"Adjust the right response of the body": an immunologist - on the causes and advanced therapy of autoimmune diseases

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Let's start with a brief definition of what autoimmune diseases are.

According to the mechanism, they can be compared with suicide, when the immune system begins to show aggression towards its own body and destroy its organs and systems.

Autoimmune diseases are always polyetiological - that is, they have many causes, most of which are triggers, starting points, and not the main root causes.

At the heart of all autoimmune diseases is a violation of the genome.

As for salt, according to one theory, its abuse affects the production of adrenal hormones that regulate blood pressure.

With increased pressure, the vessels are compressed, hypoxia and inflammation occur.

Inflammation leads to cell death.

This increases the risk that the immune system will mistakenly perceive them as antigens - foreign agents.

Not only an excess of salt can provoke inflammation, but also other imbalances of trace elements, such as calcium and vitamin D. The fact is that in the membrane of each cell there are ion channels through which it exchanges sodium, chlorine, calcium, magnesium ions with the environment - an organism.

If the necessary balance of the main mineral components of this process is disturbed, the work of the cell is also disrupted.

Again, inflammation occurs, to which the immune system reacts.

In the presence of a genetic predisposition, inflammation can flow into an autoimmune disease.

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- What does the mechanism of recognition of “self” and “foreign” proteins by the immune system look like?

- Let's start with the concept of "antigen" - this is the name of everything that the immune system recognizes as a foreign element.

It can be an infectious agent, but it can also be your own degenerated cell, which also needs to be destroyed.

There are several types of so-called antigen-presenting cells in the body that are capable of professionally recognizing, recognizing an antigen and transmitting this information to downstream cells to trigger an immune response.

If these cells "mistake" at the stage of antigen detection, an autoimmune reaction occurs.

What are the main autoimmune diseases?

- All autoimmune diseases are divided into organ-specific, systemic (they are also organ-non-specific) and mixed.

In the first group, the immune process is realized only in one organ and, as a rule, does not affect other systems.

Systemic autoimmune diseases cause severe inflammation throughout the body.

And in the case of mixed disease, the autoimmune process develops in some organ, but eventually affects the entire body.

For example, type 1 diabetes is an organ-specific disease that destroys the pancreas.

But in the end, the whole body suffers.

Organ-specific diseases include Graves' disease (Basedow's disease), Addison's disease, intestinal and liver diseases, autoimmune hepatitis, Crohn's disease, ulcerative colitis, and others.

Systemic diseases include Bechterew's disease and Sjögren's disease.

The classic version of the third type is the most aggressive autoimmune disease - systemic lupus erythematosus, when the self-DNA proteins that are in every cell become the object of attack from the immune system.

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- What else can trigger an autoimmune reaction in the body, in addition to a deficiency or excess of vitamins and trace elements?

- Often, infectious diseases act as such a trigger.

Bechterew's disease, a chronic inflammatory disease of the musculoskeletal system, can be cited as an example.

Interestingly, women are more susceptible to autoimmune diseases.

However, Bechterew's disease is a disease of men.

It often occurs after infection with sexually transmitted infections, such as intracellular parasites - chlamydia.

Infections do not cause disease, but are a factor in inflammation, after which ankylosing spondylitis occurs in the presence of a genetic predisposition.

The genetic marker of Bechterew's disease was discovered in the last century.

If a person is a carrier of such a gene, he should try to avoid angina, viral infections, not to mention sexually transmitted infections.

In the future, it will be possible to ensure the prevention of autoimmune diseases through vaccination.

Such vaccines have already begun to appear in the world, for example, earlier Japanese scientists reported success in this area.

We are talking, in particular, about DNA vaccines, vector vaccines - such drugs are able to regulate the correct immune response of the body, selectively activating different types of immune cells.

So far, such vaccines have not been used, but their development is underway in a number of countries.

At the same time, vector technologies could also be used - with the help of a viral vector, a regulatory protein can be inserted into the cell, which is able to block the part of the genome that is responsible for autoimmune inflammation in the body.

If it were possible to create such a vaccine, it would be ideal.

