Tuesday, August 7, 2012

Autoimmune Disease: The Common Threads AARDA Conference Topic

I promised that I would share some of the goodness from last Saturday's Autoimmune Disease conference sponsored by the AARDA, National Psoriasis Foundation, and OHSU, and here's a sample.

I was impressed in particular with this speaker: Dr. Noel R. Rose, Director, Center for Autoimmune Research at Johns Hopkins University.

Dr. Rose's discussion examined the far-reaching effects of autoimmune disease on several populations, affecting far more people than I had imagined:

And it's an expensive disease in more ways than one:

I wish I would have taken a better picture of this excellent graph below, which dramatically illustrates the comparison of females to males in various autoimmune diseases. The picture is a bit blurry, so I will list the diseases from left to right. Keep in mind that the pink bar represents women and the blue men.
From the left:
Sjogren's Syndrome
SLE -- Systemic Lupus Erythematosis
Thyroid disease
Myasthenia Gravis
Rheumatoid Arthritis
Multiple Sclerosis
Ulcerative Colitis
Diabetes Mellitus

The next graph shows the incidence of autoimmune disease in the US back in 1995. These numbers have increased considerably and consistently since then:

In looking at our little Sjogren's blip on the graph above, I understood just a bit more why our disease is unknown to so many. Doesn't excuse it.....just explains it. We do make up a fairly small piece of the autoimmune pie.

Dr. Rose went on to explain that current theories about the development of autoimmunity are three-pronged:

He commented that in his opinion, even though there are three factors in the causation of AI, environmental factors are more than half the risk.

One of the environmental factors which is not listed on the above slide, is the proximity to the equator: if you live in a temperate climate, your chances of having an autoimmune disease is higher. If you live closer to the equator, the chances are less. In the picture below, the pink and cream areas represent a lower occurrence than do the grey and green. Interesting.

To summarize the development of autoimmune disease, Dr. Rose explained...

Which brought us to the topic of how we can prevent this train wreck:

Early intervention is important, but also a difficult issue to address, since appearance of many biomarkers which indicate development of the disease may precede the actual symptoms and diagnosis by many years, which frustrates both patients and the physicians attempting to diagnose and treat them.

The graph above shows the gradual increase in autoantibodies over several years before symptoms and diagnosis of SLE.

Biomarkers of early disease need to be identified much more quickly than at present, and additional and more specific biomarkers need to be identified, according to Dr. Rose.

New treatment modalities are generally focused on those drugs that can interrupt the immune chain of events. Various drugs target various players in this chain:

Notice that the rituximab target is listed as Anti-CD20, which is a surface antigen -- or specialized protein -- found on B lymphocyte blood cells. I've written previously about why B cells, antibodies, and antigens are important to sjoggies, read this and this.

So. To summarize:

Autoimmune disease is HUGE. There's lots of them -- at least 80, and they affect lots of people, women more than men.

While it is not known exactly what causes AD, the current theory is that a combination of heredity, hormones, and environmental factors are to blame; with environmental factors taking up more than their fair share. It is strongly suspected that seemingly unrelated diseases such as diabetes and heart disease AND Sjogren's syndrome may all be far more similar than had previously been thought in that their causes are autoimmune in nature.

The future of research and treatment of these diseases, which all may share similar etiology, hinges on the ability to identify these diseases much sooner than at present, since we now know that the immune system begins to develop autoimmune processes and cells long before some symptoms and thus, diagnosis, appear.

A better understanding of biochemicals and their tasks in the immune response is vital to developing medications that will block these specific problematic biochemicals.

I wish that Dr. Rose could have addressed us for at least another two hours, or two days. He has an enormous amount of experience working in this field of research. I would love to know more specifics about which of these biochemicals and thus biomarkers for disease are the latest and greatest targets of research.


cargillwitch said...

It is always reassuring to see a speakers( and researchers!) focus on treating the CAUSE of the problem not just doing mop up of late stage symptoms- even if that's where the money is to be made for pharmaceutical companies.Estrogenic like compounds in our environment augmenting our own hormones? air quality? lack of vitamin D or another sun related process still yet undiscovered? So many avenues to investigate to see where the train station is located.Thanks for posting all the presentation slides- look like it was a worthwhile event!

Anonymous said...

Any new info on overlap syndromes or Undifferentiated Connective Tissue Disease or Mixed Connective Disease?

Amy Junod said...

Makes a good case for the House Bill doesn't it?
Love the work Johns Hopkins is doing. Was there any reference to the Sjogren's center and the how the center is doing?
Thanks for passing on the info to us and for deciphering what it all means.

annie said...

Thank you for all this great information and the data on autoimmune diseases. I will have to re-read as it is too much for me to absorb right now, but such great stuff, Julia.

Miki said...

Thank you Julia! Really great info!

Shara said...

I would have loved to have been a Geneticist in this lifetime. It would have served me well now, huh? I came away from the seminar with an even stronger believe that they WILL find in the future that as soon as women started working the earth with inorganic fertilizers developed mostly in the 20th century- our genetics became polluted to the point that we have these autoimmune diseases now. Look up fertilizer. And the pesticides. Do not forget the pesticides! Many studies have been done showing the results of our exposure with these deadly chemicals on our children. And their off spring,and their off spring, etc.
One of the speakers brought up the fact that she was from a very large family. When it came to looking at disease within her own family she found she could easily identify the pattern that was traceable back into her families history. That is why it is so important to have that part of your file filled out at the doctors office. What they had relates to you. Imagine in the future what your great grandchild will have in their file. I've had to tell my children to get the fact that their mother has an autoimmune disease written down in their medical records now. Take responsibility to call or visit those older relatives before its too late- if you can, and ask them where they've been and how their health is.
It was repeated that a genetic pre-disposition and environmental factors play a big roll in AD. Again I say, it is my theory that women have been genetically altered though our connection to the dirt of the earth. It wasn't that long ago that a woman could be traded for a farm animal and nobody cared because it was normal. We worked the land,grew the families vegetables and slaughtered the meat. We washed the clothes and bathed everyone in the same bath water with no indoor plumbing, hauling it from a pump out in the orchard that was across from the fields that were behind our vegetable gardens. See where I'm going here.

I think if the AARDA wants and rightfully needs money, one way they could do that is to get their show on the road and get it to an attorney experienced in class action suits and sue the pants off of the chemical companies. Our autoimmune disease is not an act of God. It is the act of some pretty ignorant, negligent men that own these behemoth sized companies that produce toxic products that are killing off the women folk of Earth.

Well Julia, that's what I was thinking coming away from this seminar. Thanks for listening.

ShEiLa said...

Lots of great information and wonderful visuals. Thanks for sharing. It would have been fun to be there.


Unknown said...

Thanks for this post, very insightful while I'm doing a case report about a patient with autoimmune disease. The current work since this post is great to follow, e.g. Prof Yehuda Schoenfeld. Hopefully we can identify earlier for generations to come, so we can change their health outcomes for the better