Autoimmunity can take many different forms, and that complicates matters. Autoimmune diseases and conditions often do not manifest homogenously – different people may experience very different symptoms. This inconsistency makes a diagnosis difficult, but it also means that identifying the specific autoimmunity is a challenge. As such, progress in autoimmune research is often not linear and frequently, quite complex.
In this article, we will briefly review the factors and milestones that have contributed to our understanding of autoimmunity today.
Autoimmune Diseases and Conditions
Autoimmune diseases are a family of conditions that lead a person’s cells, organs, and tissues to attack themselves. Taken individually, many of these conditions – there are over 100 that have been recognized by the medical community (up from 80 conditions 16 years ago and 50 in 1999) – are rare. However, when taken collectively, autoimmune disorders are quite common in one form or another, and they have been on the rise for the past few decades. The reason for this increase in prevalence is not clear.
Famous Figures with Autoimmune Conditions
Looking at historical records, it now seems apparent that many famous figures suffered from autoimmune disorders. However, they were not understood at the time. The Italian sculptor Michelangelo is believed to have had arthritis, but he called it “gout” – a term that was used to describe unexplained pains often in history. Louisa May Alcott (writer of Little Women) documented her symptoms, and it now seems apparent she had lupus. Even today, there are many celebrities with autoimmune conditions: Morgan Freeman, Fibromyalgia; Venus Williams, Sjögren’s Syndrome; Selma Blair, Multiple sclerosis.
Overview of Autoimmune Discoveries
The concept of autoimmunity didn’t come around until the 1940s and the clinical evidence of autoimmune disorders didn’t begin until the mid-1960s. Several events happened over the space of a few years. Researchers were starting to draw connections between certain infections and the development of autoimmune diseases. In 1965, auto-antibodies were detected in the diseased organs of patients with Sjögren’s syndrome. By the early 1970s, autoimmune diseases were explained in terms of molecular details. Molecular markers were identified through correlation. In the early 1980s, this knowledge introduced new concerns about bone marrow transplants and there were other developments and there was research on autoimmunity at a cellular level. For example, Professor Sir Marc Feldmann hypothesized about the existence of cytokines in 1983 and work from David Wraith looked at antigen-specific immunotherapy.
By the 1990s, the mechanisms around autoimmunity were being applied in other directions, outside of treating autoimmune conditions, such as birth control that effectively immunized against sperm and new treatments came forward. Research from Shimon Sakaguchi and Fiona Powrie looked at regulatory T cells while Sir Herman Waldmann published a paper on long-term immune system tolerance. In 1998, the first anti-TNF-α drugs received FDA approval.
Research around autoimmune conditions in the 21st century may include several components. Genetics is one option. While there is no single autoimmune gene, researchers have identified certain genes that would make it more likely for someone to develop a specific autoimmune condition. The science around biomarkers has also improved the ability for medical professionals to spot autoimmune disorders before the damage has become too great.
The Future of Autoimmune Research
However, it is still a progression. According to Immunology, “New knowledge generated by original basic science takes an average of 17 years to reach the clinic.” Plus, autoimmune diseases are complicated. Some people with autoimmune disorders are asymptomatic. There is also an issue of co-conditions – some autoimmune diseases appear frequently together – and mimics or conditions that look like one disease but are very different in mechanism.
Conducting autoimmune trials responsibly means that researchers and investigators need to have a superior understanding of autoimmunity. They also need the ability to recruit patients that meet the needs of study protocols with as much precision as possible.
Resources
- https://www.niaid.nih.gov/sites/default/files/adccfinal.pdf
- https://www.nature.com/articles/nbt1099_1038
- https://curearthritis.org/historical-figures-with-autoimmune-conditions/
- https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(15)00032-7.pdf
- https://www.immunology.org/publications/bsi-reports/60-years-immunology-past-present-and-future/the-enemy-within-new
- https://pathology.jhu.edu/autoimmune/development
- https://blog.uvahealth.com/2014/10/31/detective-work-autoimmune-disease/
- https://www.aarda.org/diseaselist/