September 21, 2020

Let’s Talk About A Vaccine For COVID-19

New York Times Coronavirus Vaccine Tracker, updated August 21, 2020.

This is the sixth of several articles about COVID-19 and related topics by Dr. Jon Crosbie, an ISU alum, sports fanatic, and all-around awesome Doctor of Osteopathic Medicine.

It’s been a while since I wrote a medical post. Let’s talk about the new mRNA vaccines, which may very well be employed to usher us out of the unmitigated dumpster fire that is 2020. I will say that this might be the most difficult one to explain because there’s just SO BLEEPING MUCH that goes into the idea of an mRNA vaccine.

Let’s start in the obvious place: Head and Shoulders Dandruff Shampoo. Back in the 80s and 90s, Head and Shoulders had a tag line in its commercials that went “You never get a second chance to make a first impression.” Since I don’t watch commercials on TV any more because of DVR, I don’t know if that’s still their slogan. However, it is apropos today because we need to talk about mRNA vaccines before someone on your Facebook feed tells you the wrong thing about them.

Now, at this point pretty much everybody who’s read any of my medical articles knows that I think vaccines are the greatest achievement in modern medicine. The ability to train our immune systems to work better and fight disease more efficiently is as fantastic as the pushback against vaccines is unreasonable. If you’re an anti-vaxxer reading this and you want to get into an argument about whether or not vaccines are good, you’re in the wrong place. Vaccines are awesome ,and they’ve saved more lives that you could possibly imagine. Certainly more lives than you, rando anti-vaxxer who might show up to troll this post (which, when that happens, I always take a little personal and professional pride in).

Who I am speaking to are people who like vaccines but have heard rumblings about a new kind of vaccine that “changes your DNA” and are understandably a little nervous about it. It’s a fair thing to be uneasy about. Lots of big words are thrown around about DNA and genetics, and it’s hard to understand because DNA is really, really complicated. When people start horsing around with anything DNA-related, it starts invoking all manner of horror movies – will we have an “Umbrella Corporation” situation as a result of this vaccine?

So let’s talk about this new type of vaccine – the mRNA vaccine. In order to understand how this works, you need to understand how mRNA works in your body and probably refresh your memory on how other vaccines work as well. Here’s a link to the vaccine refresher that involves the flu shot (which is admittedly incredibly self-involved because I wrote it). But I thought it was pretty good. Take a real quick read. I’ll wait…

Refreshed? Good. That’s just a bit on the basics of how vaccines work. These new vaccines work on the same principles of training your immune army, but they go about it in a more complicated way. To understand it, you need to understand how your DNA makes everything work in your body in order to fully appreciate the advantages of mRNA vaccines.

Your DNA is the blueprint for everything that makes you you. Your hair growing, when you heal a cut in your skin, your muscles rebuilding themselves…it’s all directed by your DNA. You have to make new blood cells every 120 days or so, and your DNA is the blueprint for the building blocks to make more red blood cells. So what are the building blocks of all of this? The building blocks are the proteins your body makes based on the instructions written in your DNA. The fancy way of saying this is that your DNA “codes” for these proteins. Essentially, the instructions in your DNA are taken to cellular machinery (the machinery is called “ribosomes”), the proteins are cranked out in a process called “translation” and you continue to exist.

By the way, if you’re a person of faith, don’t worry. Whoever or whatever designed this system was a hell of a lot better at building stuff than anybody alive today. I always thought God designed stuff this way because it works well.

Everything you do comes down to proteins that your DNA “codes” for. Even what you’re looking at right now at this very moment. When you see something, the image hits the retinas in your eyes, which are there because your DNA coded for the proteins to make it when you were developing as a fetus. The image gets converted into an electrical signal (again, via proteins that your DNA codes for), sent up your optic tract (put there because your DNA coded for proteins when you were in your mommy’s tummy), and sent to your brain. Then your brain uses a complicated series of proteins along with the infrastructure already in place (because of proteins) so you can see these letters on the screen.

More proteins in your brain help you convert the order of the letters into meaningful words. Or you might see an image of a Person. Or a Man. Or a Woman. Or a Camera. Or a TV (sorry, I’ll be honest, I don’t know what role proteins have in smartass remarks). The point is that the proteins your DNA codes for make all the stuff happen in your body *including antibodies that make your immune system work*.

But not all cells can make every single protein. This is a bit simplified, but your retina doesn’t make immune system antibodies because it doesn’t have the right machinery to crank out those specific proteins. The instructions are there in your DNA in the retina, but not the right ribosomal machinery. Your Leukocyte B-Cells (more commonly known as your white blood cells), on the other other hand, well, antibodies are just their game. And, because your DNA has instructions to make everything, your B-Cells can take the DNA instructions, crank out an antibody protein, add the special little cap on the end that binds to the bacteria or virus, and tag the invader for violent and horrible destruction. I like to think of my immune system as rolling up on a bacteria or virus and screaming at it, “And I will strike down upon thee with great vengeance and FURIOUS ANGER, those who would attempt to destroy my boy Jon.”

