Even for a fictional character whose daily work is chasing after psychopaths and serial killers, Will Graham has some pretty poor health habits. He drinks – and I mean drinks whiskey and tea and coffee (anything but water) – and pops aspirins like he’s eating candy. He is sleep-deprived and hallucinates (later we discover that he has encephalitis). Halfway through season two of Hannibal, I found myself wondering whether these symptoms were realistic, or exaggerated for the television screen. Thus began the research.
Now, for the entirety of my life, up until one week ago, I did not know what a kidney was.
I knew what a kidney was – I’d heard of kidney transplants and organ donors and the organ black market. But truly, I didn’t know what a kidney did.
So for those of you who don’t know what a kidney does – this is what a kidney does.
The digestive system is where you eat food and secrete unabsorbed matter in the form of feces. An entirely unrelated system is the excretory system, where you filter bad stuff out of your blood and dispose of it (mostly nitrogenous waste) in the form of urine. I did not know that two weeks ago. Truly.
A kidney, along with your skin, intestine, liver, and lungs, helps your body with osmoregulation – the active regulation of bodily fluids to maintain homeostasis. Your kidney has several key functions: filtration of unnecessary solutes and some water out of your circulatory blood, selective reabsorption of needed water and solutes back into your blood, secretion of unwanted solutes into urine, and excretion of concentrated urine (which now consists of nitrogenous waste, unnecessary solutes, and toxins. See image one).
When there are too many solutes in your blood, or high blood osmolarity, the body releases a hormone called antidiuretic hormone, or ADH. ADH is responsible for increasing the retention of water in your kidneys. In other words, when there’s ADH floating around, your kidneys recognize that you need to decrease the osmolarity of your blood; thus, they reabsorb water from what would eventually become your urine.
ADH amplifies water reabsorption, which in turn, reduces urine volume, and overall, helps prevent the increase in blood osmolarity.
High blood osmolarity leads to a high blood pressure. Which is bad. Because, heart attacks. And extra stress on your heart.
The opposite occurs when your body detects low blood osmolarity levels. Little ADH is produced, leaving your body to decrease the permeability of the tubes on your kidney, allowing less water to return to your body (see image two). Little ADH increases the volume of your urine.
However, alcohol and caffeine can disturb water balance by inhibiting the release of ADH, which causes excessive urinary water loss and dehydration – which may cause some symptoms of a hangover.
With that in mind, let’s think about our friend Will Graham for a minute, from NBC’s Hannibal. Mr. Graham is rather fond of coffee. And tea. And whiskey. All of which are sources of alcohol and caffeine. Never once, in all of the shows’ three seasons, can I remember Will Graham drinking water. Maybe I forgot.
Either way, dehydration is bad.
Secondly, aspirin. The purpose of aspirin is to reduce the pains of headaches, fever and inflammation.
In a localized inflammatory response, damage to human tissue by pathogens or physical injury leads to the release of histamine. Histamine is a chemical that triggers dilation and increases the permeability of capillaries and veins. Other activated compounds like prostaglandins promote blood flow to the affected area, subsequently causing inflammation as expanding capillaries leak into neighboring tissues. Blood clotting serves as a blockade, preventing the spread of microbes. However uncomfortable, this inflammation is an innate process that assists with defense against bacteria.
Back to aspirin. Aspirin prevents platelet aggregation and subsequently “thins” out blood by preventing any blockage. Aspirin reduces fever and pain by inhibiting the production of prostaglandins (compounds that promote blood flow to injured sites). However, prostaglandins are very important.
Among many other things, prostaglandins produce inflammation (as mentioned above) and feelings of pain (this is to alert the body that there is something bad going on, i.e. if touching this hot pan hurts, I’m going to stop doing it). Aspirin blocks the production of prostaglandins, therefore reducing inflammation, fever and pain.
But this also means that when your immune system is attacked – say a needle pierced your skin and left behind bacteria – prostaglandins won’t be able to promote blood flow to the site. Your blood, which is thinned from the aspirin, continues to flow around your body, possibly spreading the pathogen. Reduced dilation and permeability of veins reduces the number of defense cells that can congregate at the site, destroying the infection.
Therefore, taking aspirin – as much as Will does, anyway – can potentially weaken your immune system.
Thirdly, encephalitis – an inflammation of functional tissue in the brain, caused by viral infections or a mistake in the immune system. Some of the factors in increasing potential contraction of encephalitis include a weakened immune system, an environment with mosquitos or ticks, and age. (Weakened immune system? From taking the aspirin?)
Later, we discover that Graham has autoimmune anti-NMDA encephalitis, a condition wherein the sickness stems from his body’s own destruction of NMDA receptors. Essentially, the brain works because of these things called neurons, the most specialized cells in animals (see image three. Also, the longest cell is a blue whale neuron, which can grow anywhere from ten to thirty feet long).
The neuron is the structural unit of the nervous system. Each neuron consists of a cell body that has little spider-leg like things coming out of it called dendrites. These dendrites receive signals from other cells. The cell body tapers down into a narrow axon – the longest part of the neuron. This is where the major of neuron length comes from. An electrical signal comes from another neuron to the dendrites, to the cell body, down the axon, and finally comes to terminal branches at the end of the axon, each one ending with a synaptic terminal. The synaptic terminal then attaches to another neuron’s dendrites, passing the signal on from one neuron to the next.
