Adolat Ismailova is a scientist, professor, researcher at the Institute of Human Immunology and Genomics of the Academy of Sciences of the Republic of Uzbekistan, holder of the Order of Salomatlik II degree for dedication in the fight against the coronavirus pandemic.

— How did you become an immunologist? How popular is this specialty?

— I graduated from the medical faculty of Tashmi. For some time I worked directly with patients, but then I went into science, which I have been doing for more than 20 years. The fact is that there is no clinical immunologist in the register of specialties of the Ministry of Health of Uzbekistan. A few years ago, a department of medical immunology was opened at the Tashkent Institute of Advanced Medical Training. I even managed it for a while. The department was self-funded, and since it was not profitable, unfortunately, it was soon closed. Medical schools do not teach immunology. That's why my colleagues and I are self-taught.

The immunologist should also understand the psychological state of the patient, understand the source of the disorder. Very often my patients need the help of psychologists, psychotherapists or neurologists. Like it or not, we are forced to cross the line of personal space. For example, a patient came to me complaining of regular acute respiratory infections and herpetic rashes. I'm asking: what does he do, when did it start, and why did this situation develop? No one will say that they have this condition all their life. Everyone knows exactly when their health problems started. I realized that it was important to ask the right question. The patient will tell you everything himself. Someone changed their job two years ago, another recently moved, a third got divorced... it turns out that we always rest on the way of life of a person.

— To what extent are immunity and the immune system studied today?

- Mankind has always been accompanied by infectious diseases. Thanks to this, the concept of "immunity" and a whole direction in biological science – immunology-appeared. We are at the initial stage of studying the immune system and its development. Immunology is the youngest of all medical disciplines. It's a little over a hundred years old. And for science, and even more so for practice, this is very small. However, the immune system of a living organism is the oldest: one of the first systems that originated in single-celled organisms.

Of all our systems, the immune system is the most labile, i.e. mobile. There is not a single organ or system in the body that does not contain components or cells of the immune system. But the greatest concentration of them is where there is contact with the external environment — the ears, eyes, nose, mouth, and genitourinary system. And these "gates" very strongly protect our body. So the" decline " of the immune system and its alleged symptoms (weakness, fatigue, etc.) are primarily associated with our lifestyle.

We, as immunologists, work closely with practitioners. These are mainly pediatricians, oncologists, internists, nephrologists, urologists, infectious diseases specialists. More recently, we were approached by ophthalmologists with a request to investigate autoimmune eye pathologies. The doctor sees the pathology, but does not understand its source, what is the cause of the disease. Or oncologists who treat their pathology according to the protocol. As a rule, these are malignant processes, but some do not improve, others do, and others have metastasis. What's the matter? It's about immunity. Initially, immunology was only concerned with infections. But I am sure that in the 21st century we will prove that the mechanisms of the immune system are triggered not only in infectious diseases, but also in inflammatory processes. As, for example, with atherosclerosis, myocardial infarction, strokes.

— How attentive is the population to their health today?

- Due to pandemics, there is always a leap in the development of medical science. The story of the coronavirus is a vivid confirmation of this. If the concepts of "immunity" and" antibodies " were known only to specialists, today almost the entire population of the planet knows about them. For example, in Uzbekistan, people who are far from medicine perfectly understand what immunoglobulins G and M are, and how they work. It was difficult to get some specialists to start understanding these concepts, but here the patients themselves are already enlightened. As a scientist, I am very interested in watching this.

— What is the most common misconception related to immunity or the functioning of the immune system?

— When a patient comes, he may even be a doctor, the first thing he says is: "My immune system has dropped." It doesn't fall anywhere, and if it did, the person wouldn't be sitting in front of me. In fact, there are certain changes in the immune system.

Immunity and the immune system are different concepts. Immunity is a protective function that the immune system performs. The latter can be compared to an army. In the bone marrow, cells are born, they are called "naive", because they are still very young and immature. The blood flow carries them to the thymus, and this is where strict combat training begins. If the cell does not cope with the tests, it is instantly destroyed. Trained, prepared cells spread to all the lymphoid clusters, where they wait for the enemy-an infection or a virus.

— How can we help our immune system on our own?

— Why help her?" She does a great job on her own. It is enough to lead a healthy lifestyle. Often, parents bring to me children who have recently started attending kindergarten and, as a result, often get sick. I'm asking: how long does your child go to kindergarten? It turns out that two months. I say: let the child get sick, he trains his immunity. This process will take at least a year. He doesn't have bronchitis or pneumonia. Well, a runny nose, cough, a little fever. But which parent wants to wait? Nobody. You just need to trust your own immune system.

