel Nathans

Hamilton O. Smith

The advances in molecular biology and genetics in recent years have been largely due to the polymerase chain reaction (PCR) discovered by two American scientists (Kary Mullis) and Canada (Michael Smith), and have was awarded the Nobel Prize in chemistry in 1993.

Since 1999, this award has still been awarded to a project that is heavy in molecular biology, especially cytology related works. In summary, from 1950s to the present, the Nobel Prize in Biomedical Sciences has been awarded only to basic research works, but not to any clinical studies.

Then in 2005, the Swedish Academy surprised the scientific community by awarding this noble award to a research project related to inflammatory disease, a work of clinical research. This is an expression of ' source ', about the source of inflammation. Through this award, perhaps the professors in the Swedish Academy want to remind the world that infectious diseases still threaten us to open the global level. Recent outbreaks of SARS and avian influenza are a warning that infectious diseases still exist (not yet erased as a US health official once confidently declared "Now we have It can be said that infectious disease is completely controlled. It's time we close the disease. " )

In recent years, some scientists have questioned the practicality of the Nobel Prize for Biomedical Sciences, because they believe that this award only recognizes basic research works, and is increasingly far removed from the reality of science. Clinical study. Some even recommend a more practical biomedical award! This year, the Nobel Prize for Biomedical Sciences recorded a practical clinical science work, and did not favor Mr. Nobel when he wrote in his will that the prize should be for 'those who give their blessings. Great benefit for humans. '

Photos from http://nobelprize.org