The neuron conveys signals through a travel of action potential; essentially, if a stimulus on the neuron reaches a certain voltage, an action potential is triggered, and a cascade of channels in the axon are opened and closed, generating varying amounts of electrical and chemical potential across the cell membrane. This potential is self-propagating, propelling itself down the axon to the synaptic terminals.
At the very end of the neuron, at the synaptic terminal, the presynaptic neuron (the neuron delivering the potential to the next neuron) must release neurotransmitters into something called the synaptic cleft, the space between the presynaptic neuron and the postsynaptic neuron (the neuron receiving the signal). As neurotransmitter molecules diffuse across the space between the two neurons, they bind to receptors in the postsynaptic membrane (see image four). This binding alters the membrane potential of the postsynaptic cell and results in a response – either inhibition or excitation.
Neurotransmitters can be chemicals like acetylcholine, serotonin, dopamine, and glutamine. A derivative of glutamine is the amino acid NMDA, which stands for N-Methyl-D-Aspartic acid. When vesicles of NMDA release NMDA into the synaptic cleft (after a signal has traveled down the length of a neuron), NMDA floats through the space between the presynaptic and postsynaptic and binds to a specific receptor – NMDA receptors.
NMDA receptors, or NMDAR, are found on the dendrites of neurons; they allow the transmission of electrical impulses from neuron to neuron. NMDA, the molecule, acts as an agonist – a molecule that binds to and activates a receptor. In the case of NMDA and NMDAR, the binding of NMDA to NMDAR triggers the opening of the receptor protein and allows for an influx of calcium and salt and an outflow of potassium. Calcium functions at a second messenger in many signaling pathways in the cell.
However, if there are no receptors, then the signal cannot be transmitted, and is lost. Destruction of these receptors, like in anti-NMDA encephalitis, causes “functions [] critical for judgement, perception of reality, human interaction, the formation and retrieval of memory, and the control of unconscious activities (such as breathing, swallowing, etc), also known as autonomic functions” to be damaged (source: Anti-NMDA).
The capacity for the nervous system to be remodeled, especially to itself – according to the tenth edition of Campbell Biology – is called neuronal plasticity. This reshaping occurs mainly at synapses and depends mainly on the amount of activity present around the synapse. Among many other things, neuronal plasticity is the cornerstone of formation and storage of memories. In turn, NMDA is the cornerstone of neuronal plasticity.
NMDA receptors are particular because they will open only if two conditions are met: a high-frequency series of action potentials in the presynaptic neuron, and these action potential arriving at the synaptic terminal at the same time that the postsynaptic cell receives a depolarizing stimulus from another synapse. In other words, the postsynaptic must simultaneously receive, from the synaptic terminal of two different presynaptic cells, a) action potentials and b) a depolarizing stimulus (see image five). The net effect results in a strengthening of action potential. Depolarizing the membrane of the postsynaptic cell raises the potential of the cell membrane from resting potential (usually a negative voltage) to the threshold. This threshold must be crossed in order for the action potential to be passed on from neuron to neuron. Essentially, the depolarizing stimulus raises membrane potential, allowing the action potential to occur.
At their resting potential, cells with NMDA receptors can allow NMDA to bind to them, but they are blocked by magnesium ions. When depolarization occurs, magnesium is realized from NMDAR and the unblocked receptors can then respond to NMDA. This allows for an influx of calcium ions and salt ions (see image six).
The particulars of NMDA receptors result in long-term potentiation, or LTP, a lasting increase in the size of the postsynaptic potentials at the synapse. This is one of the fundamental processes through which memories are stored, because LTP can last for days or weeks. With that in mind, the destruction of these receptors creates a detrimental effect to the efficiency of storage and retrieval of memories.
In addition to memory, glutamine and NMDA play roles in schizophrenia and hallucinations. About 1% of the world suffers from schizophrenia – it’s a mental disturbance wherein the patient experiences hallucinations, delusions, and a general distorted sense of reality. Sound familiar?
Think back for a minute. Remember agonists? NMDA is an agonist for NMDA receptors; it binds to the receptor and triggers a response. In the case of NMDA, the reception results in the opening of the protein and an influx of several essential ions, like calcium. An antagonist is the counterpart of the agonist. Both agonist and antagonist bind to the NMDAR, but only the agonist triggers an efficacy. An antagonist takes the spot of the agonist and blocks the agonist from being able to bind – an example of allosteric inhibition. The antagonist has absolutely no efficacy; binding of the antagonist to the receptor results in pretty much nothing (I think).
While NMDA is the agonist for NMDA receptors, there are a multitude of antagonists for NMDA receptors as well. The street drug PCP, also known as ‘angel dust,’ is made of phencyclidine, a chemical antagonist for NMDAR. Usage of PCP induces strong schizophrenia-like symptoms. Another antagonist is ethanol, or drinking alcohol. Yes, drinking alcohol.
Dehydration, a weakened immune system that leads to his own body destroying his neuron receptors, hallucinations – almost like he’s on PCP – and a very sneaky and deceptive psychiatrist and a pushy boss. Poor Will. At least he has his dogs.
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1- Blood going into the kidney, waste filtered out, blood going out of the kidney |
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2 - An overly complicated diagram of something that's kind of complicated, aka maintaining blood osmolarity |
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3 - A neuron |
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5 - A combination of postsynaptic receipts result in a greater potential (C) |
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“Does anyone have
any aspirin?” – Will Graham
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