— How to understand that the immune system is working?

— Her work is manifested by inflammation, which our doctors are afraid of. If a person, for example, has a fever, then this is not a big deal. So, he has a good immune system. By the time they reach the doctor, the patient will have already taken many medications, at least a traditional litichka. Leave the person alone, let him observe the pastel mode and drink heavily. The immune system will cope with this temperature. Temperature is necessary for the immune system to develop memory cells and antibodies that remember this microorganism and then successfully fight it.

Where do frequently ill people come from? These are untreated or overtreated patients with unformed antibodies. I am very concerned about what will happen to us in 50-100 years. We stuff ourselves with drugs, don't get enough sleep, and don't eat properly. Only proper sleep helps us physically recover. And only we are responsible for our own health. I understand that now is the time: everyone is running, in a hurry. Most people would rather take medication than reconsider their lifestyle. But sooner or later, your body itself will click on "stop". So stop right now, look at yourself and listen to your body.

Our immune system wakes up by midday. At 15.00, it is at the peak of its activity, and by the evening it reaches perfection. So laid down by nature. That's why you can't get an immunogram in the morning: there won't be enough immune system lymphocytes and you'll get the impression that everyone is immunocompromised.

— What is the hyperfunction of the immune system, i.e. how to understand that there is too much immunity?

- About 99% of people come with a complaint of low immunity. In other words, any disease that they have, they associate with immunity. Either the patient convinced himself of this, read something on the Internet, or the doctor gave him such a diagnosis. By and large, doctors do not know immunology, because there is no such discipline in our medical universities. Therefore, almost every disease they reduce to immunodeficiency. But today our population, in particular, residents of Tashkent, have become atypically ill. In our time, when we were studying, there was no such course of diseases.

Hyperfunction of the immune system is expressed by allergies and autoimmune diseases. As a rule, these are some hereditary conditions or caused by external factors, for example, work in a harmful production. In this case, the treatment is aimed at suppressing the immune system. Depending on the condition, hormonal or antihistamines are prescribed.

We encountered hyperactivity of the immune system in patients with coronavirus. We consulted particularly severe patients, up to 50 people a day. Their surge occurred in the summer and autumn periods. Among them there were many young strong people without any serious concomitant diseases, but at the same time they found themselves in the intensive care unit of the Zangiotin hospital. With covid, we were wary of patients with good immune systems, they often had hyperreaction. A new antigen was introduced, which the immune system has not yet encountered. We observed a high fever, which we could not bring down until we gave the patient a large dose of hormones. This made it possible to lower the immune system and bring patients out of emergency conditions. We have seen very young people leave with seemingly good immunity. But at the same time, before our eyes, patients with diabetes and high blood pressure suddenly got out.

— Go to any pharmacy and ask for an immunostimulating drug. You will be offered dozens of titles in any form. There is not a single country in the world that produces such a huge number of immunostimulants as in the former Soviet Union. We are talking not only about the diverse market for such drugs, but also about the treatment protocols where they are prescribed. There are two recognized drugs – immunoglobulins and interferons, which are prescribed for some very serious pathologies. SARS and herpes are not treated with immunostimulating drugs. I very rarely prescribe immunopreparations, but I welcome those that work locally.

The goal of most pharmaceutical companies is to make money, while ours is to keep the patient alive at all costs and improve their quality of life.

— Are there any immune diseases characteristic of Uzbek citizens?

— It would be more correct to talk about the peculiarities of the course of these diseases in our region. Currently, for example, we are working together with the Research Institute of Virology to study the features of the course of coronavirus infection in Uzbekistan, and conduct a survey of patients who have been ill. This is my personal scientific initiative. We were given access to questionnaires, including resuscitation data of patients who had been ill with covid, as well as those who, unfortunately, did not survive. We are currently at the stage of analytics and statistics. Our research work should end with scientific publications in the world's specialized publications.

— Is there anything else you are currently working on?

