[Sciences/Junk Sciences/BBB] Aluminum adjuvants in vaccines and the blood-brain barrier. Removing the facts from the fiction, the good science from the junk science.

Preface:

This post constituted a direct response I had to the article posted by VaccinePapers.org in February 10 2015 (http://vaccinepapers.org/vaccine-aluminum-travels-to-the-brain/). However, it recently got a recycling on the Collective-Evolution article (written by an author from VaccinesPapers) through this post:
http://www.collective-evolution.com/2017/04/14/groundbreaking-china-study-links-immune-activation-by-vaccination-autism/

I will not focus more on the first half of this article and I am just providing with some facts about it that I discussed earlier on Facebook.

1. First paper (i exclude the CalTech thing since it is not peer-reviewed): They observed that mothers experiencing inflammation during pregnancy had higher risk of having offsprings with autism. Thats legit science. The senior author (Patterson) was (died in 2014) was a legit and recognized neuroscientist in the field of autism. This inflammation is either the result of some autoimmune disorder or infection. Thus the need to have mothers infection-free or avoid infectious diseases by keeping an updated vaccine schedule.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2387067/
2. The second paper, again from the Patterson lab, show again the same conclusion, this time on rhesus monkey. It again emphasize the impact of infectious disorders on maternal gestation and the risk associated on the baby. Another good reasons for expecting mommies to keep their vaccines schedule up-to-date.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322300/
3. Now the China study show that if you increase interleukin-6 levels in the brain (IL-6, a well-known pro-inflammatory molecule), you can induce behavioral outcomes in mice that are considered representative of the ASD. It goes in the same direction that what Patterson showed and further underline the danger of having an “overactive/boosted” immune system and its ability to cause neuroinflammation. This is a growing field as we speculate that some psychiatric (depression) and neurological diseases other than multiple sclerosis (Alzheimers, stroke) maybe aggravated or induced by an inflammation and overactive immune system.
http://www.sciencedirect.com/…/pii/S0925443912000234. Then we have the slippery slope in which CE drank the Kool-Aid of BS by “ergo post hoc” fallacy. The false association fallacy: If cars run on petrol and because cars kill pedestrians, therefore petrol kill pedestrians”. This is the BS they are doing. Since vaccination will induce a transient inflammation during the immune reaction and inflammation cause autism therefore vaccines cause autism”. Of course this was debunked but here they came back with the moving goalpost. Since thiomersal did not cause an increase in number of autism, then the anti-vaxxers moved to “then it should be formaldehyde. No? Then it should be aluminum….”

To better debunk the bogus claim brought by the VaccinePapers post, I have written a long but detailed description on what is wrong with that post. Since I had initially written down into a Word documents with elements embedded in it, this may have been some formatting issues in this post. My sincere apologizes.

In this blog post, the author primarily focuses on the vaccine aluminum nanoparticles to enter and accumulate in the brain. Using several peer-reviewed articles, the author tries to convince that aluminum nanoparticles in the vaccines are uptaken by macrophages, such macrophages are capable to enter the brain and trigger neuroinflammation.

Therefore, the message of this post is clear: vaccines contain aluminum nanoparticles, aluminum is neurotoxic, and therefore vaccines are neurotoxic.  If you travel in time, back in the early 2000s, the same blog post title would have talked about ethylmercury (formulated as thiomersal) contained in some vaccines and would have cited the famous “Wakefield paper” that was just published (and will be retracted a couple of years later due to gross scientific misconduct).

The blog website “Vaccine Papers” has the following slogan “an objective look at vaccine dangers”. Is it really an objective look or it is another anti-vaccine website distorting scientific studies to make fallacious claims in order to support an anti-vaccine agenda?

The goal of this article is to analyze, criticize and debunk claims made in this article and reveal the scientific fraud of this post and raise questions about the credibility of this website as a whole. In this post, we will explain why vaccines contain aluminum, which aluminum formulation has been used and is currently used in vaccines. Then we will refute the author’s arguments by directly citing passage of the post and provide a clear discussion about it.

  1. How do vaccines work?

To better understand the use of aluminum in vaccines, it is important for the reader to understand some fundamental concepts of immunology and how vaccines work. In mammals, we have a particular set of blood cells that are taking care of any foreign entity entering our body. It is called the immune system. To give an analogy, you can compare the immune system to the Department of Defense and the Department of Homeland Security, ensuring that anyone coming in to the United States is not posing a threat to the country.

Immune cells are all derived from a particular set of cells residing in the bone marrow: the hematopoietic stem cells (HSCs), such cells provide all the different cell types in your blood, whether we are talking about red blood cells, white blood cells or platelets.

In the figure depicted below (source: http://textbookofbacteriology.net/adaptive_2.html), HSCs will give two major cell lineages: the lymphoid stem cells (that will give the T and B lymphocytes) and the myeloid progenitors (including monocytes and macrophages).

When a foreign agent enters the system, it will induce two different types of response. In the case of a virus, it will infect some cells (depending on the type of virus) and will trigger the expression of molecules (usually viral proteins necessary for the spreading of the virus) on the cell surface. In the case of a bacteria or any entity that has a reasonable size (one thousandth of a millimeter), the bacteria will be swallowed by macrophages circulating nearby, digested and expose some fragment of this entity on its cells’ surface.

Finally circulating foreign agents can be recognized by a particular class of lymphocytes called B cells. B cells are like “keymasters”, they harbor millions of different types of keys capable to recognize any type of fragments coming from a foreign body. These tiny fragments are called in both cases, antigens. They are made of proteins, sugar or fatty acids, depending on the nature of the pathogen.

By exposing the antigen on the surface, it attracts the attention of certain immune cells. In the case of a virus, it will attract the attention of a set of T lymphocytes called CD8 T-cells that in turn will contact another type of lymphocyte called CD4 T-cells. In the case of a bacterium, macrophages and B-cells will recruit directly CD4 T-cells. CD4 T-cells acts a commander-in-chief, it will coordinate the immune response.

cellsindefenses75

It will train some immune cells to seek and destroy the immediate danger by having B-cells turning plasma cells capable to secrete antibodies. These antibodies are “keys” fitting exactly inside the antigen “key lock”. By this key-key lock interactions, plasma cells will trigger the immune response that will destroy the foreign agent and eliminate it from the body. Because of this threat, CD4 T-cells is training some naïve T- and B-cells as reservists to gain the military experience and that can be rapidly mobilized in case of a future threat.

The major caveat of this response is it takes time. It takes a couple of weeks to be up and running to fight off the infection and the immune system may forget it over time.

This is how vaccines work; we use decoys mimicking the foreign agent to train our immune system so they know the profile of this agent. In case of a real threat, they can rapidly mobilize and stop the threat. By having a immune system aware and ready to fight off the infection, it considerably limits the damage caused by an infection that for many of them lead to crippling conditions (e.g. polio, varicella….) or even death (e.g. measles, whooping cough….).

 In the paragraph below, you will see a chart from the Center of Disease Control (CDC) website describing of the number of crude death rate during the 20th century:

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Modern healthcare practice and medical breakthroughs (discovery of antibiotics, introduction of Salk vaccines….) introduced during the 20th century have considerably reduced the number of crude death rate in less than 100 years.

Yet, some people may argue this decrease in death rate may be inherent to the introduction of hygienist practices and refute such decrease in death rate is driven by massive vaccination campaign. To refute such claims, we are referring to a study published by the Vaccine-Preventable Disease Table Working Group published in JAMA in 2007 (http://jama.jamanetwork.com/article.aspx?articleid=209448).

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This table may appear confusing but four columns are in interests here: the pre-vaccine average number of cases and death prior the introduction of the first vaccine against the disease and the average number of cases and death as measured in 2006 and 2004 respectively. Note the dramatic decrease in number of cases and death for several of these diseases. For instance polio was a devastating disease over 70 years ago and we have zero number of cases reported.  These data clearly show the potential of vaccinations. This is why vaccines are life-saving type of therapeutics and have been able to considerably reduce the number of cases if not capable to eradicate certain diseases.

However, vaccines suffer from two important caveats: Firstly, the decoys are obtained from attenuated, dead, or small bits of such infectious agents. Secondly, such decoys are by themselves are weak to induce the “immune boost” needed to provide the biological effects necessary to create the “vaccine memory”.

Therefore, these vaccines are formulated with a solution called adjuvants, that act as a “booster” to improve the immune response, resulting in a fast and bold immune response but also help to stabilize the antigen in suspension (shelf life), as well as maintaining the sterility of such vaccines (http://www.roitt.com/elspdf/Newgen_Vaccines.pdf).

Historically, the adjuvant of choice was the Freund’s adjuvant (formulation can be found here:https://www.sigmaaldrich.com/content/dam/sigma-aldrich/docs/Sigma/Product_Information_Sheet/f5881pis.pdf) but suffered from non-negligble side-effects.

Therefore a common consensus practiced in modern biomedical and clinical sciences is a gradual shift from an empirical (for instance mineral oil contained in Freund’s adjuvant has a chemical composition that is not fully known and controlled) into a synthetic (ingredients are all known and coming from primary materials with an extremely high purity) and controlled approach.

Adjuvant and formulations varies between manufacturers and between types of vaccines. The Cender of Diseases Control provides a public fact sheet detailling the composition of all vaccines currently sold in the U.S. (http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf)

  1. Why is there aluminum in my vaccines? Is aluminum safe?

Aluminum (symbol element “Al”) constitutes a particular potent class of adjuvant and have shown to have a potent stimulatory effect on the immune response for over 50 years with no particular side effects or increased risk observed (for review:http://www.nature.com/icb/journal/v82/n5/full/icb200476a.html#bib1).

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The mechanism of action of aluminum as an adjuvant remains complex and unclear. It is the third most abundant element on Earth. It is considered as a metalloid, with its ionized form being Al3+. In contact with water, aluminum undergoes a chemical reaction resulting in the formation of aluminum hydroxide (AH): 2Al + 6H2O -> Al2(OH)3 + 3H2 (dihydrogen gas).

AH is classically used in adjuvants as it does not precipitate in solution, although an alternative form called aluminum phosphate (AP, AlPO4) is also used in certain vaccines formulation. This criteria is very important as chemicals used in injectable solutions have to be in an homogenous suspension. AH can organize and align themselves into crystalline structures, forming particles

gibbsite-crystal-3d-balls

Depending on how many AH are involved in these crystalline structures, these particles will have a particular sizes. In vaccines, AH particles distribution ranging from 2 to 10 micrometers, with a median size of 3 micrometer. In this post, the author refers to a particular type of aluminum, the aluminum adjuvant nanoparticles (AANs) without ever giving a bibliographical source or a definition to describe the nature of such term:

Aluminum adjuvant nanoparticles (AANs) are transported through the body differently than ingested aluminum. Most vaccines contain aluminum adjuvant, an ingredient necessary for stimulating a strong immune response and immunity. The aluminum is in the form of Al hydroxide and/or Al phosphate nanoparticles.

A request on search engine failed to provide us with a link on Pubmed and Sciencedirect databases with the term “aluminum adjuvant nanoparticles”, instead refers to “aluminum hydroxide nanoparticles (AHNs)” or “aluminum oxide nanoparticles (AONs)”. The usage of an uncommon term by the author is questionable and bring confusions on exactly what the author is referring to. However, the author later appears to refer to AH or AP nanoparticles, thus we speculate that AANs maybe an umbrella terms to refer to AH and APs and therefore we will refer on AHNs as AANs for the rest of this article.

Then the authors states the following: “Aluminum has been used in vaccines since the 1920s. Despite this long history, aluminum adjuvant was not studied much beyond its effect of making vaccines more effective. The safety of injected Al adjuvant was assumed, largely because aluminum is a normal (if unhealthy) component of many foods. Its one of the most common elements of the Earth’s crust. Its everywhere. So consideration of Al adjuvant safety was entirely based upon studies of ingested aluminum.” The author creates confusions for the reader as such sentences introduce a lots of concepts with few explanations and sounds more like a “word salad” than anything else.

As we have previously stated, aluminum is the third element in abundance in Earth’s crust (http://www.sandatlas.org/composition-of-the-earths-crust/). We can reasonably speculate that living organisms have been growing in an aluminum-rich environment since LUCA (last unicellular common ancestor) and therefore have adopted evolutionary traits to cope with such exposure to aluminum on the surface of Earth’s crust.

 In this section, the author discussed and misused an important concept used in pharmacokinetics that will be discussed later: bioavailability. Bioavailability defines the amount of substance that reaches the systemic circulation (in other words the bloodstream) compared to the amount dispensed at the delivery site. It is a ratio of the amount measured in blood plasma following its delivery through an extravascular route (oral ingestion, intramuscular injection, dermal patch….) divided by the amount measured in blood plasma following a delivery through vascular route (most of the time an intravenous (IV) injection). When you inject a substance by IV route, this ratio is by definition 100%. Now if I re-use the example of the author, the bioavailability by oral route is 0.3%. If a patient swallows 100g of aluminum (Al), only 0.3g will make it inside the systemic circulation, thus giving us a bioavailability of 0.3%.

