What is autoimmune disorder?
Autoimmune epidemic is taking place worldwide. The National Institute of Health (NIH) estimates up to 23.5 million Americans suffer from autoimmune disease. The overall number of cases of autoimmune diseases is rising for unknown reasons. Office of Research on Women’s Health at the NIH, named autoimmunity as the underlying cause of more than 100 serious, chronic illnesses. Of the 50 million Americans living and coping with autoimmune disease, more than 75 percent of them are women. It strikes women three times more than men.
More and more people today are developing chronic illnesses, pain, and unresolved conditions that have not been diagnosed as a disease.
These individuals are suffering from chronic inflammatory responses to various triggers such as diet, stress, and toxic pollutants. Recently three major inflammation factors: gluten sensitivity, intestinal permeability (leaky gut), and autoimmunity have become increasingly observed. All three factors are tightly connected with each other. Gluten sensitivity leads to leaky gut, and gluten sensitivity and leaky gut have shown to be major triggers for an autoimmune disorder.
What body's parts are under attack
The term "autoimmune disease" refers to a varied group of illnesses that involve almost every human organ and system. It includes diseases of the nervous, gastrointestinal, and endocrine systems, as well as skin and other connective tissues, joints, eyes, blood, and blood vessels. The most common manifestation of an autoimmune disorder is Hashimoto disease (thus, Hashimoto’s is not a thyroid disease but an immune disorder), celiac disease, pernicious anemia, ulcerative colitis, Crohn’s disease, and rheumatoid arthritis.
The host predisposition could result from genetic factors and could be triggered by gene-environment interactions. Autoimmunity is known to have a genetic component and tends to cluster in families as different autoimmune diseases. In some families, a mother may have lupus; her son, juvenile diabetes; her sister, antiphospholipid syndrome; and her grandmother, rheumatoid arthritis.
In all of these diseases, the underlying problem is similar - the body's immune system becomes misdirected and attacks its the very organs that it was designed to protect (fig 2). Antibodies are typically involved in protecting the body from infection, but they can also cause disease.
The etiology of autoimmune disease is multifactorial (Fig.1). There are many theories about what triggers autoimmune diseases including:
Hormonal imbalance (ex: estrogen shifts, insulin resistance)
Immunological factors. Defect in the regulation of immune T and B cells
Bacteria, virus, candida, parasites
Chemical irritants, heavy metals
Composition of gut microbiota
Vitamin D deficiency
Besides of all these factors, loss of intestinal barrier function (leaky gut) is necessary to develop autoimmunity. Nevertheless, the onset of autoimmune diseases remains enigmatic.
Stages of autoimmunity
There are three recognized stages of autoimmunity: silent, reactive and disease (fig 2).
The first stage is called silent and is the onset of loss of immune self-tolerance can be diagnosed by elevated self-tissue antibody. During this stage, there are no symptoms or signs. Autoantibodies characteristic of a autoimmune disease can be developed as long as 10 or more years before the onset of clinical symptomatic.
The second stage is called transitional. It is the stage in which the immune system has progressed into tissue destruction and is beginning to create noticeable symptoms associated with loss of function. It is not considered a disease yet.
The last stage is called autoimmune disease. This stage is associate with elevated antibodies, significant loss of self-tissue and function, and progressive symptoms.
Testing for Autoimmunity
Laboratory testing is of great value when evaluating a patient with a suspected autoimmune disease. The results can confirm a severity of diseases, aid in assessing prognosis and disease activity. Components of the laboratory exam include complete blood count, comprehensive metabolic panel, inflammatory markers (C-reactive protein and Erythrocyte sedimentation rate) and autoantibodies. Autoimmunity is identified by measuring antibodies to self-tissue. Elevated measure of self-tissue antibodies indicate loss of self-tolerance.
Figure 1. The most known predisposing factors
Figure 3. Immune responses to different lifestyle
A common area of autoimmune attack is the brain and nervous system. The main clue that a patient with a poorly functioning nervous system may be suffering from autoimmunity is a history of another autoimmune disease, especially of those listed above.
Red flags for neurological autoimmunity are: existence of another autoimmune disease, gluten sensitivity, genetic predisposition, brain decline not associated with age or trauma, brain decline after infection, severe stress, and environmental triggers.
The youngest example of neuroautoimminity is autism. Immunological studies have found that autism develops during pregnancy. When a woman goes into a pregnancy with a leaky gut, dysglycemia, Hashimoto thyroiditis, Graves disease or adrenal fatigue, it increases the risk for the fetus to develop health disorders, including autism.
Multiple sclerosis is recognized as an autoimmune disease.
Because there are so many different types of autoimmune disease, the symptoms vary. However, most of them cause fatigue, and general malaise (feeling ill). Symptoms worsen during flare-ups and lessen during remission.
Figure 2. Three stages of autoimmunity
Two types of major immune cell stimulate (Thelper)and suppress (Tregulator) autoimmune response (Fig 3).
The process of diagnosing an autoimmune disease involves identifying the antibodies your body is producing. The complex and frequently overlapping symptoms of autoimmune diseases make them exceedingly challenging to diagnose. This could potentially lead to late or incorrect diagnoses and failed treatments.
Fighting autoimmune diseases requires a personalized approach.
What's New on the Research Horizon?
Research that focuses on the etiology of all autoimmune related diseases rather than a singular autoimmune disease will bring us to the root causes of these diseases rather than the superficial level of treating the symptoms after the disease has had its destructive effects. At the present time, there is very little focus on basic autoimmune research.
Daniel Winer commented about autoimmunity and diabetes: "It's highly suggestive that your body targets its own proteins as part of the development of insulin resistance. It really links the concept of insulin resistance to autoimmunity." He added, "Conversely, if we could identify a panel of antibodies that might protect against developing insulin resistance, we could begin to think about a vaccine to prevent type-2 diabetes." (https://med.stanford.edu/news/all-news/2011/04/type-2-diabetes-linked-to-autoimmune-reaction-in-study.html)
Numerous publications showed that vitamin D deficiencies have been found to affect the development of certain autoimmune diseases like lupus, type 1 diabetes, thyroid, vitiligo, interstitial lung disease.
A clue to how the process is controlled came from work involving a protein in the cell nucleus called Aire (for autoimmune regulator), which regulates the expression of some 300 to 1,000 antigens in the thymus. Humans and mice lacking the normal Aire gene suffer from multiple autoimmune diseases including ones that target the thyroid, adrenal, ovary, and eye.
TNF-α (tumor necrosis factor), "inflammatory cytokine" handles infections and inflammation. TNF-α is the simple "Root of All Evil! " It is a major contributor to autoimmune disease, erectile dysfunction, heart disease, and cancer. Our modern lifestyle raises TNF to unhealthy levels and, eventually, these increased levels kill us.
Stojanovich L. published review (Autoimmun Rev. 2010 Mar; 9(5) discussed stress as a trigger for autoimmune disease. Many retrospective studies had found that a high proportion (up to 80%) of patients reported emotional stress before the disease onset. This, however, is not surprising as the disease itself causes significant stress in the patient. Recent reviews shows the possible role of psychological stress, and of the major stress-related hormones, in the pathogenesis of autoimmune disease. They presume that the stress-triggered neuroendocrine hormones lead to immune dysregulation, which ultimately results in autoimmune disease by altering or amplifying cytokine production. Stress reactions should be discussed with autoimmune patients, and obligatory questionnaires about trigger factors should include psychological stress in addition to infection, trauma, and other common triggers. The treatment of autoimmune disease should thus include stress management and behavioral intervention