Why antibodies disobey the Hippocratic Oath and end up doing harm: a new clue

Abstract

The appearance of methicillin-resistant Staphylococcus aureus (MRSA) as an endemic microbe, first in hospital and health care settings and more recently in the community, has led to a disastrous situation in which use of the available antibiotic armamentarium is increasingly ineffective and spawns further antibiotic resistance. This vicious cycle highlights the pressing need for an S. aureus vaccine. However, to date, clinical trials with S. aureus vaccines have not demonstrated sustained efficacy. In this issue of the JCI, Skurnik and colleagues report that specific antibodies to two different S. aureus surface polysaccharides, which independently promote effector cell killing of S. aureus in vitro and protection against S. aureus in animal models, bind to and abrogate the activity of one another when they are combined. This fascinating finding suggests a new paradigm to explain the failure of antibody immunity to S. aureus.

Reducing the Use of Antimicrobials as a Solution to the Challenge of Antimicrobial Resistance (AMR): Approaching an Ethical Dilemma through the Lens of Planetary Health

“…What should be the role of doctors in reducing the prescription of antimicrobials to patients: advisory or mandatory, and how does this intersect with the Hippocratic Oath's "Do no harm"? Some scholars have argued that by prescribing antibiotics in the knowledge that doing so drives resistance, medical professionals do indeed do harm [40,41] but the Hippocratic Oath, and most decisions made in medical ethics, have traditionally had to consider harm only in relation to the individual and in the present, not to the global population or to theoretical future generations. The current approach ignores planetary health's strong ethical requirement not only for distributive justice in the present, but also for intergenerational responsibility.…”

A new synthesis for antibody-mediated immunity

“…Such interactions, put forth many decades ago 1 , were believed to regulate the amount of specific antibody. An example of this phenomenon has been revealed by a study showing that idiotype–anti-idiotype binding is responsible for loss of the binding of antibody specific to the Staphylococcus aureus capsular polysaccharide to S aureus after immunization with capsular polysaccharide 34,35 .…”