Although the author will cite an article by Flarend and colleagues (http://www.sciencedirect.com/science/article/pii/S0264410X97000418) later in his post, it failed to report the bioavailability reported by the same study. By courtesy, we introduce this study in this section to bring clarity. In this study, Flarend et al measured the pharmacokinetics of AH in rabbits, using radioactive aluminum (as radioactive-based analytical methods are the method of choice to quantify metals).   In this study, they injected two rabbits with an intramuscular injection of AH at a concentration of 13.24 mg/mL. In an equivalent dose, each rabbit got “vaccinated” with 0.85mg of AH. According to the FDA guidelines, the amount of AH present in vaccines sold in US have a maximal amount of 1.25mg/dose with a cumulative amount (total amount you will get from vaccines) estimated of 4.22 mg over the infant vaccination schedule (source: http://www.fda.gov/BiologicsBloodVaccines/ScienceResearch/ucm284520.htm). [UPDATE] Keep in mind that such amount does not accumulate over time and we have a clearance of aluminum taking place over time. Because an intramuscular injection is not a vascular route, the bioavailability is below 100%. The authors here estimated the amount absorbed over 28 days to be 17%. What does it means? The amount absorbed is the amount that was able to diffuse through the epithelial barrier or from the connective tissue into the bloodstream (systemic circulation).  It also means that 82% of the Al is still present at the site of injection (take note, AVers: if it does not absorbed, it is not absorbed). So why is that? Its all about solubility. This is the solubility equation:
Al(OH)3<-> Al3+ + 3OH-
It is an equilibrium equation, in which Al3+ is only soluble at its ionic form. Therefore, you need to deplete the Al3+ to dissolve the AH nanoparticles. At physiological pH, AH is practically insoluble. This drives the bioavailability of Al3+. If we consider the absorbed amount over 28 days, we can deduct that the bioavailability is about 0.6%, slightly higher than its absorption via GI tract.
Thus, AH releases its aluminum at a very slow pace but also at the very long time. This is why we have this biphasic curve after Cmax, with the second slope being more steady and explaining the long half-life of Al.

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At baseline values (before injection), the amount of Al detected in plasma was about 30ng/mL. Upon injection of these four doses simultaneously, AH (black triangles) show a tmax (a time by which the concentration of aluminum peaked) at 10 hours, bringing a Cmax (maximal concentration) of 32ng/mL. In other means, a 6% increase in the amount of aluminum. Thats a bit of extra noise over noise. Not much a dramatic peak that would double up your exposure to aluminum. You don’t face an aluminum storm upon vaccine injection, but more a slight added noise over time. This is not a problem for healthy patients unless those with a kidney condition (we will discuss that later). [END UPDATE].
In the body, the authors estimated that AH mostly accumulated in the kidney, followed by the spleen and liver. This high retention is understandable as these organs are highly perfused with blood and therefore may accumulate more aluminum than other organs. These organs (liver and kidneys) are always monitored when drugs are developed as they can have serious toxic effects. However the amount accumulating is very negligible. The authors report an amount of 0.00001mg/g of tissue after 28 days. Put back into the context, at the time of injection, this tissue concentration may have peaked at 0.000283mg/g. Brain tissue, in contrast, have shown 100 times less accumulation than kidney. After 28 days, 3% of the initial aluminum injected remains in kidney, we can therefore estimate only 0.03% of the initial amount is accumulating in the brain. Aluminum has a long half-life (time to eliminate 50% of a compound from your body), as it is estimated around 100 days.

Because it takes some times to eliminate it, we can reasonably raise the question: what about the acute and chronic toxicity? The acute toxicity is defined by the toxicity obtained by a single injection, whereas the chronic toxicity is obtained from a continuous exposure.

An important concept in toxicology has been established in the 17th century by Paracelsus, the father of modern pharmacology and toxicology: “Every substance is poison, no substance is no poison. The dose and only the dose makes the substance the poison”.

It is all about how much you get exposed over time and about how long it takes to get it eliminated. A poison with a short half-life can see its toxic effect cleared very fast, whereas a poison that has a long half-live will accumulate if exposed continuously and show its toxicity after weeks if not years. This is often the case observed in poisoning with heavy metals (like lead, silver, mercury, arsenic). An historical example is Napoleon Bonaparte’s death by poisoning during his exile on the island of St. Helena. Because the amount of arsenic ingested was  low and did not alter taste, it did not raise suspicion of poisoning. However because arsenic half-life is high (12 days), it kept building up in the body until it reached a toxic level.

In a review published in 2007 by Krewski and colleagues (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782734/), non-occupational exposure to aluminum is mostly driven by food consumption, with a daily intake of 8.6 and 7.2mg/day for males and females respectively. The author of this post claim 0.3% oral bioavailabity in the following statement: “Ingested aluminum has a low absorption (about 0.3%), and when this low absorption is taken into account, there is good reason to expect vaccines to create aluminum toxicity. But that is not the subject of the present commentary. Commentary about the total amount of aluminum in vaccines can be found here: http://vaccinepapers.org/danger-aluminum-vaccines/

[UPDATE] For our demonstration, we will rely on the data provided by the review, citing 0.1% of bioavailability. Based on this number, we can estimate males and females are exposed daily to 0.0086 and 0.0072mg/day (or 86 and 72 micrograms/day) (values were corrected for bioavailability). If we use the study from Flarend and colleagues, we should expect to add 0.21mg (or 210 micrograms) of AH per injection. Considering the 6% increase in Cmax  concentration observed in rabbits following injection, we are expecting about an extra 12.6 micrograms of aluminum added to the systemic circulation. Another review by Yokel & McNamara (https://www.ncbi.nlm.nih.gov/pubmed/11322172) provides a more exhaustive comparison and sources for the amount of aluminum exposure summarized in the table below.

Yokel_Al.jpg

Now, we have more information available since I have written the first iteration of this post. We have an estimation of 0.07-0.4 micrograms/kg/day provided by vaccines. We will assume the more conservative number of 0.4 micrograms/kg/day. With the average weight of an infant (median weight at birth ~3.3kgs), we can assume a daily dose from vaccines of about 1.32 micrograms/day or about 237 micrograms over a 6-months period. These are plasma concentrations, therefore a better comparison would be to compare to the administration of aluminum via IV route as well.

As you can see in the chart, the most common medical procedure involving the IV infusion of aluminum is the total parenteral nutrition (TPN), or feeding directly via intravenous diffusion. The daily amount via TPN are much higher, we have values of 11-27micrograms/kg/day or for an infant getting a TPN at birth of about 36.3-89.1 micrograms/day. Therefore, the daily amount of aluminum obtained by vaccines is about 200 times less than the daily amount obtained by TPN route.
Now, this review came out before the FDA roundtable and risk assessment of aluminum in TPN bags. Following recommendation, the FDA consider an IV concentration of aluminum of 4-5micrograms/kg/day as possible neurotoxicity in premature and neonates connected to TPN bags.
Again, we have to compare to same scale. For an newborn, thats about 13.2 micrograms/day. Put the vaccine daily exposure, we are about 10% of this threshold value. Therefore, daily aluminum exposure in a vaccinated newborn infant is 10 times less the amount considered to have a possible neurotoxicity.
We have also to assume that the water and food intake does not apply to an infant and may bias our calculations. According to the Children Hospital of Philadelphia website (http://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients/aluminum), they estimate the total aluminum intake in infants from vaccines during the first 6 months 4.4 miligrams (thats about 4000 micrograms). This have to put into contrast from the 7 milligrams (about 7000 micrograms) from breast milk and 38 milligrams (38’000 milligrams) from formula-fed.  At this point, the author is simply hand waving about the danger of aluminum by ignoring the fundamental concepts of pharmacology, pharmacokinetics and toxicology. Therefore, the question I would like to raise is why the author failed to mention the study of Flarend in this section? It constitutes the right place to discuss about it.

Now, does aluminum is harmless? Well it is all about the dose and the patients condition. Again, the review by Krewski and colleagues can bring us useful information. Al is excreted primary via kidney route, with about 95% of renal clearance. For a patient with normal kidney function, this is not a problem. For infants that receive injections on a monthly basis, this is not a problem either. The problem arises if you have a patient or a premature that have to be on a constant IV infusion, like patients on TPN bags. There is a risk of aluminum accumulation as the intake amount is much more important than the amount excreted. Such case in patients that display either immature kidneys or signs of renal failure. However, in such cases, such patients will have aluminum-depleted IV bags to avoid such accumulation. [END UPDATE]

  1. Aluminum and neurotoxicity

If there is a concern about aluminum toxicity, it is its possible effect on the central nervous system (we refer to it as aluminum neurotoxicity). A rapid review on Pubmed using “neurotoxicity aluminum” bring us a total number of 387 articles, including 73 reviews. A classical model to assess aluminum neurotoxicity is the model of aluminum chloride (88 articles) in rodents.

In these models, aluminum chloride (Al(Cl)3) is administered by oral route with concentration varying from 5mg/kg/day (http://www.ncbi.nlm.nih.gov/pubmed/21543463), 50mg/kg/day (http://www.ncbi.nlm.nih.gov/pubmed/25940660), with a maximal values of 200mg/kg/day as reported by Prakash and colleagues (http://www.ncbi.nlm.nih.gov/pubmed/23315010). In all these studies, anatomical changes in the brain as well as motor and cognitive functions were reported. Now, it is important to relativise these amount to a 70kg body. At the minimal concentration of 5mg/kg of Al(Cl)3, the dose-equivalent needed to achieve these neurotoxic effects would be 350mg/kg/day. Thats about more than 43 times the daily dose of aluminum obtained with food intake. Every single day. With a chronic high exposure to aluminum, we would expect to reach such toxic level. However such model is not representative as Al(Cl)3 and AH (Al(OH)3) are distinct chemical entities and therefore do not share same physical and chemical features. But this did not stop the author from making false assumptions.

“Ingested aluminum enters the blood from the gut. In the blood, ingested aluminum is in a water-soluble ionic form, typically Al3+ or an aluminum complex*. This aluminum is separated into individual atoms, like ordinary salt dissolved in water. Ionic aluminum is toxic, but it is blocked from entering the brain by the blood-brain barrier (BBB), and it is rapidly filtered from the blood by the kidneys. Unless large amounts are consumed it does not cause a problem.”

A critic I have with his statement is how the author can exclude that Al3+ cannot cross the blood-brain barrier (BBB)? I will talk about the BBB later but I wanted to mention this logical fallacy. We just discussed about the neurotoxic effects of aluminum in the CNS, using Al(Cl)3.
To better understand the difference, we have to compare the solubility of Al(Cl3) and Al(OH)3 (AH). To be soluble, a compound has to interact with water molecules and breakdown its chemical bonds to become an ion. Some can easily break their bonds (example H-Cl breaks into H+ or Cl-), some less (like H-O-H or water). Water is a polar solvent. The oxygen atom attract the electrons of the shared bonds more towards it, it then becomes electronegative. In the other hand, hydrogen discretely loses its electron and becomes slightly electropositive. Ions will mix very well because they counter the charges around. If a compound can ionize, it will dissolve in water. If it cannot ionize (like hydrocarbon chains found in oil and fat, because the carbon atom is not greedy for electrons), then it will not mix with water. That’s why oil and water never mix.

According to Wikipedia, Al(Cl)3 solubility index is 43.9g/100 mL of water and AH is only 0.0001g/100mL. In other words, Al(Cl)3 in solution is under Al3+ and Cl- forms, whereas AH remains in its Al(OH)3 form. How can the author explain the experimental studies that show the neurotoxic effects observed in animals treated with Al(Cl)3 if he claims Al3+ cannot cross the BBB?

In a section of his article, the author cites one study to disagree with it, the study of Movsas  (http://www.ncbi.nlm.nih.gov/pubmed/23856981) published in JAMA Pediatrics.

The Movsas study (published in 2013) used human infants and obtained similar results. Movsas looked for aluminum in urine and blood before and after routine vaccination with 1200mcg aluminum at the 2-month date. No change in urine or blood levels was observed. Movsas states: “No significant change in levels of urinary or serum aluminum were seen after vaccination.“ Of course, these results contradict the claims by vaccine advocates that aluminum adjuvant dissolves and is removed by the kidneys.”

An important criteria when investigating journals is the impact factor. A high impact factor is usually associated with high-quality studies as the peer-review process in such journal has a higher expectation level. In the other hand of the spectrum, we have a new category of “predatory journals” (always based on fee for publications) that will publish studies with a weak or not peer-review process. JAMA Pediatrics impact factor is fairly good (7.13) to consider the study reliable. The authors investigated the levels of aluminum before vaccination, about 11.1+/-10.3 ng/mL. Note the extreme variability of these levels among 15 pre-term babies. The author reported no changes in aluminum after vaccination and estimated to increase the concentration to 1% following the publication by Flarend (see previously). You have to remember Flarend used radioactive Al to measure the kinetics, whereas in this study, we measure aluminum using another analytical technique that may have less sensitivity. It also indicates that the aluminum contained in vaccines injection is not giving higher values than the basal aluminum level, thus you cannot distinguish the aluminum from the vaccine from the aluminum contained in food. But this important point, the author failed to understand.