But much can be done to prevent autoimmune diseases even before the advent of special vaccines.

When a pediatrician examines a newborn child, his family tree is compiled, which takes into account all the diseases that his relatives suffer from.

According to these data, the percentage of genetic hereditary burden is calculated, this figure is written in the medical card.

And if autoimmune diseases were diagnosed in relatives, then such a child requires special attention - it is necessary to protect him from infectious diseases, be sure to vaccinate, but according to an individual calendar and with a mandatory assessment by an immunologist of a blood test before each vaccination.

Vaccination is vital because infections can provoke autoimmune diseases, but incorrectly administered vaccines at the wrong time can also act as such a trigger.

And such a careful approach does not require large economic resources, but can protect many people from developing severe autoimmune diseases.

In addition, such a child with a genetic predisposition does not need to be taken to the south for up to three years, where there are high temperatures and increased insolation.

Because these factors also serve as a trigger for the development of autoimmune diseases.

You don’t need to fill everything in the house with hydrogen peroxide, figuratively speaking, go to extremes.

But there are basic principles that must be observed: the child should receive his own food, hypoallergenic, and not the same food as adults, and be in conditions with a controlled infectious load until the age of three.

- Regarding the causes of allergies, there is a so-called hygiene hypothesis, according to which people in developed countries have become more likely to suffer from allergies due to too sterile living conditions.

This hypothesis is also used to explain the spread of autoimmune diseases.

At the same time, children with a genetic tendency still need to be protected from infections - how does this compare with the hygiene hypothesis?

Or is she wrong?

— Do not interpret this hypothesis literally.

Before the invention of vaccines, a child's immunity was formed under the influence of infections - and not all children survived this exposure, unfortunately.

Now we have at our disposal a safe tool for the proper formation of immunity - vaccination.

That is why most vaccinations are given to children under the age of five, so that the immune system has matured before school.

And if an unvaccinated child enters kindergarten and school, then the cells of his immune system may not adequately perceive the antigens that they encounter for the first time.

This threatens with allergies and autoimmune diseases.

As for the hygiene hypothesis, it has many reservations.

For example, in the family, the father has atopic dermatitis, and the mother has a drug allergy.

But they still get a dog after reading theories about the dangers of sterility.

As a result, the child develops an allergy, at first it can manifest itself not even on a dog, but on other allergens.

But then it turns out that the base allergen is dog hair.

And the family has to part with the pet.

There are many such cases, unfortunately.

And this is a big problem, it could be solved at least partly through active medical education.

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“That's not entirely true.

In this case, we are talking, most likely, about the whipworm - a roundworm that causes the disease trichuriasis.

There is evidence that its presence in the body can inhibit the development of multiple sclerosis and even have a positive effect in the case of cancer.

So far, this method has not been applied in wide medical practice.

However, some patients themselves put on such experiments on themselves, infecting themselves with whipworm.

At the same time, it should be understood that, in general, human infection with helminths is more likely to create conditions for the onset of cancer, since parasites secrete compounds that suppress immune responses.

And this can prevent the immune system from destroying degenerated cells in time.

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— Is it possible to isolate the useful compounds that this parasite produces, or learn how to synthesize them artificially?

- It is believed that the biochemical structure of the substances that the worm secretes is very unstable, so it is difficult to isolate them to create a drug based on this.

However, it is impossible to say that this is impossible at all - science is constantly developing.

- How are autoimmune diseases treated now, what are the promising developments in this area, in addition to vaccines?

- As a rule, anti-cytokine drugs are prescribed that suppress the activity of precisely those cytokines, mediators of the immune system, which cause an autoimmune reaction.

The effectiveness of such drugs is 100%, their appearance is a big breakthrough.

Such therapy is very expensive, in Russia it is provided through high-tech medical care.

Unlike conventional immunosuppressants, these drugs do not suppress the entire immune system and allow the patient to live normally.

In the future, we hope for the emergence of gene technologies that would allow such patients to be treated simply by blocking or cutting out the parts of the genome responsible for the autoimmune reaction.