Where was I? RIGHT! DNA. Now, like I said, your DNA has instructions for literally every single thing your body can do. Taking that package of information and running it through a ribosome to make one protein is inefficient. Imagine if you were trying to build a building and all you were in charge of was painting the walls. But you had to flip through a 300,000 page manual to find the color of each wall you wanted to paint. That’s not efficient, right?

Enter your mRNA. mRNA stands for messenger RNA. It’s a like a copy of a few pages of DNA. Again, the ribosomes can’t deal with the entire DNA library to make one protein, so instead your DNA unzips itself, makes a copy of the section that codes for the protein you need made, and that copy is called mRNA. It’s the mRNA that goes to the ribosome to make the protein so you can continue to exist.

Sylvia June | The Tailgate Society Credit: The Conversation

That’s how this new type of vaccine works. The vaccine is a manufactured mRNA particle that finds its way to your ribosomes and starts cranking out the proteins you need. Basically, we’re not holding a uniform or an enemy soldier in front of your body’s army, we’re just downloading the instructions to make the proteins you need.

Because I need pop-culture references for everything, it’s like that scene in The Matrix when Trinity needs to learn to fly a helicopter and she gets the instructions downloaded immediately. Your immune system is saying “Hey, you, let’s not get sick. I need to create the protein chains to make the antibodies to tag the coronavirus so if it shows up I can deal with it and you can keep binge watching stuff. Can you show me some coronavirus proteins/enemy uniforms so I can train the army what to look for?” And you’re answering with, “Nah bruh. I got something better. I got you the bleeping instructions to make the antibodies straight up.”

There are a bunch of pretty sweet advantages to this:

1. People who are immunocompromised can take an mRNA vaccine. See, it’s not an infectious particle, unlike the live attenuated vaccines, so it’s safe for people with a compromised immune system (go back and read the flu shot post again if you need). Maybe you haven’t heard, but people with compromised immune systems kinda need a good vaccine right now.

2. It’s more effective to prevent illness. With the older vaccines, you still have rely on your body’s B-Cells to recognize the enemy uniform and translate that into effective antibodies. That’s a pretty important step and sometimes your immune system, as damn near perfect as it is, makes a mistake. That mistake gets avoided here.

3. We can make mRNA vaccines way more quickly. It’s way easier to manufacture this type of vaccine on a faster scale. Which we need right now. A lot.

4. We can play around with the mRNA itself and “turn down” or “turn up” the immune response. If we see that people are having 2 or 3 days of chills and fever as a result of this vaccine and now everybody is claiming the vaccine gave them COVID-19 (FFS, IT DIDN’T), we can play around with coding to increase or decrease the immunogenicity. And your immune response can be turned down or turned up. This is really, really cool.

5. Work on this might just cure cancer. mRNA vaccines could be the next evolution in cancer care. Your immune system stops you from getting cancer waaaaaaay more often than you want to know about. When cells start to grow out of control, most of the time your immune system steps in and stops it. This is one of the reasons that immune suppression drugs for Crohn’s Disease or Psoriasis come with the “rare lymphomas have happened” warning on TV. This is also the reason for Kaposi’s Sarcoma, a rare soft tissue cancer that occurs in AIDS patients.

This is also the reason that people get cancer more often as they get older. Your immune system starts to wear out – it’s called “immunosenescence”. When your immune system starts to get a little long in the tooth, sometimes it misses things. It misses cells that start to divide when they shouldn’t and turn into tumors. And you know what happens next.

Now it’s possible that we might be able to someday take a cancer cell, analyze it, and then make an mRNA that codes for the antibody your body’s immune system can use to go tag and kill the cancer cells. It’s POSSIBLE. And if we can do that, well, that’s effing huge.

Sylvia June | The Tailgate Society Credit: National Institutes of Health

An mRNA vaccine can’t change your DNA. It just can’t. Your DNA is your DNA from before you took your first breath until even after your last. Your DNA became your DNA about twelve hours after a romantic evening between your parents. Your DNA is the instructions for everything about you. mRNA is simply another set of instructions to help your body make more proteins. The fact they made this work is amazing (which, by the way, has been done before with the Ebola vaccine, and I’m sure you’d want one of those vaccines if you saw infected people who were bleeding out of their eyes on the reg).

If you didn’t know, now you know. I hope that was a good first impression. And if you have questions, I’ll do my very best to answer them down in the comments.

Dr. Jon Crosbie, D.O., is a Physician and Assistant Professor at Des Moines University Medical School.

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Jon Crosbie
Jon Crosbie 6 Articles
Staff Writer

I grew up in Ames and Earlham, Iowa, and went to undergrad twice because it was awesome. The first time at The University of Northern Iowa and the second time at my beloved Iowa State University. The first stint in undergrad earned me a degree in Marketing, but I decided I wanted to do something different with my life and went back to undergrad to take the classes necessary to get into medical school. At Iowa State, I played rugby and wrote for the Iowa State Daily, which is how I know some of the staff that runs this site. I went to medical school at Des Moines University, and did my residency in Family Medicine at Mercy in Des Moines. After residency I worked in private practice at the Iowa Clinic for a few years and then came back to Des Moines University to teach and practice. I like watching sports, woodworking, motorcycling, and spending time with my family.

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