Indeed, there is another study that tried to reproduce a model of vaccines injection using mice that the author surprisingly failed to cite in his report: the study of Shaw CA and Tomljenovic L published in 2013 in Journal of Inorganic Chemistry (http://www.sciencedirect.com/science/article/pii/S0162013413001773). In this study the authors tried to develop a mouse model of newborn vaccine schedule and see the effect of such repetitive doses would impact on the neurological function.

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However, the experimental design is inconsistent and raises question about the validity of the data. The author never explain why they change the experimental paradigm in the low AI group. A common sense in science is when you want to show a biological effect you change one parameter at the time. For instance, the dosing schedule should stay the same, only the dose be different (as presented 50% of the normal dose) and have the control (injection with saline solution only).  A poorly designed experimental setup can only to poor results and poor interpretations.

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Based on this experimental setup, the authors observed an increase in weight in mice following the normal (or in this case, high) Al injections. No weight changes were observed in low AI or the control. Because of the flaw in the experimental design, we cannot tell if this effect is due to stress (remember the mice received more frequent injections than the other groups) or due to the treatment. Because of the poor experimental design, this result is worthless and resulted in an unfair use of animals to get this data. Now things become very interesting, the authors use behavioral tests for all the experiments and determined that high Al showed a decrease in the number of successful tasks. There is also a sexual dimorphism as males showed statistical differences but not females. Again, there is the experimental flaw that do not let us know if it stress related or if it is due to aluminum.  In a behavioral test, you are observing your animal and try to count how many times your animal displays a movement of interest. For instance, in neurosciences, we can put a mouse into a Y-shaped maze and put a bit of cheese in one branch of the maze. Each day, you put the mouse in the bottom of the Y-maze and let the mouse find the right branch (the one containing the cheese). After 10 seconds, you will take out the mouse and score if it succeeded (1) or not (0). After scoring, you will put the mouse again in the maze and score again the mouse for 9 times, this everyday. After a few days, the mouse will remember where is the cheese and will achieve a perfect score. If the mouse has some memory problems, it will perform poorly and will maintain a low score. Now the problem is if the mouse is stuck between the two branches, do you count that as a success or a failure? That’s the problem of subjectivity. I may consider it as a success because the mouse faced the right branch, another experimenter may consider it a success only if the mouse reaches and touches the cheese.

There is also some concerns about the authors’ affiliations. Both researchers were faculty members from the University of British Columbia, Vancouver, BC (Canada) (Dept. of Ophthalmology and Visual Sciences), (Program in Experimental Medicine; Program in Neuroscience) until 2013. Surprisingly one of the authors address displayed an unusual email for an academic researcher in a public institution (cashawlab@gmail.com) but furthermore later publications saw a change in the affiliation (Neural Dynamics Research Group, 828 W. 10th Ave, Vancouver, BC, V5Z 1L8, Canada). Firstly, I would question how a faculty researcher appointed in a department in which the mission is related to eye research has the expertise to study vaccines and toxicology.

Here is the website of Neural Dynamics and surprise, we find the same authors. What is interesting, is this page has been outdated for a while and it seems funding occurred for up to 2007. Are these authors still funded? Things become more and more murky when you see the name of Stephanie Seneff (a computer scientist at the MIT that claim autism is caused…..by glyphosate….in a journal called “Entropy”) as a co-author in one the publications (http://www.ncbi.nlm.nih.gov/pubmed/25349607)……in a predatory journal! Yes, that’s what I call entropic, sorry messy publication records. Orac from “Respectful Insolence” raised a red flag on this study published earlier on and it is worth a read (http://scienceblogs.com/insolence/2011/12/08/and-global-warming-is-caused-by-the-decr/). How reliable is a peer-review from a journal aiming to publish inorganic chemistry, in assessing the validity of scientific claims that are aimed for experts in vaccines and neurotoxicology? As reliable to publish my work on the blood-brain barrier in a journal that studies plankton biology.

[UPDATE] The lab of Shaw and colleagues came again in the spotlight recently for a retracted study on the effect of HPV vaccine on behavioral issues in mice, as mentioned by Retraction Watch (source: http://retractionwatch.com/2016/02/15/journal-temporarily-removes-paper-linking-hpv-vaccine-to-behavioral-issues/). The editor-in-chief of the journal (Vaccine) did not comment about the cause of the temporary retraction. It is also worth noting that the WHO called this study on aluminum adjuvants “seriously flawed”. The full report on the WHO related to the study on the effect of aluminum adjuvant can be found here: http://www.who.int/vaccine_safety/committee/reports/Jun_2012/en/

  1. Aluminum nanoparticles and macrophages

Later in the post, the author discussed about how aluminum nanoparticles (AANs) can enter into macrophages as citing the following: “This model is wrong because what actually happens is that a type of white blood cell called a macrophage (MF) engulfs or “eats” (process is called “phagocytosis”) the AANs before they can dissolve. Eating foreign material is normal behavior for MFs. When MFs detect bacteria or other pathogens, the MFs engulf the pathogens, and digest them with enzymes. They then tell other immune system cells about the pathogen and how to detect it. The problem with AANs is that they are not digested by the MF enzymes. And the AANs, once inside the MF, dissolve much more slowly. The AANs persist for a long time and cause the MFs to slowly leak aluminum. MFs that consume the AANs become highly contaminated with aluminum, and spread this aluminum around wherever they go.”

Again, the author never identifies the nature of these AANs, bringing confusion to the reader. Because the author focuses on the vaccines, we speculate that he is referring to Al(OH)3 particles (AH). The author continues his explanation on why macrophages are the main cause of “MFs that consume the AANs become highly contaminated with aluminum, and spread this aluminum around wherever they go. And they go everywhere in the body.”  Now the author claims these AH enter macrophages (MF), then these macrophages enter the brain and deliver aluminum across the BBB. Interestingly, after a search on Pubmed using the query “aluminum hydroxide AND macrophage”, I failed to find any relevant literature that demonstrated the inclusion of AH inside MF. Therefore the quote “Several studies show, with certainty, that MFs engulf AANs. In several studies, the AANs have been stained and photographed inside the MFs, and identified using several different methods. This is not surprising because it is well known that MFs will engulf nanoparticles just from being grown in a solution containing nanoparticles. The composition of the nanoparticles does not seem to matter“. This statement is not only exaggerated (the authors failed to provide citations to support that claim) but also provocative and fraudulent. In biological sciences, we rarely use a bold statement such as “certainty”, only when you have millions of individual records.

Only pseudoscientists would take a single study as the absolute truth.

The only study that can bring some information is the study cited by the author of this post (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155332/) using THP-1 cells.  What are THP-1 cells? THP-1 cells are monocytes derived from a patient that suffered from an acute monocytic leukemia. As any other cell line isolated from patients, these cells are readily available through cell collections such as ATCC (http://www.atcc.org/products/all/TIB-202.aspx). Technically, there are monocytes and not macrophages (see the schematics in chapter 1). Macrophages are derived from monocytes but in terms of biological identify these cells have distincts identity. It is like claiming my daughter is like my spouse. My daughter shares 50% of her DNA with my spouse and have the other 50% of mine, but she is different and unique. That simple concept appears not obvious for the author as at the end of his post cited: “Monocytes and macrophages are basically the same thing.”. Such statement is simply wrong and raises some skepticism on the rationale the author will use this study to establish his claims.

Furthermore, we have to remember that THP-1 cells are by essence a cancer cell line, they came from a patient suffering from a certain form of leukemia. Cancer cells are known to have a complete different biology than normal cells, because they are cancer cells. This is where we can start to discuss and question the validity of the authors claim: why did he not cited a study using macrophages isolated from healthy patients. The problem is there is no study that have investigated the uptake of AH by normal macrophages and we can reasonably speculate that THP-1 may have an abnormal uptake activity, resulting in an abnormal accumulation of AH.

However, there are several studies mentioning a condition called “myofasciitis”, all sharing the same co-author: Gherardi RK, the same Gherardi cited in this blog post. The author cited the following article to support the claim of AH-laden MFs: http://brain.oxfordjournals.org/content/124/9/1821. Myofasciitis (also referred as autoimmune/inflammatory syndrome induced by adjuvant) is a rare medical condition, as reported by Orphanet (http://www.orpha.net/consor/cgi-bin/OC_Exp.php?Lng=GB&Expert=592) but not listed in the Office of Rare Diseases (National Institutes of Health). The World Health Organization (WHO) provides a fact-sheet page available for information (http://www.who.int/vaccine_safety/committee/topics/aluminium/questions/en/). According to the website, it was identified in 1993 and most of the cases are located in France. Knowing that Gherardi is a French scientist currently affiliated with the Assistance Publique-Hopitaux de Paris Creteil (Department of Pathology, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris/Paris-Est University, Créteil, F-94010, France; Reference Center for Neuromuscular Disorders, H. Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, F-94010, France; INSERM U955-Team 10, Créteil, F-94010, France.).  The WHO teaches us two important features about the diseases:

Q1. What is MMF and how is it related to aluminium in vaccines?

  1. Deltoid muscle biopsies performed in France in patients with a variety of complaints have revealed in a small number the presence of a minute inflammatory focus of macrophages, along with crystal inclusions and associated microscopic muscle necrosis. These localized lesions have been shown to contain aluminium salts. Since the location of the lesions in the deltoid muscle coincides with the usual site of injection for vaccines, it would appear that these microscopic lesions are likely to be related to immunization with vaccines that contain aluminium adjuvants.

Q4. Does everyone vaccinated with an aluminium-containing vaccine have the MMF lesion?

A. Since muscle biopsies have only been carried out in patients with myopathic symptoms, there is currently no information on whether the characteristic localized histological pattern would be found in the healthy population after vaccination. It has been suggested that there might be a predisposed subset of individuals with impaired ability to clear aluminium from the deltoid muscle. Whether this reflects macrophagic dysfunction, or the tail-end of a normal population distribution of aluminium clearance and local tissue response, has not been determined.

It seems the disease is related to vaccination in patients marked by macrophages infiltration and aluminum deposition at the site of vaccination,  that apparently harbor a genetic background predisposing these patients to elicit an autoimmune reaction following vaccination.

This article appears as legitimate as it shows the presence  of macrophages in the muscle biopsies by tissue imaging and by using other techniques such as atomic force microscopy to quantify the amount of aluminum in such tissue samples. However, the major flaw of this paper? The absence of proper controls. There are controls documented (1252 individuals) but they never show the tissue sections from these controls or the quantification in the amount of aluminum. I found it very disturbing that such blatant flaws in the experimental design had been overseen by the peer-reviewed process, since Brain has a fairly high impact factor (IF~10).

If you inject a vaccine, you will expect an immune reaction to take place (that’s the goal of a vaccine). This translates into an inflammation stage that everyone experience few hours after injection: hot, red, swollen and painful. Inflammation also recruits a lot of macrophages (thus you would expect to see them under the microscope in your tissue samples) and you also expect  to see an important amount of aluminum in the site of injection, an amount that will take time to disappear (remember the half-life of aluminum? 100 days, it takes some time to get rid of it).  There is no biopsy samples from patients that have shown no side effects.

Most patients are identified in France. So there may be a rare autoimmune disease, that has a genetic background and that may be triggered by vaccines adjuvants following vaccinations. Because this condition appears only after vaccination, we may be tempted to claim vaccines caused this autoimmune disease. This conclusion is wrong as correlation is not causation. If adjuvant was causing autoimmune diseases,  we should see the same condition occurring in patients not carrying the genetic mutation, with a number of cases high enough to raise some epidemiological alert. Again remember, 600 cases in France, a country that count 60 millions inhabitants.

In conclusion, although the authors theory of macrophages loaded with aluminum nanoparticles may have some scientific basis, it still remains unclear as we have almost no studies to support its claim and have a rare disease that is only documented to one country (France) and mostly by one single group (Gerhardi group). To make a claim valid, you need a high number of studies (20 and more) coming from independent laboratories and described into different parts of the world. Therefore the macrophage-loaded theory raises some skepticism and clearly contradicts the claim of “certainty” posed by the author.

  1. Aluminum, macrophages and the blood-brain barrier

The author claims the blood-brain barrier protects the entrance of ionized aluminum (Al3+) but completely ignored the studies showing the toxic effects using Al(Cl)3. Indeed, the author come with one esoteric theory to explain the claims: “And they go everywhere in the body. The MFs are able to travel across the blood brain barrier (BBB). The MFs, once loaded with AANs, act like a Trojan Horse and carry the AANs into the brain. This is very harmful, because the brain is very sensitive to aluminum.” Before we can talk about this theory, we have first to understand the blood-brain barrier (BBB) and how aluminum may cross the BBB.

The BBB is a blood-brain interface separating the blood flow from the brain tissue (source: http://medicalterms.info/img/uploads/anatomy/blood-brain-barrier.jpg). As other blood vessels, brain blood vessels are lined by endothelial cells separating the blood flow from the brain tissue. These endothelial cells (that we usually call brain endothelial cells) are unique: they are very tight, much tighter than other vessels. Such tightness is ensured by the presence of tight junctions between endothelial cells, that block exchange of molecules as small as water and ions between the blood and the brain. These tight junctions provide a “physical barrier”. In addition to such barrier, the BBB has another type of barrier: a “chemical barrier” .

