Why Autoimmune Diseases Cause the Body to Attack Itself

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iStock

A new study published in the journal Cell explores the cellular "runaway train" that allows lupus and other autoimmune diseases to spread throughout the body.

Autoimmune disease is exactly what it sounds like—the body mistakenly fighting itself. This attack may take the form of type 1 diabetes, celiac disease, rheumatoid arthritis, inflammatory bowel disease, or lupus, among others. But what begins as a local problem often eventually goes global.

"Once your body's tolerance for its own tissues is lost, the chain reaction is like a runaway train," co-author Michael Carroll of Boston Children's Hospital and Harvard Medical School said in a statement.

The disease tricks the body into expanding its attack. In a process called epitope spreading, autoantibodies target more and more tissues and organ systems over time, causing new symptoms like joint pain, kidney damage, and severe skin rashes.

To find out how it happens, Carroll and his colleagues zoomed way, way in to examine the progression of lupus in the tissues of lab mice.

"Lupus is known as 'the great imitator' because the disease can have so many different clinical presentations resembling other common conditions," first author Søren Degn, of Boston Children's Hospital and Aarhus University, said in the statement.

"It's a multiorgan disease with a plethora of potential antigenic targets, tissues affected and 'immune players' involved. Lupus is considered a prototypic autoimmune disease, which is why it's so interesting to study."

The researchers used what's called a confetti technique, marking different types of diseased B cells with different colors, then watching the colored dots multiply, scatter, and spread.

Graphic of multicolored autoantibodies
Immune cells called B cells battle each other to produce the best antibody. Here, green represents the B cells that produce the "winning" antibody and stamp out competing B cells (other colors).
Carroll Lab/Boston Children's Hospital

The confetti images revealed a microscopic soap opera, as the different colors struggled for dominance and power. As time went on, the makeup of the confetti shifted. One color, or cell type, had won.

Those toxic cells then began converting their neighbors.

"Over time, the B cells that initially produce the 'winning' autoantibodies begin to recruit other B cells to produce additional damaging autoantibodies—just as ripples spread out when a single pebble is dropped into water," Degn said.

The researchers were surprised but excited by their results, which they believe could someday lead to new types of treatment.

"Blocking germinal centers in the midst of an autoimmune response could potentially block the epitope-spreading process," Carroll said. "If you could stop the adaptive immune system for a transient amount of time, it might allow the body to reset its immune responses and shut off the autoreactivity."

7 Terrifying Historical Remedies for Migraine Headaches

George Marks/Getty Images
George Marks/Getty Images

Migraines are more than just splitting headaches. Migraine symptoms, which affect about one in seven people worldwide, can include throbbing pain on one side of the head, nausea, sensitivity to light and sound, and visual disturbances called auras. Today, several classes of drugs are prescribed to either prevent migraine headaches from happening or halt them once they’ve started. But in previous centuries, migraine treatments weren’t so convenient—or effective.

1. Bloodletting

Whether by scalpel or by leeches, bloodletting was the most common remedy for migraine headaches (and many other ailments) before the advent of modern medicine. Throughout most of history, Western physicians subscribed to the humoral theory, in which human health was governed by four fluids (humors) that must be kept in balance. Sickness was explained as an imbalance of humors, and bloodletting was thought to rebalance the system. The methods varied, though. In the case of migraine headaches, the Greek physician Aretaeus suggested sticking a barbed goose feather up the unfortunate patient’s nose and prodding around until blood flowed.

Even as late as the 18th century, bloodletting was still believed to help migraines. Swiss physician Samuel Auguste Tissot, who was the first to describe migraines as a discrete medical condition in the 1770s, recommended bleeding, better hygiene and diet, and drugs including infusions of orange leaves and valerian.

2. Garlic

The 11th-century physician Abu al-Qasim suggested sticking a clove of garlic into the migraine headache sufferer’s temple. He offered a handy recipe:

“Take a garlic; peel and cut at both extremities. Make an incision with a large scalpel in the temple and keep under the skin a cavity wide enough to introduce the garlic and to conceal it completely. Apply compresses and tighten, let it remain about 15 hours, then remove the device. Extract the garlic, leave the wound for two or three days, then apply cotton soaked in butter until it suppurates.”

Once the wound started oozing—which was considered a good sign—the physician would cauterize the incision with a hot iron. Cauterization was meant to prevent infection, although modern research has shown that it actually lowers the threshold for bacterial infections.

