‘Thinking’ white cells go from place to place, as needed

Health Scan: City survey for better health in Jerusalem; Health Ministry says February's medical licensing exam was too difficult.

Stem Cells 311 (photo credit: (University of Louisville Medical School)
Stem Cells 311
(photo credit: (University of Louisville Medical School)
White blood cells don’t seem complicated enough to have “brains” or a decision-making process, but they’ve been found by biologists at the University of Haifa to play a critical “thinking” role in the healing of bacterial infections. Dr. Amiram Ariel headed a study just published in the European Journal of Immunology. His research has led to a “breakthrough” in which he and colleagues revealed a critical component in the “decision-making process” of white blood cells.
“The process we have discovered can assist in the development of drugs based on natural processes that take place in the human body, unlike most of the existing drugs, which attempt to curb inflammation by artificial means,” said Ariel. “Bacterial inflammation forms when bacteria penetrate body tissue. In response, specific types of white blood cells called neutrophils begin to fight the invaders, destroy and remove them from the tissue.
In normal conditions, inflammation is halted once the cells have eradicated the bacteria, and then undergo programmed cell death. At that point, another type of white blood cells come on stage – macrophages – whose job is to eliminate the dead neutrophils and restore the tissue to its normal state.”
Ariel added that while the macrophages feast on their cell meal, they gain the ability to begin the tissue’s rehabilitation process. However, at one point they abandon the tissue and make their way to the immune system organs via the lymphatic system, where they deliver the “back to routine” message. “This message is important for the body’s return to normal functioning.
Until now, however, the when and how that directs macrophages’ leaving of inflamed tissue remained unknown.
The University of Haifa researcher explained that even when the body manages to cope with bacterial invaders, there is also the danger of “excessive healing” that results in fibrosis and scar formation.
This happens when the system reels out of control and “over-heals” the previously infected area. Fibrosis can lead to malfunctioning of the healing tissue, tissue death and sometimes even death. To understand why this happens, it is important to identify and understand the way macrophages’ govern the healing process.
The current study, conducted by Ariel alongside a team of students led by Dr. Sagie Schif-Zuck, set out to probe the critical stage of the healing process, when the macrophages decide to relocate and adjust their healing activities, moving from local rehabilitation of damaged tissue to the shutting down of systemic immune responses by organs of the immune system.
The researchers discovered that the macrophages have a fascinating “uptake threshold” of seven cells. After engulfing seven neutrophils, they are “permitted” to leave the tissue and continue with their remote tasks. “Our new study,” Ariel said, “has found a major event in the inflammatory healing process that is responsible for the transition of macrophages from local rehabilitation of damaged tissue to their consequent role in promoting the immune system’s return to routine.”
The findings can help develop biological drugs based on the body’s natural processes.
“By harnessing the natural healing process we have discovered, the body will be able to naturally terminate all the inflammatory processes and avoid the deficiencies of existing anti-inflammatory treatments,” Ariel concluded.
Some 2,200 Jerusalem families – a representative sample – will over the next few months be asked to participate in a health survey to assess their lifestyles, the health services they use and their immediate environment. Among the surveyors will be Jerusalem Municipality pensioners.
City Hall recently joined the Healthy Cities Project of the World Health Organization, headed in Israel by Dr. Milka Donchin of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine. The municipality thus took upon itself the improvement of health levels among residents, along with institutions and organizations that influence health and promote quality of life.
The city called on all residents randomly chosen as participants to agree to meet with the interviewers. The survey will be completed in around six months, and the results will be made public. Deputy Mayor Naomi Tsur, who holds the Healthy City portfolio, concluded that many things contribute to physical and emotional wellbeing. “On the basis of our findings, we will act together to turn Jerusalem into a healthier city, where it is good and pleasant to live,” she said.
The most recent medical licensing exam, conducted in February, was too difficult and may have to be repeated, Health Ministry director-general Dr. Ronni Gamzu said recently during a special session of the Knesset Labor, Social Affairs and Health Committee at the initiative of several MKs, several of them doctors. Some of those at the session contended that the exam was intentionally made too difficult.
The test consisted of more than 70 pages, and those taking it had to answer 110 questions in two-and-a-half hours. In addition, it was said, rain entered the hall and noise in the area made it difficult to concentrate, not to mention the “unusual difficulty” of the February exam.
Baruch Stuchiner, a representative of the students, said he and his peers “left the exam feeling degraded. Why 65 percent of those tested failed must be investigated.
Doctors who come from abroad get only two test dates a year; those who fail have to wait six months for another exam, and in the meantime, one can’t work as a physician,” he said.
MK Ahmed Tibi, who was trained as a gynecologist/obstetrician, said there is already a shortage of physicians, and that he had heard of intentions to import non- Israeli physicians from Georgia and Romania due to shortages. “I wonder why, if so, we make it difficult for those who want to return home and work as a doctor,” said Tibi.
Gamzu conceded that “it was a difficult exam. It would be fair to give these people a good chance to pass the test and work as physicians. I promise the committee that our ministry will meet to look at the test and consider the possibility of having another test soon.”
MK Rachel Adatto, a Kadima MK who is a trained gynecologist and lawyer who is acting chairman of the committee, said it demands that the ministry look into the complaints and not publish the exam results until the matter is investigated. She called on the ministry to consider equalizing the conditions of foreign medical graduates tested abroad with those of Israeli medical students who study here, and also to increase the number of test dates.