Picture6

As we mentioned, if you are a small water-soluble compound (a, like sucrose (table sugar) or water), your entrance into the brain is very limited. Now if you are a chemical compound that dissolves in oil (b, lipophilic), then you can diffuse across the BBB because cells have membranes made of fat (think about biological oil droplets). However, many of the compounds are still pumped out the brain because of presence of efflux pumps. These pumps block the diffusion of toxins and also drugs (such as cyclosporin A or AZT). Indeed, these pumps are responsible in the blockade of 95% of known chemicals, either natural or synthetic. This is one of the reasons why we fail to have effective treatments for brain cancer, because our current chemotherapy drugs are blocked by the BBB and we don’t have techniques to open this barrier.

Picture7

If you have a bigger cargo to deliver (like protein), it is almost impossible to deliver it across unless you have a dedicated receptor (key lock) and you have the right key to unlock it (d, receptor-mediated transcytosis). We only know a few of them, among them are insulin (insulin receptor), transferrin (transferrin receptor) and low-density lipoprotein (LDL, LDL receptor). There is an important discussion about when the BBB appears during fetal development and when do we have a mature BBB that has the function of an adult. Up to ten years ago, we believed the BBB was immature in newborns based on studies using rat and mouse pups. However, with the recent development in modern biology techniques, it seems that indeed humans have a functional BBB that maybe are as mature as adults after full term pregnancy. This was firstly supported by Saunders and colleagues that demonstrated that BBB from the opossum, a small marsupial from the same family than kangaroos and koalas, have a tight barrier (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267212/). This observation was also observed on rat pups following stroke injury. During stroke, the BBB opens and lets water and ions enter inside the brain and causes brain damage by brain swelling. If the newborn BBB was more fragile than the adult one, the damage would be more devastating. Indeed it seems not and maybe the opposite. In a recent study, Vexler and colleagues demonstrated that rat pups better dealt with stroke injury than adult rats and showed lesser brain swelling (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539825/).

Thus, the concept of the newborn BBB being more sensitive to vaccines than adults’ BBB maybe completely wrong. If vaccines induced BBB disruption, we should have epidemiological data showing an increase in severe neurological disorders including cerebral palsy or epilepsies. As we mentioned in the previous section, aluminum is known to show neurotoxicity, based on the Al(Cl)3 model. In this model, we speculate that Al3+ is in free form. Al3+ can bind to transferrin (a protein that normally delivers iron to the brain), thus using the transferrin receptor as an entrance mechanism (http://www.ncbi.nlm.nih.gov/pubmed/7580055). Indeed, there is little or no studies that investigated if Al(OH)3 can enter the BBB. One possible mechanism is that aluminum may disrupt the BBB, which in turn induce a BBB leakage and brain damage. The only study found is from Wiesnieski and colleagues (http://www.ncbi.nlm.nih.gov/pubmed/3730864) that investigated the effect of Al(Cl)3 and Al(OH)3 on rat BBB using radioactive sucrose to follow changes in the barrier tightness. The authors noted an increase in BBB leakage 2 and 4 hours after administration but did not show any differences after 24 hours. More interestingly, Al(Cl)3 triggered such leakage whereas Al(OH)3 showed no difference on the BBB. This study therefore refutes the idea that AH cross the BBB and/or induces BBB breakdown.

However, the author believes in the AH-loaded macrophages theory and made the following claim: “The MFs are able to travel across the blood brain barrier (BBB). The MFs, once loaded with AANs, act like a Trojan Horse and carry the AANs into the brain. This is very harmful, because the brain is very sensitive to aluminum.”
This claim is fairly outrageous for the BBB expert that I am, for different reasons. Firstly, the author simply ignores the notion of “immune privilege” organ such as the brain (for review: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597357/). In the difference of other organs, the brain has no immune cells residing inside healthy patients. Only one type of cells, microglial cells (derived from monocytes), is the only immune cell residing inside the brain. Immune cells (including lymphocytes and macrophages) cannot enter the brain because they don’t have the right keys to open the BBB.  Immune cells only cross the BBB following certain neurological disorders such as stroke or multiple sclerosis. In such diseases, brain endothelial cells undergo a phenomenon called “endothelial cell activation”, resulting in the expression of cell adhesion molecules (for review: http://www.ncbi.nlm.nih.gov/pubmed/20946472).

Following this activation, now immune cells (also known as leukocytes), have anchor points to anchor at the surface of the BBB as displayed in the schematics below. Leukocytes get anchored, undergo a complicated tango dance with the activated endothelial cells, squeeze through the endothelial cells (by diapedesis) and finally enters inside the brain. Because the brain is an “immune-privileged system”, these immune cells identify antigens present in the brain as foreign agents and triggers an neuroinflammation. A poster child of such neuroinflammation is multiple sclerosis. Therefore macrophages can only enter the brain, if you have have an activation of the BBB that will allow these cells to bind to the endothelial cell surface.

To support the claim that Al-loaded MFs are causing a neuroinflammation, the author goes again with another study from Gherardi again (remember the previous article missing the proper controls?). This time, he uses another study looking at the effect of fluorescent latex beads surface-coated with AH and published in BMC Medicine (IF~7) (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616851/). Before we further investigate this paper, it is important to note that BMC has been recently caught in a massive fraud scale involving fake peer-reviews and the subsequent retraction of 43 papers (http://retractionwatch.com/2015/03/26/biomed-central-retracting-43-papers-for-fake-peer-review/)

The author used the following image figure to claim the presence of aluminum inside the brain section. What appears disturbing is the inconsistency of the panel presented. On panel a, the author show a muscle biopsy tissue sample using hematoxylin-eosin staining, a common mixture of chemical dyes to observe tissue samples under a light microscope. Then for the spleen and the brain, the author show fluorescence tissue sections. Why did the authors switch from technique to another? Then we have the pseudo-colored pictures showing aluminum deposition. For the injected muscle, we can see some accumulation of aluminum consistent with the macrophages (deep purple) staining. But we cannot associate the aluminum deposition with the tissue sections of spleen and brain. Therefore nothing proves to me that the aluminum deposition observed in the spleen and brain are consistent with the presence of macrophages in that region. Also the aluminum analysis fails to show a proper scale bar. I cannot tell if panel b, c and d used the same magnification. For a manuscript of such caliber, it is unacceptable. Finally, the bar graph on the bottom right is not annotated properly. What tissue are we measuring aluminum levels over time? Muscle? Spleen? Brain?

This is the figure annotation: “Aluminum deposits in tissues following injection of alum-containing vaccine in the TA muscle. a) Granuloma composed of PAS+ cells is formed in the injected muscle envelope; b) PIXE mapping shows muscle Al deposits in pseudocolors, with confirmatory Al emission spectrum (d21); c) Section of spleen tissue (left panel) displays the large 500 × 500 μm and restricted 100 × 100 μm protonized fields corresponding to the PIXE maps (middle and right panel, respectively) enclosing eligible Al spots (d21); d) Section of brain tissue (left left panel) displays the restricted 100 × 100 μm protonized field corresponding to the PIXE map (middle panel) enclosing eligible Al spot (d21); the number of fields containing one or more Al spots was increased at all tested time points compared to unvaccinated (right panel) mice. (bars: 100 μm). d, day; PIXE, particle induced X-ray emission, TA tibialis anterior.

We have been just at figure 1 and we have already the same botched and neglected experimental paradigm that not only make the results inconclusive but also a complete waste of animals for the experiment. A complete opposition to the author’s claim as “In an impressive study in mice, AANs and other nanoparticles (e.g. latex) were injected intramuscularly into mice”. It is not impressive; it is a deeply flawed study that anyone holding a Ph.D. degree would be outraged to read. An important point to note: I never found information on how many mice have been used for the study. The minimum required to perform statistical analysis in animal models is 8 mice per group or treatment. Therefore, I call this study as “n=1” or a single mouse study. A single individual study has no scientific value unless it is a clinical case report (however, a case report remains the lowest level in the pyramid of scientific evidence).

In the next part of this study, things become even murkier. The authors now use fluorescent latex beads (FLB) to model alum agglomerates. This is something very important. Latex and AH are completely two different chemicals. Latex is a natural polymer made of number of cis-isoprene repeats (http://www.learnnc.org/lp/media/uploads/2008/09/polyisoprene1.png). It is basically a series of repeat of a molecule made of carbon and hydrogens atoms. These are two distinct structures and FLB cannot model AH. Furthermore, why did the authors not inject AH-loaded macrophages? even AH-loaded THP-1? So instead of investigating AH accumulation in the brain, we are now having a paper that investigates the accumulation of latex particles inside the brain. Latex is a natural product that is biodegradable. Such degradation is ensured by micro-organisms (http://www.wiley-vch.de/books/biopoly/pdf/v02_kap10.pdf). Animals do not have the enzymatic toolkit to degrade latex. Latex beads will accumulate in our body. The information in Figure 2 is basically telling us we are accumulating latex beads in the site of injection and because latex is not synthesized by our cells, it is recognized as a foreign agent and macrophages will try to clear these beads from the injection sites by swallowing them.

Picture8

we are accumulating latex beads in the site of injection and because latex is not synthesized by our cells, it is recognized as a foreign agent and macrophages will try to clear these beads from the injection sites by swallowing them.

In Figure 3, we are seeing the accumulation of FLB inside the brain. This is a natural consequence of injecting a substance that cannot be degraded. Because of the systemic circulation, these beads will reach the circulation from the site of injection and being spread in all areas perfused by the circulatory system. At the BBB, you will expect some non-specific uptake occurring. It is called pinocytosis, as endothelial cells will form some small sacks trapping liquid from the blood side and deliver this content to the other side. This event is rare but that happens. We can also speculate that because these animals are undergoing an important inflammation, such inflammation may be sufficient to activate brain endothelial cells and to allow FLB-loaded macrophages to enter the brain parenchyma.

Now, the onset of inflammatory response at the site of injection maybe what drives the opening at the BBB. If you look at figure 6, the intravenous injection of FLB did not trigger the infiltration of the BBB, simply because you need to have macrophages to swallow these beads in order to trigger an inflammatory signal. Macrophages are rarely circulating and mostly located in tissues. Following inflammation, macrophages will migrate to the inflammatory site. Thus explaining the absence of FLB infiltration inside the brain once injected by intravenous route. Now if you have a compromised BBB (like in mdx mice), you can see an important increase of FLB detected in brain sections from mdx mice.

To conclude, this story fails to directly demonstrate that AH triggers an inflammation in healthy mice, the authors using a complete different material (latex) to make a scientific claim that has no scientific values. You cannot claim that if I observe an allergic reaction following the ingestion of apples, it can be reproduced by ingesting oranges instead. I cannot show data using oranges and claim that these results reflect what happens when you have apples!

In addition to this study, the author also cited a study that used gold silica-loaded macrophages to target brain metastasis originated from metastatic breast cancer using a study from Clare and colleagues and published in Cancer Nanotechnologies (no impact factor as it is an open-access journal) (http://www.ncbi.nlm.nih.gov/pubmed/23205151). The authors showed they can load gold-silica nanoparticles inside macrophages directly obtained from whole blood samples of their institution Blood Center. Silica is a different entity than aluminum. It is formed by silicium (Si) that can ionize into Si2+. Like AH, silicium can bind hydroxyde and form Si(OH)2 that can crystallize and form particles. Why didn’t Gherardi and colleagues perform the same approach?

Again, this is a form of cherry-picking data, because the author tries to make the analogy between AH (Al(OH)3) and silica (Si(OH)2) – remember that these are completely two different chemical entities. Second Gherardi paper, second poor experimental designed study, second misleading conclusion. Not only did the author just drank the “Kool-Aid” without questioning it, he is also clueless on whether the Kool-Aid was genuine or tainted.

 

  1. Aluminum, autism and inflammation

Until now, we have been able to breakdown and debunk one piece at the time all these studies and showed that either their data were cherry-picked by the author to support its claim or the papers are of questionable quality that let us wonder how such papers went through the peer-review process without rejection. In the last piece, the author uses a study from Vargas and colleagues (http://www.ncbi.nlm.nih.gov/pubmed/15546155) published in Annals of Neurology, a journal with a good impact factor (IF=9.97).

It is important to note, this study is not investigating if aluminum or vaccines are causing autism. It is investigating what anatomical and biological changes can be observed between autistic brains and healthy brains. The authors used brain tissue samples from 11 autistic patients characterized by an IQ less than 70. Normal IQ score ranges from 90 to 110, so we can consider these patients as borderline. They have intelligence below average but not showing severe mental retardation. There is also an association of with epileptic seizure, with ~30% of autistic patients were epilepsy-positive. This study is legitimate and fairly well designed. We have proper controls and autistic patients. Interestingly, there is an increase in GFAP (activated astrocytes) astrocytes  and HLA-DR (a cellular marker expressed in antigen-presenting cells such as macrophages, dendritic cells or B-cells) in brain samples from autistic patients. This suggests the presence of brain inflammation in these patients compared to controls. The authors further investigated and measured changes in cytokines extracted from brain tissue homogenates and cerebrospinal fluid (CSF). The brain homogenates will tell us if cells produce (and maybe releases) these cytokines, whereas the CSF (a fluid in which our brain is soaked) will tell us if these cytokines are freely circulating. Cytokine measurements were done by antibody array using cell extract and patients CSF. It measures the cytokines by trapping them on a surface and then are detected by chemical reaction resulting in the formation of a dark spot. The darker and bigger the spot is, higher is the amount of cytokine. This method has the advantage to provide some information, although a more absolute method for quantification would have been a 2-D gel electrophoresis that directly identify these cytokines by their chemical structure and count the exact amount present.

