AUTOIMMUNE DISEASES: At war with self

If our immune system starts recognising our own body cells as foreign, the consequences could be disastrous.

Vaccination

We are in good health until all parts of our body work well and in tandem. One such part is the immune system — a structure that acts like a guard, protecting us against the harmful invaders. The system works on a simple principle — recognition of the "self" from a "non-self". The non-self is anything that is foreign and capable of harming our body like bacteria and viruses. Immediately after to the entry of a pathogen [disease-causing germ], the system triggers what is called an immune response, in which antibodies [also called the T lymphocytes] are produced against the invader, eventually killing it.

However, at times there is an interruption in the normal process and the system makes a mistake of identifying the self as non-self, thereby creating what are called the auto-antibodies, which are capable of destroying the body's own cells. This forms the basis of a group of disorders called Autoimmune Diseases.

The autoimmune process leads to various results — it could be slow damage of a cell, tissue or organ or stimulation of an organ into excessive growth or interference in the functional process. Moreover, the disorders could be either organ-specific such as Hashimoto's thyroiditis or Grave's Disease, in which the autoimmune activity is directed against a particular organ — thyroid in this case, or are non-organ specific in which the activity affects many organs and systems in the body such as Systemic Lupus Erythematosus [SLE] in which skin, kidneys, joints, blood vessels and even DNA and other nuclear components are affected. Organs or tissues usually affected in this group of ailments are the endocrine glands [such as thyroid, pancreas or the adrenal], blood and its components, digestive tract, skin, connective tissues, muscles and joints.

The cause of autoimmunity

The exact reasons for onset are still not very clearly understood, but genetic predisposition is said to play an important role. First-degree relations such as siblings or children are at higher risk than others; so are women than men.

Further, autoimmune diseases are numerous; they occur worldwide, however, only a few are more common to any given population. For example, the incidence of SLE is higher in Chinese and in the black population, while Diabetes type-1 is widespread in India than in Japan. Thus, autoimmunity could also have an ethnic background.

Autoimmunity could also be acquired. For instance, the incidence of multiple sclerosis is higher in US and Europe than in India or Japan. However, it is seen that Japanese or Indians born and brought up in the US or Europe, tend to acquire the disease more easily than those who go there after adolescence. Oppositely, migrants to Africa are more susceptible than their children born there. Thus, it can be said that environmental factors, lifestyles of the adopted country and dietary habits play a role in autoimmunity. Other causes include bacteria, viruses and certain drugs that could trigger an autoimmune response in people with a predisposition to the disease.

In India

We all know that Amitabh Bachchan was ill with Myasthenia Gravis and that Vidya Balan played a girl with Multiple Sclerosis in the movie Guru. But not many know that both these come in the category of autoimmune diseases and the prevalence of either is not statistically high in our country unlike a few others that need attention such as diabetes type-1, thyroid-related ailments or rheumatoid arthritis [Refer table].

Dr Jayant Sohoni Nasik-based, Consultant of Internal Medicine, says, "With state-of-art diagnostic tools, modern medicines and increased awareness, the management of autoimmune diseases has become easier. In most of the cases, diagnosis is based on medical history, symptoms and blood tests to check the antibody presence."

Current treatment is based on three goals - relieving symptoms and secondary complications, preserving organ function and reducing the autoimmune activity. Apart from this, it is important to boost the morale of the person as living with a disease needs patience, stamina and will power," adds Dr Sohoni.

People with autoimmune diseases mostly face problems with their self-esteem, caring for themselves, family relationships, sexual relationships, pregnancy, and child bearing. Families, friends and acquaintances can contribute a great deal in making life easy for them. He or she may just need a willing ear to listen, may need company for an excursion or to a distracting movie, or may need something completely different to take his or her mind off things. Try not to be too direct but creative in your ways to render help - a coupon for a therapeutic massage, a refreshing movie or even a walk in the park. Such simple gestures can do more wonders to the patient than you can ever imagine.

