Molecular Biology
No Other Way Out for Iron
Infectious Disease
Milestone Reached, But Campaign Against Polio Continues
Developmental Biology
Stem Cell Niche Discovered in Placenta
Medical Practice
Dual Loyalties at Abu Ghraib: Squeezing Ethics out of Care
Leak-patching Protein Shuts Down Tumor Growth, Swelling
Specialization Seen in Chromatin Remodelers
Study Plays Cat and Mouse with Development of the Visual Cortex
Proceedings of the HMS
Faculty Council
Donor Funds Labs for Aging Research
MassCURE to Advocate for Regenerative Medicine
Lemelson Prize Awarded for Innovations in Cancer and Stroke
Match Day Links One Third of Fourth-years to Internal Medicine Residencies
Honors and Advances
Consortium Formed for RNA Interference
AIDS and Isolation Among the Navajo
Milestone Reached, But Campaign Against Polio Continues
April Marks 50th Anniversary of National Polio Immunization Program
The year the long-awaited Salk vaccine was approved, Massachusetts suffered the worst polio epidemic in its history. Authorities rushed to vaccinate schoolchildren in the first and second grades within weeks of the April 12, 1955 announcement that the intervention worked. But in late May, the state halted the immunization program after several bad batches were found to have caused more than 200 cases of the disease across the country.
About half of the 600,000 U.S. survivors of paralytic polio will develop a delayed and often misdiagnosed cluster of disabling symptoms known as postpolio syndrome, said Julie Silver, founder of the International Rehabilitation Center for Polio at Spaulding-Framingham. (Photo courtesy of Spaulding-Framingham) |
Polio has lost its terrifying power in this country, but the virus, the survivors, and the remaining unvaccinated populations worldwide remain vital scientific, clinical, and public health concerns. Every day researchers and physicians affiliated with HMS build upon the efforts of their predecessors, who worked through the annual waves of the incurable contagion that killed and crippled tens of thousands of people every summer. Their stories resonate with many of the current issues in cutting-edge research, emerging infectious diseases, and bioterrorism preparedness.
“Fifty years after the introduction of the vaccine, we’re in the late stages of trying to eradicate the disease entirely,” said James Hogle, the Edward W. Harkness professor of biological chemistry and molecular pharmacology at HMS. “The fruits of the labors of the early pioneers are really showing up.”
Borrowed Breath
Long before the vaccine, the iron lung was the first effective treatment
for severely paralyzed patients like Purington. The airtight horizontal
respirator designed by Philip Drinker and Louis A. Shaw of HSPH was
first used at Children’s
Hospital Boston in 1928. Purington lived inside a later version of
the cylinder for the better part of two years, first at her local hospital
and then at
Children’s, which had dedicated all but one ward to the care
of both children and adults with polio. After the first few months,
when she was
able to breathe on her own for several hours a day, she could spend
some time outside the tanklike breathing device.
An estimated three dozen polio survivors in this country still depend upon the iron lung. Now living in the Colrain, Mass., farmhouse where she was born, Purington traded in her nighttime iron lung five years ago for a fiberglass model, after a respiratory therapist told her there would soon be problems getting spare parts for the old machine. During the day, she uses a smaller respiration device nicknamed a “turtle shell.”
The critical scientific advance that enabled the vaccine’s development took place in a Children’s research laboratory. John Enders, Thomas Weller, and Frederick Robbins were trying to grow ordinary chicken pox in a mixture of skin and muscle from human embryonic tissue.
“Suppose we tried a little polio, too?” Weller asked, according to Splendid Solution: Jonas Salk and the Conquest of Polio by Jeffrey Kluger (G.P. Putnam’s Sons, 2004). “We’ve got some Lansing strain in the freezer. Might as well use it up.” The chicken pox experiment failed, but the polio grew, leading to a practical way to grow large quantities of polio-virus in the lab and earning the trio the 1954 Nobel Prize in Medicine.
Vaccine Safety
Killing the virus soon became a bigger concern to Weller, who argued
that safety testing for the Salk vaccine needed to be more rigorous
to destroy
all traces of live poliovirus. “I was a father to two children who
would be receiving the vaccine,” said Weller in his autobiography,
Growing Pathogens in Tissue Cultures (Boston Medical Library, 2004). “I
was genuinely worried about the risks of the vaccine. However, I also knew
that the vaccine, imperfect as it might be, might well contain more benefits
than risks for society—and for my children.” Weller served
on the Massachusetts advisory committee that first recommended, then
suspended,
immunizations in 1955.
This room-sized respirator, circa 1932, could comfortably hold four patients. A fifth patient fit in the central port in times of high demand. The device was in nearly continuous use during polio epidemics through the early 1950s. (Photo courtesy of Archives of Children’s Hospital Boston)
Scientists still do not know how the poliovirus sneaks into the cells lining the nose, throat, and gut, and from there, into the motor neurons. But the recalcitrant virus has taught them many other lessons about the normal cellular machinery it hijacks for its nefarious purposes. The bug serves as a good model system for all other viruses that lack membranes, or “envelopes,” according to Hogle. He and his colleagues at Scripps Institute were the first to solve the structure of the whole poliovirus in 1985. Hogle’s latest discovery shows how a virus changes shape when it encounters a cell receptor, believed to be the first step in creating a channel to shoot its genome into the cell and begin replicating itself.
Hogle’s new structure has been rendered in bronze for an exhibition opening April 12 at the Smithsonian Institution to commemorate the 50th anniversary of the first national polio immunization program. The sculpture will be on display at the April 9 reunion of polio survivors organized by Children’s, Spaulding Rehabilitation Hospital, and the Medical School.
Both events were the brainchild of Julie Silver, HMS assistant professor of physical medicine and rehabilitation, who founded the International Rehabilitation Center for Polio at the Spaulding–Framingham Outpatient Center in Framingham, Mass., five years ago.
About 1.6 million polio survivors now live in the United States, Silver estimates. Survivors who have settled into a stable disability may be surprised by the onset of new symptoms, such as fatigue and weakness, now known as postpolio syndrome.
“It’s like a double-whammy,” Silver said. “They were hit when they were kids, and then boom, they get hit again.” As in polio, there is no cure for postpolio syndrome, she said, but there is treatment to preserve strength and energy and avoid the falls and injuries that could increase patients’ disability.
The World Health Organization has designated the year 2005 as the target date for the global eradication of polio. That effort had a recent setback when three northern Nigerian states stopped vaccinations due to rumors of HIV contamination. Now, a resurgent wave of polio is making its way across Africa.
| “The worst thing about polio is that it hasn’t gone away; it’s still here.” |
Meanwhile, the compelling stories of polio survivors will not be lost, thanks to the Polio Oral History Project (see www.polioclinic.org), said Anna Rubin, the principal interviewer for the project, which is based at Spaulding. “The worst thing about polio is that it hasn’t gone away; it’s still here,” said one interviewee, Stephen Burwick, a Massachusetts lawyer who contracted polio in 1954. “I thought it had gone away and it was all over, but it comes back to haunt me in my everyday life more and more.”
For further information about the April 9 polio reunion, contact Anna Rubin at 508-872-2200 ext. 241 or agrubin@partners.org.