3. Cupping

Cupping—inverting hot glass vessels on the patients’ body—was thought to perform the same function as bloodletting. Prominent Dutch physician Nicolaes Tulp, depicted in Rembrandt’s 1632 painting The Anatomy Lesson of Dr. Nicolaes Tulp, treated a migraine sufferer by cupping. She soon recovered.

A substance called cantharidin, a potent blistering agent secreted by the Meloidae family of beetles, was also applied as part of the cupping and blistering process to draw out bad humors. Unfortunately, if the cantharidin was left on too long, it could be absorbed into the body and cause painful urination, gastrointestinal and renal dysfunction, and organ failure. (Perhaps unrelatedly, cantharidin was also used as an aphrodisiac.)

4. Trepanation

One of the oldest types of surgery, trepanation is the practice of cutting away part of the cranium and exposing brain tissue to treat injuries or chronic conditions like migraine headaches. The 16th-century Dutch physician Petrus Forestus, who meticulously recorded the ailments and treatments of his patients, performed trepanation on a person with incurable migraines. In the brain tissue he found something he called a “black worm.” According to a 2010 study by neurologist Peter J. Koehler, the mass may have been a chronic subdural hematoma—a collection of blood between the surface of the brain and its outermost covering—and a possible cause of the patient’s agony.

5. Dead Moles

Ali ibn Isa al-Kahhal, the leading ophthalmologist of the medieval Muslim world, described more than 130 eye diseases and treatments in his groundbreaking monograph Tadhkirat al-kaḥḥālīn (The Notebook of the Oculists). While his descriptions of ocular anatomy were sound, he also touched on remedies for headaches, and here his prescriptions seem more suspect. To treat migraines, he suggested tying a dead mole to one’s head.

6. Electric Fish

Long before scientists fully understood the principles of electricity, ancient doctors recommended it as a remedy for migraines. Scribonius Largus, the court physician for the Roman emperor Claudius, saw that the torpedo fish—also known as the electric ray, native to the Mediterranean Sea among other areas—had the power to shock anyone who touched it. Largus and other doctors prescribed the shocks as cures for headache, gout, and prolapsed anus.

In the mid-18th century, a Dutch journal reported that the electric eel, found in South America, emitted even stronger shocks than the Mediterranean fish and were used for head pain. One observer wrote that headache sufferers “put one of their hands on their head and the other on the fish, and thereby will be helped immediately, without exception.”

7. Mud Foot-Baths

Compared to expired rodents, warm foot-baths must have sounded positively decadent to those afflicted with extreme pain. Nineteenth-century physicians suggested that migraine sufferers take the waters at Marienbad (now Mariánské Lázně) and Karlsbad (now Karlovy Vary), two spa towns in what is now the Czech Republic. While the mineral waters were useful for alleviating congestive headaches, mud foot-baths were believed to draw blood toward the feet and away from the head, calming the nervous system. “The foot-bath ought not to be taken too hot, and the feet should be rubbed one over the other while washing the mud off, and afterwards with a coarse towel. A brisk walk may be used to keep up the circulation,” suggested Prussian Army physician Apollinaris Victor Jagielski, M.D. in 1873.

A 12-Year-Old Designed a Teddy Bear to Make IV Infusions Less Scary for Kids

Medi Teddy
Medi Teddy

When Ella Casano first began getting treatment for an autoimmune disease, she found the various bags, lines, and fluids attached to her IV pole a little unsettling. That’s when the 12-year-old had the idea to obscure the infusion with a little misdirection by placing a teddy bear over the medication.

Casano, who suffers from Idiopathic Thrombocytopenic Purpura (ITP), a disease that causes the body to destroy its own blood platelets, decided that others could benefit from her idea. Ella and her family created a GoFundMe so she could raise money to mass-produce the Medi Teddy, a special plush bear that doubles as a pouch for IV fluids.

The rear pouch of the Medi Teddy is pictured
Medi Teddy

From the front, the Teddy looks like a stuffed pal. The back has a mesh pocket for medication.

“When I had my first infusion, I was surprised and a little intimidated by the look of the amount of tubing and medical equipment on my IV pole,” Casano wrote on the Medi Teddy website. “As I saw more and more children experiencing the same feelings, I became more interested in creating a friendlier experience for young IV patients, so I created Medi Teddy. I hope that Medi Teddy helps you just as much as it helps me!”

The fundraiser, which has already raised beyond its $5000 goal, will allow Casano to order 500 Medi Teddys and distribute them at no cost to children receiving IV treatments. People interested in donating can contribute via the GoFundMe or the donation page on the website.

[h/t WTHR]

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