Autoimmune Diseases

Disease What is it Self that is recognised as non-self Trigger for autoimmunity Prognosis Treatment
Vitiligo Disorder of skin pigmentation; sets in usually at a young age. Colour giving melanocytes Genetic predisposition and occupational - mostly due to chemicals Patches of skin lose colour, usually on face, hands, armpits and the groin. Affected skin is light-sensitive. Light make-up to conceal areas. Phototherapy, corticosteroid drugs and grafting or plastic surgery. Sunscreen essential to prevent UV damage.
Diabetes Mellitus Type-1 Almost complete or total absense of insulin production by the pancreas. Insulin secreting cells of pancreas Primarily genetic predisposition, but even a viral infection to the pancreas could be a trigger. Sets in usually in the juvenile years. Frequent urination, thirst, weakness and fatigue, since cells are starved of glucose. Weight loss as cells try obtaining energy from fat cells. Could also cause urinary infections, boils, delayed wound healing, blurred vision and tingling in hands and feet. Regular check-ups with the doctor, espeically to prevent secondary complications. Regular injections of insulin. A monitored diet, especially carbohydrate intake is must. Monitoring of ketones in blood and urine, since excess leads to ketone shock that could cause coma and death.
Hashimoto's Thyroiditis The thyroid gland is unable to produce enough hormones. Thyroid gland cells Genetic predisposition, environmental or due to an infection. Tiredness, muscular weakness, weight gain, constipation, dry hair, sensitivity to cold and goitre [enlarged thyroid gland] Thyroid hormone replacement for a lifetime. In case of goitre, drug treatment or surgery may be essential.
Grave's Disease An overactive thyroid leading to excess hormone production. Thyroid gland cells - here the antibodies stimulate rather than destroy the cells Genetic predisposition, environmental or due to an infection. Insomnia, irritability, weight loss, heat sensitivity, muscular weakness, brittle hair, shaky hands and bulging eyes. A lifetime of anti-thyroid drugs, to reduce the levels of hormones
Rheumatoid Arthritis An inflammatory condition wherein joints of fingers, wrist, ankles, toes and others swell up, get stiff and at times deformed. The synovial membrane that surrounds and maintains the joint space. Usually sets in due to inflection. Inflammation in the tissue lining joints. Muscle pain, painful and deformed joints, weakness, fatigue, weight loss. Early mornings are the worst times due to stiffness. Non-inflammatory and/or immunosuppressive drugs [in severe cases] are given. Physiotherapy and occupational therapy help. Few feel diet rich in with omega-3 fatty acids helps.
Pernicious Anaemia Failure to absorb Vitamin B12 which is needed for production of normal red blood cells and nerve cell metabolism. Intrinsic factor produced by the stomach lining - Vit. B12 combines with this before getting absorbed. Familial condition, more common in women and in the middle ages, also associated with disorders like diabetes mellitus. Could show no symptoms. In few, headache, tiredness, sore mouth and tongue, weight loss and jaundice. At times loss of balance or tingling in feet. Folic acid tablets or injections of Vit. B12 are needed, at times permanently.
Multiple Sclerosis Chronic disabling. Damage to the fatty myelin sheath of the nerve fibre that helps smooth transmission of impluses from brain and spinal cord to rest of the body Myelin sheath of the nerve fibres Genetic disposition, ethnic, acquired, environmental, viruses of herpes and measles at times Vary amongst people, could last for weeks at times; tingling, nubmness fatigue due to muscular weakness, rigidity leading to paralysis, vertigo, unsteady gait, slurred speech, difficulty in swallowing in incontinence when bladder is affected. No available cure as yet. Drugs given to alleviate the secondary complications. Corticosteroids may help in an acute attack. Few claim changes in diet and inclusion of evening primrose oil and sunflower in diet helps. Physiotherapy for muscular weakness
Myasthenia Gravis Muscles become weak and tire easily The acetylcholine receptors of the muscles, responsible for picking up nerve impulses. Genetic predisposition, infection, injury, sex [women are affected more than men] Either a sudden or gradual onset. Affects people differently. Muscles of the eyes [drooping eyelids], face, throat [difficulty in swallowing], larynx [hoarseness, weak voice, difficult speech], arms and legs and respiratory tract may be affected. Drugs to facilitate nerve impulse transmission to the muscles. Corticosteroid drugs to suppress autoimmune process. Physiotherapy also helps strengthen the weak muscles.
Systemic Lupus Erythematosus[SLE] A multi-organ disorder affecting skin, kidneys, lungs, heart and even the brain in later stages, however, primarily the lesions are in the connective tissues. Mainly the connective issue Mainly genetic predisposition and hormonal factors, but triggers could be viruses, sunlight or few types of drugs. Joints feel painful and swollen, fatigue, loss of appetite, nausea and hence weight loss. Skin is sensitive to the sun. Commonly seen is a "butterfly rash" on the cheek and nose and red, circular rashes on other parts of skin. Still no cure. Drugs given to alleviate swelling and symptoms. Use of sunscreen with higher SPF is the must. Immuno-suppressive drugs are given in severe cases.

An emerging therapy for Vitiligo

Vitiligo or leukoderma is a chronic skin condition that causes loss of pigment, resulting in irregular, pale patches of skin. The normal brown or black colour of the skin is produced by cells called melanocytes, found at the lowest layer of the epidermis. In vitiligo, there is destruction or inactivation of these melanocytes. Vitiligo is an autoimmune disease, which means that the body's own immune system is damaging the melanocytes.

How is stem cell therapy different from the other available treatments?

Some cases of unstable vitiligo do not respond to standard treatments. Mesenchymal stem cells have the property of immunomodulation i.e. they might be able to set the aberrant immune system right. Thus, these cells have the potential to stop the spread of existing lesions and appearance of new lesions. This is known as stabilisation of vitiligo. Once stabilised, these patients can be offered standard therapies like punch grafting.

How does this therapy work?

Mesenchymal stem cells are specific types of stem cells found in the bone marrow [BM] which have immunomodulatory properties, making them useful in treating autoimmune disorders by cell therapy. Human mesenchymal stem cells [hMSC] are present as a rare population of cells in the bone marrow, representing 0.001-0.01per cent of the nucleated cells. But they can rapidly grow in culture without loosing their stemness.

The hMSCs are ideal candidates for cell therapy because of their following attributes:

  1. Ease of isolation
  2. high expansion potential
  3. genetic stability
  4. reproducible attributes from isolate to isolate
  5. reproducible characteristics
  6. compatibility with tissue engineering principles and
  7. potential to enhance repair in many vital tissues.

Are they any side effects?

There could be some local pain at the injection sites and mild, transient fevers. The type of stem cells we use is mesenchymal stem cells, which are derived from the bone marrow. This therapy has been found to be safe with no major adverse reactions.

Cost and availability of the treatment

The total cost of the treatment is around Rs 2 lakhs. It is offered as an experimental therapy at the Manipal Hospital in Bangalore.

Post-treatment

After treatment, the person can resume normal life in a couple of days. He/she needs to consult a dermatologist for regular follow-up. Significant recovery usually takes around 6-9 months.

With inputs from Dr Radhika C. R — Clinical Research Physician at Stempeutics Research Pvt. Ltd.

Team CW

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