You get interesting information from this table that compares the levels of various cytokines detected in the CSF from autistic versus controls.

Picture9

We can clearly see very high levels of cytokines known to promote inflammation (such as IFN-gamma, MCP-1) but there are also other cytokines known to promote BBB leakage (VEGF) and other cytokines with a biological function that remains unclear (TGF-beta2, FGF-9). This is some serious study that is supported by another research group, as published by Croen and colleagues (http://www.jneuroinflammation.com/content/11/1/113).

These studies tell us that there is an inflammatory component in a certain form of autism, with experimental data that are robust and reliable. Yet, these studies is not telling us autism is caused by inflammation or if autism causes brain inflammation. Furthermore, this study do not tell us if AH causes autism or if vaccines causes autism. However, by citing such articles at the end of this tortuous and fallacious pseudo demonstration, the authors want us to follow in the following fallacy: “Vaccines contains aluminum. Aluminum induces inflammation and get swallowed by macrophages. Macrophages causes brain inflammation. Inflammation is causing autism. Therefore vaccines causes autism”. You can see that such construction is invalid, flawed and completely irrational. Correlation IS NOT causation.

[ADDED SECTION] 7. Aluminum, the blood-brain barrier and neurotoxicity

As I have mentioned, the claim that macrophages loaded with aluminum leave the injection site and migrate to the brain via the lymphatic system and enter the brain via the BBB is unfounded and not back by science. Does it mean that aluminum does not cross the BBB?
The answer is no, aluminum can cross the BBB and therefore exert a neurotoxicity. This is why the presence of aluminum from external sources such as TPN bags can be problematic for patients that have either immature kidneys (premature newborns) or present some kidney malfunction (kidney failure, patients needing dialysis).
If I have to cite an expert in aluminum and neurotoxicity, the name of Pr. Robert Yokel (University of Kentucky) comes in mind (http://pharmacy.uky.edu/faculty/ryokel/Robert-Yokel). He has an impressive track-record in terms of peer-reviewed articles (145 publications) and other documentations. You can find his studies in Pubmed (https://www.ncbi.nlm.nih.gov/pubmed/?term=aluminum+yokel)
Aluminum can enter the BBB via various mechanisms. Because aluminum is an ion, it cannot diffuse through the BBB per se, it requires the use of carriers to piggyback on. According to a study by Yokel and colleagues, the monocarboxylate transporter 1 (MCT1) might be one of these carrier (https://www.ncbi.nlm.nih.gov/pubmed/9699794).
Another study speculate the possible use of zinc-transporter (ZnT) as Song and colleagues (https://www.ncbi.nlm.nih.gov/pubmed/18786610) described a protective effect of zinc on aluminum-induced disruption of the BBB following co-administration with zinc. We can speculate a possible competition between Zn and Al for the uptake at the BBB or we can speculate a competition for the site of action. Keep in mind that such study noted a disruption of the BBB following intraperitoneal (IP route, considered similar to IV route in terms of pharmakonetics) injection that were 5 and 10mg/kg, a value 1000x and 2000x higher than the value considered by the FDA to display neurotoxic effects (5microg/kg/day).
Another name that comes in the aluminum and neurotoxicity is the name of Chris Exley from Keele University (Staffordshire, UK, you can see his profile here: https://www.keele.ac.uk/aluminium/groupmembers/chrisexley/).  He has a legitimate expertise in alumium research in chemistry, but his positions and claims on aluminum neurotoxicity are not very accurate (the link between Al and Alzheimer’s Disease is mostly based on a case report from occupational exposure: https://www.ncbi.nlm.nih.gov/pubmed/24513181), fallacious (calling on the risk of aluminum as adjuvants in vaccines without providing direct evidence for the claims: http://www.sciencedirect.com/science/article/pii/S0264410X11013089?via%3Dihub), if not simply borderline conspiracy theory (https://www.ncbi.nlm.nih.gov/pubmed/25386158).
One of the most fascinating yet skeptical claim is the ability of silicon-rich water to “clear out the brain from aluminum”, according to his clinical trial  published in 2013 (http://content.iospress.com/articles/journal-of-alzheimers-disease/jad121231) and promoted by “woo” website and UK tabloid (in his case, The Daily Mail) as here (http://www.dailymail.co.uk/health/article-4320406/Silicon-rich-mineral-water-new-healthy-have.html), citing brands like Fiji water and Volvic (French mineral water)
I don’t know what he calls “silicon-rich water” (in other words, silicium dioxide (SiO2) the same chemical that make sand and your electronic chips) but I am highly skeptical how this highly polarized molecule can cross the GI barrier and the BBB, trap the Al inside the brain and clear it out.
To refute his claim, I would use the data from a study by Che and colleagues that looked at the effect of chronic exposure (13-weeks) to various dioxide via oral administration in rats (http://onlinelibrary.wiley.com/doi/10.1002/jat.3125/abstract;jsessionid=57E87335BDC127B06DAB5E9DAE7BF815.f04t01).
One figure worth a thousand words, the one about brain distribution of SiO2 in the brain of males and females. Brain_SiO2

Note the dose given (mg/kg) and the dose measured in the brain (ug/g). Even by literary eating silicon (245mg/kg/day), only a bare fraction make it inside the brain (0.28% to be precise). But foremost, even at the highest amount (almost 1g/L), there is no difference between the background noise (see the control values). I would be curious how does the silicon contained in Fiji water (95mg/L) and Volvic (32mg/L) will show higher SiO2 levels when concentration 2 to 7 fold higher cannot do better than background noise. Should we assume Exley is profiteering from Big Mineral Water?

[ADDED SECTION] 8. Aluminum and infants: my comments on the “Dorea” papers

I have some comments claiming the toxicity of aluminum from vaccines, using the publications of Jose G. Dorea (Department of Nutritional Sciences, Universidade de Brasilia, Brazil). You can find his publication on that topic on Pubmed (https://www.ncbi.nlm.nih.gov/pubmed/?term=aluminum+dorea).
His research can be interesting because of the issue of soil contamination of Amazonian soil with heavy metals (lead, methylmercury, aluminum….), but also is flagged by his claims that aluminum and mercury contained in vaccines is responsible for such effects.
For example, I refute his claims that aluminum and mercury contained in vaccines are providing much higher levels than breastmilk from his 2009 paper because his claims are based on a flaw in data interpretations (http://www.nature.com/jes/journal/v20/n7/full/jes200964a.html?foxtrotcallback=true).
First, his claims are based on values published, not from experimental data. Therefore, he never provide experimental data for his claims and we are just speculating. Second,  in the only figure of his paper, he assumes the bioavailability factor for the absorption of breastmilk but completely went south on the bioavailability of vaccines following IM or SC injection (see Figure below). If we assume the calculated bioavailability of the Flarend paper (~0.5%), then the graph looks much less impressive and completely destroy his claims. There is a big difference between 100% and 0.5% bioavailability, 200x  difference.
Thats enough to bring aluminum from detectable range to potential toxic range.

jes200964f1

We can go the same way with his other papers, they suffer the same methodological flaws: they all assume the toxic effect of Al and Hg based on hypothetical values and poor correlation, comments to studies that have nothing to do with the data presented in that study (the classical “whataboutism” and gaining one citation in Pubmed on the way, https://www.ncbi.nlm.nih.gov/pubmed/21664460). When the few times he published a paper with experimental data, he dismiss such data because it simply does not fit to his narrative. One of them is about measuring Al in infants hair, with the idea that infants who got immunized will show much higher accumulated Al levels than those not-vaccinated. Of course, the amount of Al from vaccines is marginal from Al from dietary exposure and resulted in no statistical differences. He was unhappy enough to conclude that this technique is not reliable enough. It is like trying to find patterns and hidden images in the static of an old TV (https://www.ncbi.nlm.nih.gov/pubmed/24183841).
In conclusion, I would definitely recommend not to take the Dorea’s papers as the gospel and strongly recommend anyone that has enough critical thinking and statistic literacy  to not suffice with the abstract and dig in to re-analyze the data to sort the scientifically correct from the misinterpretations. There are some nuggets of interesting data in his publications but also a lot of speculations and wrong conclusions.

 

  1. Concluding remarks

In this article, we investigated, analyzed and criticized the blog post that questioned the safety of aluminum in vaccines, with an ending clearly pointed to associate autism with vaccines. The same logic can be applied to thiomersal, an adjuvant containing mercury and initially cited as a causative agent of autism following MMR study in the Wakefield study. [Correction: One reader noted the inaccuracy of this claim and I make an apology for this mistake. The retracted Wakefield paper made an association between children displaying autistic traits with MMR vaccinations (see Table 2). However, the origin (manufacturer) of such MMR vaccines was not reported and therefore such study could not pinpoint which agent contained in those vaccines was the cause of such condition. Neither such study mentioned which MMR vaccines contained thiomersal. End of correction]. Of course, the Wakefield study scientific fraud has been raised and resulted in the retraction of it. Thiomersal has been removed but anti-vaccinationists now turn to another component: aluminum hydroxide, despite the clear evidence of no association between autism and vaccines (http://www.sciencedirect.com/science/article/pii/S0264410X14006367).

Early on, we demonstrated the confusion brought by the authors. The author creates confusion by introducing the terms “aluminum adjuvants nanoparticles”. There is two class of aluminum adjuvants used in vaccines: aluminum hydroxide (AH) and aluminum phosphate.  For the clarity of this article we focused on the AH nanoparticles. Unlike some websites making claims without providing any source for primary literature to support their claim, we indeed observed a smart strategic move from the author to use primary literature as sources but never showing the real data or discussing the main information coming from these studies. I call such move as a “hijack” method in which a legitimate study is used as a decoy making the claims supported by scientific evidence. A neophyte will accept this claim for granted but a more scientifically alert person will access the primary source to ensure what have been claimed on the website is in agreement with the original study. This strategy has been applied by pseudoscience websites such as “Natural-News” or “Collective-Evolution” that will have legitimate references listed to make their claims appear credible.

Another fraud observed in this post is the obvious copyright infringement by hosting and embedding PDF files of manuscripts published under conventional editorial processes. Unlike open-access journals, conventional journals requires the subscription to access their article databases. As a scientist, once my manuscript is accepted by a journal for publication, I have to secede my author’s rights to the journal. I can share the link to the abstract of my studies. If I put the PDF of the journal article on my website, freely available, I am violating the journal copyrights (you can see the copyrights information here: http://www.elsevier.com/about/company-information/policies/copyright).

However, if my studies have been funded with federal research grants (from the National Institute of Health), then my papers will be freely available through Pubmed Central after 12 months of publication embargo (I have linked to the PMC versions whenever it was possible).

Finally, we also found the few articles that were directly supporting the author claim were also the ones with questionable origin, flawed experimental setup if not suspicion of blatant scientific misconduct, even after undergoing a peer-review process.

The peer-review process has been initially designed to use the expertise of scientists to filter studies with an adequate methodology and results from those with a poor or questionable methodology. However such method is not perfect and have been subject to criticism. Even a fair and genuine peer-review in journals with the highest impact factor (Nature, Science) may fail to detect the presence of data manipulation and fabrication. If you are interested to follow on paper retraction, an excellent website to consult is Retraction Watch:http://retractionwatch.com.

We rightfully questioned several publications, all coming from two groups. An important criteria for robust scientific discovery is the ability to reproduce similar results in different laboratories, but also having such publications being reviewed in journals harboring an editorial board capable to assess the quality of your research. As a BBB researcher, trying to publish my research inside a plant biology journal may not give me the best peer-review.

Finally, statistics and certainty in science. Scientific method starts with a question (hypothesis), the design of an experiment and the subsequent outcome of such results and eventually the share of such results by publication into peer-reviewed journals. Once peer-reviewed anyone can ask to reproduce your data in their lab settings. A single study is not sufficient to qualify a phenomenon as a fact. When you have the same phenomenon that has been published a number of times by different groups and most of them show a similar outcome, we can call about a consensus. If this consensus rely on thousands of experiments that predict the same outcome each time, we can consider it robust enough to set as a theory.

In our study, we presented evidence that the additional aluminum due to vaccines injection is negligible and non-distinct from our daily exposure (food), an allergic reaction to vaccines is possible but affect so far only 1 individual per 100’000. Therefore, these individual will have a greater chance to develop such condition following massive public health campaign (for instance, France had a massive Hepatitis B vaccine campaign in 1994, which was marked by  the first report of myofasciitis).

Based on the current literature, there is no evidence that AH incorporate into macrophages, such macrophages cannot enter the healthy BBB and therefore the neurotoxic effects of aluminum due to vaccines is unproven. The house of cards built by the authors just crumbled under an intense and scientific scrutiny.

