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The Immune System, COVID-19, and the Future: An In-Depth Conversation with Immunologist Akiko Iwasaki

Core Concepts
The immune system plays a crucial role in COVID-19 and its long-term effects, with multiple potential disease drivers that require tailored therapeutic approaches. Developing effective nasal vaccines and exploring novel immune system functions are key frontiers in immunology.
This wide-ranging conversation with renowned immunologist Akiko Iwasaki covers several key topics: Long COVID: Long COVID is a heterogeneous condition with multiple potential disease drivers, including persistent viral infection, autoimmunity, reactivation of latent viruses, and inflammation-induced tissue changes. Understanding the distinct pathogenic mechanisms is crucial for developing targeted therapies, such as antivirals, immunomodulators, and treatments to address reactivated viruses. Clinical trials are underway to test interventions like Paxlovid and gut microbiome modulation, but more research is needed to fully address the long-term effects of COVID-19. Nasal Vaccines and Mucosal Immunity: Nasal vaccines that can establish mucosal immunity in the respiratory tract hold promise for preventing SARS-CoV-2 infection and transmission, but their development has faced barriers. Repurposing readily available compounds like the antibiotic neomycin, which can induce a local antiviral state in the nasal cavity, may provide a stopgap solution while nasal vaccine development continues. New Frontiers in Immunology: The immune system's role extends beyond just fighting pathogens, with the potential to regulate normal physiological processes and maintain homeostasis. Concepts like "Tx cells," which monitor and maintain tissue homeostasis, suggest new avenues for understanding and harnessing the immune system for healthy aging and disease prevention. Women in Science: Iwasaki has been a vocal advocate for women in science, drawing on her own experiences and working to address persistent inequities in academia, such as pay gaps and toxic work environments. Promoting gender equity and creating supportive environments for women scientists is crucial for advancing scientific progress.
"If there's one person you'd want to talk to about immunology, the immune system and COVID, holes in our knowledge base about the complex immune system, and where the field is headed, it would be Professor Iwasaki." "Akiko Iwasaki was just recently named one of the most influential people in the world by TIME100." "Akiko Iwasaki has been elected to the National Academy of Medicine, National Academy of Sciences, and is the president of the American Association of Immunologists."
"Long COVID is not one disease. It's a collection of multiple diseases and that are sort of ending up in similar sets of symptoms." "We need to be up to date on vaccines and boosters because those seem to reduce the risk for long COVID and whether Paxlovid can reduce the rate of long COVID at the acute phase for the high risk individual, it seems to be yes, but for people who are not at high risk may or may not be very effective." "We came up with a new subset of T-cells known as, or we call it Tx cells, which basically is an interoceptive type of T-cells that monitor homeostasis in different tissues and are helping with the normal process of biology as opposed to fighting viruses or bacteria or fungi."

Deeper Inquiries

How can we leverage the immune system's homeostatic functions to promote healthy aging and prevent age-related diseases?

The immune system plays a crucial role in maintaining homeostasis within the body, not just in fighting off infections but also in monitoring and regulating various physiological processes. As we age, the immune system undergoes changes that can contribute to the development of age-related diseases and a decline in overall health. Leveraging the immune system's homeostatic functions to promote healthy aging involves understanding how immune cells interact with other systems in the body and how they can be modulated to support overall health. One approach to promoting healthy aging through the immune system is to focus on reducing chronic inflammation, which is a common feature of aging and is associated with many age-related diseases. Chronic inflammation can be detrimental to tissues and organs, leading to conditions such as cardiovascular disease, neurodegenerative disorders, and autoimmune diseases. By modulating the immune response to reduce chronic inflammation, it may be possible to mitigate the impact of aging on the body. Another strategy is to enhance the immune system's ability to respond to pathogens and maintain immune surveillance. As we age, the immune system may become less efficient at recognizing and eliminating pathogens, leading to an increased susceptibility to infections. By boosting the immune response through targeted interventions, such as vaccines or immunomodulatory therapies, it may be possible to improve immune function and reduce the risk of infections in older individuals. Furthermore, promoting healthy aging through the immune system involves maintaining a diverse and balanced immune cell population. Age-related changes in the immune system, such as thymic involution and alterations in T cell function, can impact immune surveillance and response. Strategies that support immune cell diversity and function, such as dietary interventions, exercise, and targeted therapies, may help to preserve immune health and promote healthy aging. In summary, leveraging the immune system's homeostatic functions to promote healthy aging and prevent age-related diseases requires a comprehensive understanding of immune system dynamics and interactions with other physiological systems. By targeting key aspects of immune function, such as inflammation, immune surveillance, and cell diversity, it may be possible to support overall health and well-being as individuals age.

How can we ensure that the development of novel immunotherapies and diagnostics, such as the "immunome," is accessible and equitable for all, rather than just the wealthy?

The development of novel immunotherapies and diagnostics, including the concept of the "immunome," holds great promise for advancing personalized medicine and improving patient outcomes. However, ensuring that these innovations are accessible and equitable for all individuals, regardless of socioeconomic status, is essential to promote health equity and address disparities in healthcare. One key strategy to ensure accessibility and equity in the development of novel immunotherapies and diagnostics is to prioritize affordability and cost-effectiveness in the research and development process. This includes exploring innovative funding models, such as public-private partnerships, government subsidies, and philanthropic support, to reduce the financial burden of developing and producing these technologies. By lowering the cost of production and distribution, novel immunotherapies and diagnostics can be made more accessible to a wider range of individuals. Additionally, regulatory agencies and policymakers play a crucial role in ensuring that novel immunotherapies and diagnostics meet rigorous standards for safety, efficacy, and quality, while also considering the needs of underserved populations. Implementing policies that prioritize patient access, affordability, and equitable distribution of healthcare resources can help to address disparities in healthcare and ensure that novel technologies reach those who need them most. Furthermore, promoting diversity and inclusivity in clinical research and trials for novel immunotherapies and diagnostics is essential to ensure that the benefits of these technologies are applicable to a broad range of individuals. By including diverse populations in research studies, developers can better understand the impact of these technologies on different demographic groups and tailor treatments to meet the needs of all patients. In conclusion, ensuring that novel immunotherapies and diagnostics, such as the "immunome," are accessible and equitable for all individuals requires a multi-faceted approach that addresses affordability, regulatory oversight, and inclusivity in research and development. By prioritizing health equity and patient access, we can work towards a healthcare system that benefits everyone, regardless of their socioeconomic status.