— About 15 years ago, I learned about such a disease as primary immunodeficiency (PID). This is an innate suppression of the immune system. Such people are born perfectly healthy. But in the course of life, this disease suddenly occurs. Its diagnosis and treatment in Uzbekistan is partially possible, but many health workers, as well as the population, do not have knowledge about this disease. There are a lot of children, teenagers and young people with this disease. Many of them die in childhood or at a very young age without a diagnosis. We hope and look forward to the Ministry of Health of the Republic introducing this diagnosis in the register of life-threatening diseases. This is necessary to provide qualified care to such patients. For this to happen, the department needs to provide a list of patients, and for this they need to be identified. Today I have about 12 such patients. All of them are physically and mentally complete people.

There are a number of signs that should alert you. If you and your loved ones have regular purulent otitis media (ear inflammation), severe sinusitis (inflammation of the mucous membrane of one or more paranasal sinuses), more than two pneumonias (pneumonia), antibacterial therapy performed for more than 2 months without effect, complications during vaccination with weakened live bacteria (BCG poliomyelitis) , etc., then be wary and contact pediatricians or immunologists. With such a disease, it is very important to avoid false diagnoses and attempts at useless treatment.

— What is happening with immunotherapy today?

— Go to any pharmacy and ask for an immunostimulating drug. You will be offered dozens of titles in any form. There is not a single country in the world that produces such a huge number of immunostimulants as in the former Soviet Union. We are talking not only about the diverse market for such drugs, but also about the treatment protocols where they are prescribed. There are two recognized drugs – immunoglobulins and interferons, which are prescribed for some very serious pathologies. SARS and herpes are not treated with immunostimulating drugs. I very rarely prescribe immunopreparations, but I welcome those that work locally.

The goal of most pharmaceutical companies is to make money, while ours is to keep the patient alive at all costs and improve their quality of life.

— Are there any immune diseases characteristic of Uzbek citizens?

— It would be more correct to talk about the peculiarities of the course of these diseases in our region. Currently, for example, we are working together with the Research Institute of Virology to study the features of the course of coronavirus infection in Uzbekistan, and conduct a survey of patients who have been ill. This is my personal scientific initiative. We were given access to questionnaires, including resuscitation data of patients who had been ill with covid, as well as those who, unfortunately, did not survive. We are currently at the stage of analytics and statistics. Our research work should end with scientific publications in the world's specialized publications.

— Is there anything else you are currently working on?

— About 15 years ago, I learned about such a disease as primary immunodeficiency (PID). This is an innate suppression of the immune system. Such people are born perfectly healthy. But in the course of life, this disease suddenly occurs. Its diagnosis and treatment in Uzbekistan is partially possible, but many health workers, as well as the population, do not have knowledge about this disease. There are a lot of children, teenagers and young people with this disease. Many of them die in childhood or at a very young age without a diagnosis. We hope and look forward to the Ministry of Health of the Republic introducing this diagnosis in the register of life-threatening diseases. This is necessary to provide qualified care to such patients. For this to happen, the department needs to provide a list of patients, and for this they need to be identified. Today I have about 12 such patients. All of them are physically and mentally complete people.

There are a number of signs that should alert you. If you and your loved ones have regular purulent otitis media (ear inflammation), severe sinusitis (inflammation of the mucous membrane of one or more paranasal sinuses), more than two pneumonias (pneumonia), antibacterial therapy performed for more than 2 months without effect, complications during vaccination with weakened live bacteria (BCG poliomyelitis) , etc., then be wary and contact pediatricians or immunologists. With such a disease, it is very important to avoid false diagnoses and attempts at useless treatment.

In Russia and Kazakhstan, PID has been seriously and quite actively developed since 2000. According to various sources, in the world for 1000 (in the USA for 500) newborns there is one child with such a diagnosis. That's quite a lot. We don't have any data, but I think that given the considerable birth rate, related marriages and a multi-million-strong population, this problem is already quite serious.
 

My first patient with this diagnosis is a schoolboy. In total, he visited the school about 7 times in three years. I, on my own responsibility, diagnosed him with PID, and soon this disease was confirmed. I think this is the first time this has happened in our country. I adapted international treatment protocols and prescribed him immunoglobulin therapy. The boy has been going to school for two years, even taking into account the quarantine.

Another child was not given the correct diagnosis in time, and he lost an ear. None of the doctors were confused by regular otitis media. The boy was made disabled only because they could not see and recognize the primary immunodeficiency.

If the Ministry of Health recognizes this diagnosis, then the state will be able to provide these patients with expensive medicines that will prolong their life and improve its quality. According to statistics, they rarely live to be 30 years old, and no one knows the cause of death. This should not happen in the 21st century.