In my final words, I would say to anyone trying to argue with conspiracy theorists is the same than with wrestling with a pig: you will end up exhausted, covered with mud and the pig will feel happy.

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[Pharmacology/Junk Sciences] About the FDA recall on Dr. Hyland’s homeopathic tooth relief….

You may have heard about the recent FDA recall for Dr. Hyland’s homeopathic teeth relief and any products similar to it as listed in their report below (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm523468.htm).

There are 10 children deaths and 400 adverse events reported with the association of this homeopathic product. Homeopathy has always lauded itself as “natural, effective and harmless”. Even when it was faced with the lack of efficacy, proponents of homeopathy always use the “what’s the harm?” as a defense. Seems that not only it will not treat your ailment. Worse it can kill you. Why? Simple pharmacology.

A tenet of pharmacology is known since Paracelsus with his famous citation “Every substance is poison. No substance is no poison. The dose and only the dose makes a substance a poison”. Even the natural products are poison. You see, Mother Nature in all its grandeur has developed a certain affinity for developing some of the most toxic substances designed to kill living species. Because of evolutionary constraints, plants have been very good as being “chemical plants” and use chemical warfare as a method of invasion and defense.

Now, you can use this poison effect to treat certain conditions. If you find the right dose, you may treat a condition. This is how pharmacology works. Under a certain dose, there is no effect. We only start to see some biological activity after a certain dose. This is what we call the Minimum Efficacy Concentration (MEC). On the other hand, if you reach concentrations high enough, then you start to hit on off-targets and develop the minimum toxic concentration (MTC). This is where we start to see side effects and if the doses are high enough you will see adverse and toxic effects.

Homeopathy is by definition an unproven therapy because its principles defy common laws of physics and chemistry. Because it is relying on extreme dilutions to explain its activity, the amount of active substance is so low that it can be compared to dilute one single molecule into a swimming pool.

In this case, we don’t exactly know what compounds and what amount of each alkaloids are extracted. We know the total amount is 0.0000000000003% or 0.3 pico-grams per 100mL of solution or 100g tablets.

belladonna

That amount is simply ridiculously low. First, we have to assume that its PO administration will result in a 100% bioavailability (that is probably false and surely below). Second, you should be able to detect the compound in plasma samples. At that level (pg), the odds of detection are very low if not non-different from background. Therefore the odds of having this single molecule finds its target inside a body is almost zero (and the probability is something like 0.0000000000000000000000000000001%).

Yet, homeopathic treatment are all starting from raw extract (usually an hydro-alcoholic solution as extracting solvent) called “tintura matter”. Thats a concentrate and it contains indeed active substances in a high concentration. The nature and quantity of active substance in it are not known and not even reported since homeopathic products are not falling under the FDA supervision (you can thanks the DHSEA provision for that). Basically, no one (even the manufacturer) will tell exactly what and how much of active compounds are inside this tintura matter.

This raises a problem because Mother Nature has been excelling in producing poisons, what only matter is the dose. In the case of the teething relief product, the main culprit appears Atropa belladonna, a common poisonous plant that get easily confused with edible berries.  One of the classical substances purified from Atropa is atropine, an acetylcholine muscarinic receptor blocker. Because Atropa belladonna is known for its poisonous activity, we had some disaster in waiting that was cooking here. Anyone working with drugs will tell you how dangerous it is to overdose on an active substance.

Acetylcholine is an important neurotransmitter in mammalian cells, with peripheral (heart, muscles, lungs….) and central actions. Acetylcholine is a key target of organophosphates and sarin gas, as these agents block its degradation by acetylcholine esterases (this is why you have atropine administered as a side treatment for poisoning).

However, atropine can and will have severe side effects if ingested in a poisoning event (see this case report of accidental ingestion of Belladona: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361210/)

So whats exactly happened in this situation? We dont know and only now the FDA can provide clues. The FDA is toothless and cannot execute any order unless there are fatality cases involved. On their page, they are aware of the anticholinergic side effects of it but minimized the risk (that logically make sense since the amount is ridiculously low)

belladonna2

At this point, I speculate that something wrong likely happened with these homeopathic products. My speculation is something went wrong with the preparations, resulting in inconsistant extraction and effective concentrations in tintura matter. Because homeopathy are not ruled by FDA, they do not have to follow the stringent quality control and good manufacturing practices (GMP) imposed on pharmaceutical companies. So we have here a production that was on a free ride without any oversight on the QC. Now you can easily imagine that we may have ended up on with overdosed preparations.

Considering the special population (pediatrics), this risk of overdosing was even more amplified. One thing we consider when we develop a drug and prescribe a drug is the benefits/risk ratio. If the risk or adverse effects are too high, the drug cannot be used because it overcomes the benefits.

In that case, not only the benefits were quasi-null, we provided access to a product that was deemed “safe because natural” but indeed has a risk of adverse effect. Now we have likely some precedent in directly demonstrating the danger of poisoning with homeopathic products. This is already the case with essential oils (there are cases of children poisonings with Eos) and now we have the same with homeopathic products.

[BBB/Sciences] 19th International Symposium on Signal Transduction at the Blood-Brain Barriers

Today marks the third and last day of the 16th International Symposium on Signal Transduction at the Blood-Brain Barriers held this year in Copenhagen, Denmark.
This is typically a conference that is considered as a European Blood-Brain Barrier because it takes place usually in a EU country and has mostly a European audience. Still it attracts few speakers, poster presenters and attendees from the US and from other places. We were few US scientists attending this conferences and also few Japanese scientists.
The Euro-centric did not remove anything to the science presented and the attendance. We estimate about 150 people attended this conference and the scientific programming, the venue and the dinner event was fanatastic.
On the first day (Wednesday), we had some local stars such as Maiken Nedergaard and Kjeld Mollgard (University of Copenhagen) discussing about her latest research in glymphatic system and ABC transporters respectivelly. Furthermore, Joan Abbott (Kings College London, London, UK) provided a very nice and exciting keynote on some evolutionary trait on the brain barriers, discussing about the presence of a glial-based brain barrier and its subsequent evolution into a endothelial-based brain barrier and suggested that it may not be a single evolutionary event but may have happened several times independently in different phylae.
The venue of the first day in the Ceremony Hall at the University of Copenhagen was also giving this formal and colloquial atmosphere, as this room was nicely illlustrated with wall paintings highlighting different periods of Denmark history and the inclusion of the University in such history (the passage of the battalion of 200 students that stood up to Swedish Army in the 18th century was very interesting).
The second and third day took place in the much modern Scandic Hotel located downtown, in one of their ballroom allowing to share the same room with the posters). A lot of very interesting talks were highlighting the conference with Margareta Hammarlund (Uppsala University, Uppsala, Sweden) discussing about the pros and cons of animal models for assessing brain pharmacokinetics and also the need to itemize the different compartments in the brain. Other noteworthy talks were from drug delivery standpoint where a couple of talks on receptor-mediated transcytosis and their impact in neurodegenerative diseases and drug delivery (Claus Piertrizk, University of Mainz, Mainz, Germany), the migration of T cells in multiple sclerosis (Britta Engelhardt, University of Bern, Bern, Switzerland), the protective role of microglial cells following stroke injury (Zena Vexler, UCSF, San Francisco, USA) or cell-cell interactions between brain metastatic cells and the BBB (Imola Wilhelm, Hungarian Academy of Sciences, Szeged, Hungary). Finally the last talk of the day was a keynote by Maria Deli (Hungarian Academy of Sciences) about the current limitations and advances of in vitro models and also the need of BBB expertise in the field of bioengineering. Maria rightly pointed the elegancy of the microfluidics systems for modelling a “BBB on a chip” but also noted that such models fall flat as they use BBB cells with poor barrier properties, far from “the in vivo representation” selling tags in many publications in the field. For me, it clearly emphasize the need of having more bioengineers to come attend BBB conferences as well as the need to have BBB speakers in Bioengineering conferences. Maybe this is something worth considering for the next international meeting.
The conference organizers also included a dinner at the “Skuespilhuset”, a restaurant and theatre located on the shore of Copenhagen, facing Christiana (the famous hippy-turned-hipster village). The food was fantastic and the wine eased the tongues for better social interactions and exchanging ideas.
The third day was as rich as the previous days, with a session on in vitro modelling of the BBB using stem cells with a keynote from Eric Shusta (University of Wisconsin-Madison, Madison, USA), but also an interesting keynote by Ingolf Blassig (Leibnitz Institute, Berlin, Germany) that has done an exhaustive survey on the expression of claudins at the BBB and differences between rodents and human models.
Overall, it was a great conference well organized, short but dense enough to allow interactions, discussion and novel ideas of collaborations to stem.
Last but not at least, the classical photo group of the European (though incomplete) blood-brain barrier community in a nutshell. If you feel like to play “Where’s Waldo?” game, feel free 🙂

14289858_10154210140153110_1198038248657986592_o

[Stroke] Surviving stroke injury with a little help of my friends: Astrocytes provides neurons with mitochondria following stroke injury

A very nice study published by Eng Lo (Mass General Hospital), a whiz kid in the field of stroke research. It really brings in a new paradigm in terms of our understanding of stroke injury and stroke repair.
We know that astrocytes play a crucial role in helping the brain recover from stroke injury and try to rescue neurons by secreting growth factors.
But we have been failing to find methods to deliver growth factors in a non-invasive way because producing growth factors by biological engineering is very expensive but also you can only deliver them by directly injecting them in the brain with limited spread.
This very nice piece of work published in Nature and reported by Science (if Science reports on a paper published in a concurrent journal, you bet it should be that good) tells you it is surely a very elegant piece of work here. The paper indeed show that astrocytes seem to go the extra-mile and even provide mitochondria to neurons to help them cope with stroke injury.

Source: Transfer of mitochondria from astrocytes to neurons after stroke : Nature : Nature Research

[Junk Sciences] About that scientific paper retracted from Scientific Reports yesterday and the limits of peer-review

A tenet of becoming a scientist and earning a doctoral degree (Ph.D) in hard sciences is to be able to develop a critical thinking and skepticism over scientific findings. We learn how to not accept scientific claims as facts “just because someone said it” and learn to fact-check such claims by analyzing the data and see if the data are robust enough to support the claims or if they are simply inaccurate, non-conclusive or worse…..simply fabricated.
Data fabrication, adulteration, plagiarism and manipulation is unfortunately present in science. This is why peer-review is playing an important role in filtering out studies that are robust enough from studies that are murky or questionable enough. That latter is usually what I refer as “junk science”, scientific studies that are not standing to scientific rigor and should not have been reaching the publication stage. The peer-review process is not the most optimal one. If you want an analogy, consider peer-review as the wooden fence lining your backyard: it will not stop a burglar to climb over it but it will stop trespassers and marauders to come too close from your home.
Yesterday, I woke up straight in a middle of a Twitter firestorm about the retraction of a paper. Seeing papers retracted is not uncommon, there is even a website for that called “Retraction Watch” that track studies retracted by scientific journals. But yesterday it was such a bad paper that yesterday’s Dr. Derek Lowe that hold a PhD in Chemistry from Duke University had a fiery blog post about it (the access was denied soon after I read it but seems to be online again this morning) named “Crap, courtesy of a major scientific publisher“.
The problem was not facing a junk scientific paper, there are plenty around nowadays since Open-Access journals started to kick inside the world of scientific publishing and thanks to predatory publishers (I will talk about it later). The problem was the journal that has such junk paper published: Scientific Reports (SciRep, from Nature Publishing Group) (Disclosure: I have co-authored a paper published in Scientific Reports). Scientific Reports is the response of NPG to open-access (OA) journals such as Public Library of Sciences (PLoS). Because it is coming from NPG, everyone is expecting to attain a certain rigor for peer-review (Nature is one of the hardest journal to get your scientific study published). I always joke around that it is so demanding that we are facing “icebergs” papers, studies with five main figures and 50 supplemental figures that are only accessed online.
Using this debacle, I thought it would serve well as a poster child to expose some scientific fraud and provide some tips to distinguish good papers from bad papers.

1. Scientific Publishing 101: Peer-review, open-access, predatory journals and publication fees.

Publications in peer-reviewed journals is the bread and butter of academic researchers. It is as vital for a researcher as a credit report is for anyone living in the US. Two criteria matters in big time decisions such as finding a job or earning tenure in an University: how many papers you have your name affiliated to and which journals. These metrics are very important, especially with the latter driven by the impact factor (IF). The IF is the equivalent of a BBB rating: the higher, the better. Two giants dominates the field: Nature (from NPG, IF ~42) and Sciences (From the American Association of Advancement of Sciences or AAAS, IF~32).
It is so important that the number of papers coming from these two journals conditions the odd of a researcher to get a job in prestigious institutions such as Harvard, MIT, Stanford or UC Berkeley.
Papers are part of a particular cycle that I don’t know if we should call it vicious or virtuous.
1. To publish papers you need data.
2. To obtain data you need research funds.
3. To obtain funds, you need to write winning grants.
4. To have a grant having a chance to get funded you need papers
5. Repeat step 1.
All peer-reviewed journals follow the same procedure: I submit my draft manuscript that I consider solid enough for peer-review to a journal. The editor-in-chief (usually a well seasoned scientist) decides using both an objective and subjective point-of-view what to do with it: the objective one is if the paper fits into the editorial policy (for instance publishing my work on BBB into a plant biology journal is fairly no-sense) and the subjective one is if the paper is “attractive” enough for the editor-in-chief or not. If not, it will toss it fast. If it is, it will proceed and pick 2 reviewers that have more-or-less the adequate expertise. Such reviewers are kept anonymous for most journals with very few exceptions. Reviewers have a moral obligation to keep their review objective and fair. Sometimes they do, sometimes they don’t. You can easily imagine that if reviewer X is a scientist working on the same topic than me, that reviewer feels the risk of being scooped and therefore will work hard to find flaws to get my paper rejected and work hard to scoop me.
At the end, 2 or 3 reviewers will provide their comments and feedback giving the editor-in-chief the decision to accept or reject your paper. Once rejected, you have no other choice to move on to another journal and restart the same game.
The competition is fierce, with only less than 1% of papers submitted to the top 2 journals will end up being published. This also raised a race-arms to publish only papers that are groundbreaking science in big way and usually can shake up an entire field and a fierce competition for getting published. This is what I call the “wow factor”. But thats only a small problem that raised to OA journals and sometimes it can backfire due to scientific misconducts (examples: Two stem cells papers retracted because of data fabrications such as the Hwang paper about the cloning of hESCs from human oocytes published in Science in 2005 and the STAP “pickled stem cells” published in Nature in 2014)
The main problem is that once accepted, this study will suffer from a double-jeopardy in terms of publication fees: the authors have to pay publication fees to get the accepted paper published (usually goes from ~$1000-3000 per study). Once published,  you secede the copyrights to the publisher, this publisher will ask anyone wanting to read the paper to pay for its accession (~$50 per study). This second fee hinders how many scientists can read your study, limit access of scientists from developing countries to these studies and also limit the number of studies that will cite your study. Certain public health agencies like the National Institute of Health (NIH) responded to such issue by asking any studies funded with $$$ from NIH grant to be available free 12 months after publication through their “Pubmed Central” portal.

OA journals were born from these concerns. The OA publication follows the same protocol than regular published journals except for two aspect: they will accept any papers based on the robustness of the data rather than the novelty or “wow factor”. If your paper is not as exciting and breaking ground as higher journals but it solid and can provide the field with small but solid information, it will get accepted.
once published such studies are made open-access. Anyone can read them freely. This is because once accepted, the journal recover the costs by asking higher publication fees (~$2500-$3500) from the author of the study.
This is an interesting alternative publication method, however it also opened a new wild wild West in academic publishing. Like any good Western movies, you have wandering snake oil sellers and in academic publishing these snake oil sellers are represented by predatory journals and publishers. These publishers found some easy preys to feed on: academic scientists with studies that are so poorly designed or just simply fraud and could not pass the peer-review filters. As long as you give them money in form of publishing fees, they will publish your paper through an expedited review. This lead in recent years in the appearance of “junk papers” that are little or no scientific merit and yet get the right to get cited. This lead to a hall of shame through the Beall’s list of predatory publishers providing a database of journals and publishers with suspicious or demonstrated predatory practices. There is even one publisher found with a mailing address pointing….to a suburban house. How serious this can be? This is what feed most of the pseudoscience outside. Anti-GMO, anti-vaccines, chiropractic, naturopaths and homeopaths are all relying heavily on such “junk science” to provide a scientific rationale to their claims.

2. What was about this paper that made such firestorm and retraction by Scientific Reports?
The paper in question is titled “Novel piperazine core compound induces death in human liver cancer cells: possible pharmacological properties” by Samie and colleagues from the University of Malaya, Kuala Lumpur, Malaysia and published in SciRep last April. As today, the paper was not available through SciRep yesterday and seems back online today. I guess the academic firestorm put the server into severe stress.
I will go step by step and explained in comments what is wrong with this paper (see figures below).

Slide1

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3. Conclusions

After reviewing the paper, you can notice how many flaws and blatant data manipulation was mined inside this paper. Peer-review cannot be a fool-proof system, as some very elaborated data fabrication may go unnoticed even by the most seasoned reviewer. I am not surprised either to see such junk study to made it through publication, if it was coming from a predatory journal. But seeing such paper coming from Scientific Reports being unnoticed although a fairly reasonable turnover (it was received in October 1 2015, accepted March 23 2016 suggesting at least one round of review and the submission of a revised form) is disturbing. Scientific Reports editorial has to consider what went wrong and investigate the review history of this paper but also whether reviewers assigned to review this study displayed the expertise needed and the objectivity to do it.
At that time, I would not be reviewer 1 or 2 (even 3) that reviewed this junk paper. Garbage in, garbage out.

[Neurosciences/Junk Sciences] MTHFR, folate, folic acid, spina bifida, autism…..Oh my!

Lately a lot of media attention has been revolving about folic acid (or folate which is strictly the same I will explain to you later) and I have seen a lot of worried and less worried mommy bloggers panicking about folate or obviously making comments about being diagnosed with MTHFR mutation, that folic acid is not folate, that the former is the “all-natural” and the latter is not absorbed, that folate-supplemented food is “evil”.
Add to it the recent oral communication presented at the International Society of Autism Research (ISNAR) Annual meeting in Baltimore that suggested an association between excessive folate consumption and increased risk for autism (as reported by ScienceDaily here) that was blown out of context in mainstream media (because of course mainstream media has a fond for blowing up single studies and junk science as fact).
You have the perfect storm for a major sanitary disaster to happen and the right condition for quacks to prey on panicking expecting mothers.
I feel it is important that we desacralize and demystify the “folate/MTHFR” scare using science and facts to better understand folate and folic acid, the physiological function of folic acid, why folic acid is essential and have been added to wheat and corn flour and why you should not stop taking folic acid without recommendation of your physician and pharmacist.

1. What is folic acid?
Folic acid  is also known as folate or vitamin B9. Some people will argue that it is not the same molecule. The fact is folate=folic acid, even Sigma-Aldrich (one of the main chemical manufacturer for scientific research) agree on me with this term (Sigma-Aldrich technical data sheet can be found here). Both share the same chemical identification number known as CAS (CAS-59-30-3).
The only difference is subtle and has to do whether you are referring to the non-ionized form (folic acid) or the salt (or ionized form, folate) form of folate. To understand it, you have to have a basic in organic chemistry but if you remember your high school science class, you should be able to understand the chemical structure below.2000px-folat-svg
As you can see we have two carboxylic acid groups (COOH<->COO- + H+) and one basic primary amine (NH2 + H+ <->NH3+) that is conjugated with two neighboring secondary amines.
If you remember your chemistry class, carboxylic acids are what we call weak acids, same for amines (weak bases). Each weak acid and base has a particular  feature called the pKa value. This pKa value is important as  giving the properties of a pH buffer solution. When pH=pKa, we have a 50%/50% ratio between ionized and non-ionized form and this gives the buffer properties of a solution. Most biological solutions have a defined composition that results in a particular pH. Most body fluids (with some exception such as stomach), have a pH defined by various chemicals. In blood and tissular fluid, this pH is set at 7.4. You should go slightly below (pH=7.3) or over (pH=7.5) and you will enter into an acidosis or alkalosis situation that can kill you if your body does not remediate. This is why the idea of alkaline diet or trying to alkalinize your body with lemon juice (an acid made mostly of citric acid) is completely useless and based on junk science (I have been discussing this aspect of junk physiology in an earlier post).
The pKa of folic acid/folate is about 3.37. At intestinal pH (~5.5), you are roughly 2 pH units over the pKa of folic acid, that means 99% of folic acid will be under form of folate and will harbor its two carboxyl groups as COO-.

2. What is folate biological function?

Folate is actively transported from the intestinal lumen and converted into different metabolic intermediates but usually will end up as 5-methyltetrahydrofolate (5-MeTHF).

gr2b1

Like any vitamin, Vitamin B12 plays an important function as a co-factor. You don’t need much of it, but you need it to have some enzymes to work. Without it, enzymes cannot work and you may develop severe vitamin malnutrition. For instance, a lack of vitamin A (beta-carotenoid) is a important cause of Vitamin A deficiency resulting in children blindness in South East Asia (this is the raison d’être for the genetically-modified rice or “golden rice” that can provide a steady Vitamin A supply in the region). This is also the case for vitamin C (ascorbate), an important co-factor for prolyl-hydroxylase, an enzyme synthesizing collagen that form your connective tissue. Without it, you end up with scurvy.

In the case of 5-methylfolate (named mTHF in the graph below), it is a pivotal cofactor in several biochemical reactions as depicted below:
nrc3557-f3

mTHF carry a very important chemical called methyl (CH3-) group. This methyl is given to the homocysteine that becomes methionine, an important amino acid. This methionine can in turn serve as a co-substrate for methyltransferase to transfer such methyl into an another molecule. Why methylation matters? Because methylation is a key element of epigenetics (epi=over). Epigenetics is a branch of genetics that studies how living organisms can modify DNA without altering its sequences. Mutations affect the DNA sequences, epigenetic do not affect the sequences. It is the same than putting your smartphone into a lock position. If you don’t enter the password, it will remains locked.
It is a way for the living organisms to switch off certain DNA regions that they do not need anymore for their function. This explains why you have nerve cells, blood cells, muscle cells, bone cells despite having the same DNA sequence in all of them. This explains why some bees will become queen and the rest will remains workers, foragers or soldiers. This explain why your hair become grey over time.

Remember the methyl group that was for donation? Here we go, it goes into one nucleotides forming our DNA, cytosine. Once added, cytosine becomes 5-methylcytosine.

zakhari01

3. What about folate and spina bifida?

Now you may have heard about folate deficiency and spina bifida. Folate plays an important role during embryonic development, as it will serve as a co-factor for various enzymes responsible for the neural tube closure.
The neural tube is an important embryonic structure as it will give rise to the central nervous system. In particular, there is a step that is in crucial need for folate, it is the closing of the neural tube (step D) on both the rostral (head) and the caudal (tail) region, to close the brain and spinal cord. Folate deficiency impairs such closure and results in two dramatic and lethal congenital malformations: spina bifida and anencephaly.

 

tmp1411

Because such condition can be prevented by ensuring a minimum daily folate uptake, the Food and Drug Administration adopted the enrichment of wheat flour with folate in 1995.
As you can see, upon introduction of folate-enriched flour, we can see a net decrease in the number of cases of spina bifida:
usa_spina_bifida_rates

However, this public health intervention was missing an important population at risk for folate deficiency, the Latin-American community, as corn flour rather than wheat flour is their staple food. The recent FDA approval to enrich masa corn flour should help to reduce such levels.

4. MTHFR mutation: Fact or fad?

In recent years, we have seen a sudden urge in number of persons claiming to have an MTHFR mutation and claim all their issues related to such mutation including fatigue, dizziness and other ailments. The problem encountered is the recent development of genetic testing is a wild wild West in which modern snake oil sellers claim to have accurate genetic testing . Science-based Medicine has done an extensive job to debunk this fallacy and novel type of quackery currently flourishing.
To be concise, I will say that MTHFR polymorphism is not an important concern for most individuals. However, it can be a serious risk for mother to be and pregnant women as their MTHFR enzyme maybe working at slower pace than normal MTHFR and therefore impair proper methionine metabolism. Because patients become aware of such mutation only after having an history of miscarriage or abortion due to spina bifida or anencephaly diagnosis during ultrasound maternal screening and constitute only a small population (~10% of the US population), the supplementation with folic acid is an easier and safer intervention.
If you want to know more about MTHFR mutation, please visit the adequate page at the National Institute of Health (NIH).

5. Folate supplementation and autism risk: what you should know

Asia was reported in the news, a recent study presented in a scientific conference associated an excessive folate intake with an increased risk of autism. Let it be clear, this is an oral presentation presented in front of other scientists at the meeting. This has not been processed through peer-review yet. So we have a lot of unknown and in particular we have to assess the quality of the data.
I want to be clear about this: if you are pregnant and on folate supplementation, do not change your treatment without having your physician (real physician, not a DC or a ND. A real physician in a real hospital) or pharmacist recommendation. By stopping your folate supplementation, you are putting your pregnancy at risk to develop a spina bifida or anencephaly that so far exceed the risk of autism.
This is also a grim reminder on a lot of supplements prescribed by quack doctors and naturopaths may have not the quality control to ensure you receive the correct amount of folate supplementation and you may have a risk of overdosing on it. Do not consider such supplement harmless and ask your physician and pharmacists to direct you and counsel you for the right folate dosing and source.

 

 

[Junk Sciences] Homeopathy Awareness Week – Modern quackery?

As this week ends, so does the “Homeopathy Awareness Week”.
As a professional scientist and pharmacologist by training and skeptical thinker, I have to say that the tenets of homeopathy are puzzling me.
Recently, the Swiss government applied laws to allow reimbursement of homeopathic products following a popular referendum. What does it tell? It tells that in the mind of public opinion homeopathy appears as a safe, efficient and natural alternative to conventional medicines. But does homeopathy is indeed supported by its claim or do we have indeed some marketing ploys in action that are just working as a smoke screen?
In this post, we will revisit the homeopathy and of course why science refutes most of the claims of homeopathy.

1) What is homeopathy?

The term homeopathy (from the Greek homeos = same,equal and pathos = suffering) was coined by  Samuel Hahnemann (1755-1843), a German physician from Meissen, Saxony.

hahnemann

In Hahnemann’s mind, diseases could be treated by treating the patients with natural extract known to induce similar effects than the disease when administered in high doses, an analogy of “battling fire with fire”.

The tenet of homeopathy is defined by extracting compounds from a natural source, either from animal, plant or mineral product into a solution called “tincta mater”. This tincta mater undergo a series of dilutions and agitations steps that are believed to increase the potency of the remedy. The dilution are referred as “Cs”, with a 1/100 dilution step between each Cs. At 1C, the tinctura mater is diluted at 1/100, at 2C is has a dilution factor of 1:10’000 (100*100=10’000) and so until you achieve the desired dilution. Some preparation harbor a 12C (in other means 1 molecule of active ingredient surrounded by 10e12 molecules of water or one trillion molecules of water) or higher. “Oscillococcinum (R)”, a homeopathic product obtained from liver duck extract by Boiron laboratories, boast a 200C dilution or 10e200 dilution factor.
2) The mass-action laws of pharmacology and the concept of ligand-receptor

In pharmacology and modern medicine, the tenet of all medication is resumed by the “ligand-receptor” dogma. Ligand (from the Latin “ligare”: that bound, attach, unify) is a chemical compound that can bind to a receptor. Such ligand can be as small as an elemental atom as small as a proton (H+) and as big as a macromolecule made of thousands of atoms, that can be a protein, a sugar, a lipid or a nucleic acid.

A ligand and receptor interaction occurs following established physical and chemicals laws called action-mass laws that dictates how atoms and molecules can interact together. In practice, we can refer it as the “key and keylock” analogy:

L + R <=> LR

Such interactions follow a dynamic pattern in which the ligand and receptor can bind and separate equally, forming an equilibrium. Such equilibrium is dictated by different parameters including physical (temperature, pressure….) and chemical (Van der Waals interactions, hydrophobic, ionic interactions, hydrogen bonds, reagents concentrations…..) parameters that will dictate the amount of interactions ongoing. Indeed the association and dissociation are defined by two constants: ka and kd by the following equations:

ka= [LR]/([L]+[R]) and kd=([L]+[R]/[LR]).

In practice, kd is the most often parameter used for defining a drug interaction with its drug target. It is named as the dissociation parameter and usually is referred as the affinity for a ligand to its receptor. The lower this kd value is, the higher the ligand has affinity to its receptor. This dictates another tenet of pharmacology: the selectivity of a ligand to its receptor. A ligand will bind to one or several receptors at a defined concentration but can develop an affinity to other receptors when the concentration of the ligand increase. Such non-desired interactions are the same ones that are involved in medications side and averse effects.

As we mentioned, concentrations are key to a drug biological activity. These concentrations by convention are expressed as molar concentration (M or moles/L). A molar concentration is the amount of moles of a defined molecules dissolved in one liter of  water or body fluid (usually we will discuss about drug plasma concentration).

A mole of a chemical is defined as the amount of a chemical atom or molecule that equals to the Avogadro Number N. N is  to the number of carbon atoms contained in 12g (the mass element of carbon) of pure carbon. By convention this number referred as N is equal to 6.022 x 10e23 atoms/mol. Thus one mole of carbon contains 6.022 x 10e23 carbons, one mole of eggs will contain 6.022 x 10e23 eggs.

As we have discussed, concentration are referred as a molar concentration. In 1M (or 1 mole/L), we have one mole of a chemical dissolved in 1L (liter) of water. 1L of water weights 1000 grams. As the molecular weight of water (H2O) is 18 grams/mole, we can calculated that the amount of moles of water molecules in 1L is 1000/18=55 moles.
As 1 mole of water contains 6.022 x 10e23 molecules of water, 1L of water contains about 335 x 10e23 molecules of water per liter.

In pharmacology, a drug with a good affinity for its receptor is usually in the nM range. As 1nM= 10e-9M/L, the number of drug molecules in one liter of water will be 6.022 x 10e14 atoms per 335 x 10e23 molecules of water. If we make a ratio of this number, we would have less than 0.02 particle per billion (ppb) or 20 particles per trillion (ppt).

If we go back to numbers advanced by homeopathy preparation, a 12C preparation already is below our nM range, as this dilution translates into 1 ppt that is already twenty times below the standard level. I dont even mention oscillococcinum that has 200C dilution, you can do the math. But you can see that there is already an issue with the homeopathic dilution. Either compounds in homeopathy are super-selective and hit affinities in the order of the picoM range (10-12M) or we deal with virtually an absence of molecules in the solution.

3. Drug concentration, dose and pharmacokinetics

In practice, we have to consider a concentration as dose, expressed usually as mg/kg and refer to the plasma concentration (mg/L) as a circulating concentration to define the drug biological activity.

DrugPlasmaConcentration

To give a practical example, we will discuss  the case of acetaminophen (Tylenol (R)), an OTC painkiller that everyone can buy in any pharmacy. Acetaminophen common dose is 50mg/kg. For a adult weighing 70kgs, thats brings us about 1000mg dose.

To ease the understanding, we assume we inject the acetaminophen using the oral route. The average plasma concentration at maximal absorption is about 18 ug/mL (or 18mg/L) following the oral absorption of 1000mg at once (http://www.rxlist.com/tylenol-drug/clinical-pharmacology.htm).

To be effective, a drug has to achieve a concentration higher than the minimum efficacy concentration (MEC) but also stay below the minimum toxicity concentration (MTC), as concentrations above this level are known to induce side effects and even toxic effects.

Now if we go back to our active concentration, we need to have 18mg (=0.018g) of acetaminophen per liter of plasma. Acetaminophen has a molecular weight of 151 g/mol.  The molar concentration of acetaminophen is therefore equal to 0.018/151 = 0.000119 mol/L plasma or 1.19 x 10-4 mol/L plasma. Therefore, we need about 7 x 10e19 molecules per liter of plasma to achieve a therapeutical activity. If we approximate plasma to water, we have to have about 2 particles per million (ppm) to achieve an activity. Yet homeopathic products rely on an extract of a natural product. Because of the DHSE Act, homeopathic products are not falling within the Food and Drug Administration accountability and therefore the manufacturer have no need to provide any information sheet on the composition of their product, as well as any data related to their pharmacokinetic profile. 
If we assume, a 12C preparation (that titrates 1ppt) and a 1 ounce fluid (30mL) administered to an healthy adult (5L of blood) , with 100% bioavailability, we will have a dilution of 166 times of the active compound. We are now discussing about a compound that can exert its activity to a concentration of 0.006 ppt. We are discussing here a compound that carry its activity with one million lesser concentration that a common painkiller. I am not even discussing about the duck liver extract that makes homeopathic claim the most ridiculous ever.

Conventional Medicine = 2 – Homeopathic Medicine = 0.

  1. Clinical efficacy and placebo effect:

A tenet of modern and science-based medicine is the assessment of clinical efficacy of a compound. This is usually run through clinical trials, in which a drug candidate is tested in a small number of patients volunteering to participate (Phase II) and further extended to different locations with a higher number of patients enrolled (Phase III).

A common experimental setup for clinical trial is the “double-blind/placebo-controlled” study in which patients are divided into two groups: a treated group that receive the drug candidate prepared in a pill or solution, a placebo group that receive the same pill or solution except devoid of the drug candidate.

Neither the patient nor the doctor knows which group they have been assigned to until the end of the study period. By comparing the results between the two groups with the use of statistical analysis, clinical researchers can determine if a drug showed an activity.

If the treatment showed a therapeutical effect that was significantly different from the placebo, it is considered effective and further continue in the R&D pipeline until the FDA approval and its entrance in the market. If not, it is dismissed and its R&D is tossed.

Because homeopathy is considered natural, it does not have to follow the same pipeline than conventional medicine. However, because there are some proponents of homeopathy as a viable alternative medicine, there are some clinical studies that have been achieved. In the case of oscillococcinum, the outcome is fairly terrible.
In a recent meta-analysis (http://www.ncbi.nlm.nih.gov/pubmed/23235586) done on six independent studies (two aimed as prophylactic treatment and four as ability to treat flu-like symptoms), patients treated with oscillococcinum failed to show a significant improvement compared to placebo-treated groups.
At best alternative medicine treatments (including acupuncture, chiropractic or hypnosis) failed to show a robust response in patient versus placebo in various meta-analysis investigating conditions such as nocturnal enuresis (http://www.ncbi.nlm.nih.gov/pubmed/22161390), postpartum hemorrhage (http://www.ncbi.nlm.nih.gov/pubmed/24277681), irritable bowel syndrome (http://www.ncbi.nlm.nih.gov/pubmed/24222383) or psychiatric disorders (http://www.ncbi.nlm.nih.gov/pubmed/21733480).
If homeopathy was effective as conventional medicine, it would be used to treat conditions that are qualified as serious or life-threatening. Yet, it failed because it is simply not working. 

Conventional medicine = 3 – Homeopathy medicine = 0. 

  1. If homeopathy is not working, so where is the harm?

When faced with evidence of lack of efficacy, homeopathic proponents usually will come with this statement “where is the harm?”.

The harm is coming in two folds: a waste of taxpayers money on useless treatment and the cases of fatalities due to lack of proper treatments. 

Homeopathic proponents boast the recent move of the Swiss government to include homeopathic treatment in the standard of care, claiming such decision was made on scientific basis (http://www.swissinfo.ch/eng/complementary-therapies_swiss-to-recognise-homeopathy-as-legitimate-medicine/42053830).

In reality, such decision is solely based on political decisions. Switzerland applies a form of direct democracy that can be overstretched if not wisely used. The common cliche is the popular vote still conducted in tiny villages in Switzerland by which the population vote by referendum on any decisions proposed by the town hall.

In Switzerland, you can force the referendum on the federal stage if you gather enough signature to support your proposition. Usually, you will need to gather 100’000 signatures to force the Federal Chancellery to set a referendum. Such initiative is laudable but also can reach some unexpected consequences, in particular as some populist political parties have been spearheading to advance some of their political agenda. Homeopathy proponents knew this tactic and were capable to bring to the referendum. Once in the referendum, any proposal that achieve a majority of yes will have to get enacted into law. This is what happened in Switzerland, in which the 2009 referendum ended up with a majority of “JA” and passed into law recently in the Swiss legal code.

To conclude this first point, the recent move in Switzerland was driven by political movements, not by science-based evidence. It shows that a high GDP and education index is not indicative of a science literacy index. If you can adopt political tactics, you can spread the most insane pseudoscience as fact within the average Joe, regardless of their socio-economic or educational background.

The second harm is driven by the recent stories of toddlers death  in the news outlet due to parents neglectence to seek professional medical assistance for severe complications due to an infectious disease.  Two recent cases made the news outlet: Ezekiel, that died from meningitis after parents refused to seek medical assistance and to rely on naturopathy to cure their son (http://news.nationalpost.com/full-comment/alheli-picazo-when-naturopathy-kills) and the Dleozier case that relied on homeopathy to treat a streptococcus sore throat (http://www.rocket-courier.com/node/141065#.VX111HD3aK0). Both died of infectious diseases that could have been avoided if properly treated with conventional medicine.
Not even mentioning the 400 other cases in which the recourse of homeopathy had lead to severe complications (http://whatstheharm.net/homeopathy.html).

Conventional Medicine = 4 – Homeopathy Medicine =0. 

6. Concluding remarks:

Homeopathy medicine is perfect example of how irrational beliefs and lack of science literacy is allowing outdated and snake-oil quackery practice of medicine and pharmacy are maintained alive in the 21st century.
Do we still follow Galen’s four vital fluids to treat diseases? Do we still practice bleeding to adjust such fluids? Do we still ask barbers to perform surgery? Do we still ask the local shaman or sorcerer to prepare an herbal concoction? Of course not because as our knowledge has improved, we put these techniques in the archive of time because we understood these techniques did not work.
In less than 100 years, we have increased average life expectancy and population quality of life in a magnitude higher than 10’000 years of modern humankind (as I referred it considering modern humankind as set by the neolithic age). Yet, we maintain outdated practice of medicine and pharmacy that all fall either into the category of inefficient medicine  or into quackery.
As science-based medicine have advantages, it also has issues that need to be addressed in particular the progressive distance in the patient-physician relationship or conflict of interests in certain clinical trials. These issues will be only solved when public authorities will understand that healthcare is not a business that should be build on the same standard of any other business: productivity and profit-driven goals.
In the other hand, the practice of homeopathy in the age made of personalized medicine and -omics based methods (proteomics, genomics, metabolomics) is not only based on irrational and pseudoscientific assumptions but also based on a certain form of medical dishonesty as healthcare professionals relying on homeopathic products consciously know that such products have no proven efficacy and will certainly not cure the patient and ultimately increase significantly the risks over benefits. An important axiom of Hippocatres oath is “do not harm”. Homeopathy has proven over and over that it is doing more harm than good.