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."

What Happens When an Astronaut Gets Sick in Space?

NASA/Getty Images
NASA/Getty Images

Astronauts are among the fittest and healthiest people in the world. They're rigorously trained, vetted, and quarantined before they’re allowed up in space—and yet, despite all those precautions, they do sometimes get sick. Apollo 13's Fred Haise, for example, had to deal with a painful kidney infection during the dangerous mission that gave us the phrase "Houston, we have a problem," and one-time astronaut Jake Garn, a Utah senator, got so motion-sick during a 1985 Discovery mission that astronauts now rate their nausea levels on the Garn Scale. And because space missions are on a strict schedule planned far in advance, sick astronauts on a space mission can't just pop down to Earth to see a doctor.

But when astronauts fall ill, they don't have to worry—NASA and other space agencies that have missions aboard the ISS are prepared.

SPACE ADAPTATION SICKNESS

Zero gravity can change a lot of normal bodily functions. One effect it has is to make the fluids inside the body float, which confuses the inner ears and makes them unable to tell up from down. This causes space adaptation syndrome (SAS), a common illness that's kind of like seasickness in space. Motion sickness, the most frequently reported ailment, is a subset of SAS; it affects 67 to 75 percent of astronauts.

It takes a few days for astronauts' bodies to adjust to weightlessness, during which they may experience symptoms ranging from headaches to vomiting. And though it might seem like a nightmare to deal with puke, NASA has a system: Astronauts carry special barf bags with attached face wipes and Ziploc seals that they can use during launch or while in orbit if they get the urge to hurl. Once used, the bags are tossed in the trash.

COLDS AND SNIFFLES

Because astronauts are quarantined before spaceflight, the likelihood of being exposed to a pathogen in space is rare. But if an astronaut does come down with the sniffles, they can expect an Earth cold on steroids: Sinuses don't drain in zero gravity, so congested astronauts feel even stuffier than we do here on the ground. To make matters worse, germs seem to thrive in weightless environments—pathogens can develop “thicker cell walls, greater resistance to antimicrobial agents and a greater ability to form so-called biofilms that cling to surfaces” in zero gravity, according to TIME.

Luckily, colds and even the flu tend to go away on their own, even in space—so astronauts just need to wait it out.

BUMPS, BRUISES, AND OTHER MINOR INJURIES

Astronauts floating around in zero gravity have a tendency to bump into things, which can sometimes cause an injury. When they want to check on a wound, abrasion, or another condition, they place a phone call to a physician on the ground, who will advise them what to do.

“We get calls for bumps, and bruises, and little lacerations or cuts,” Shannan Moynihan, deputy chief of space and occupational medicine at the NASA Johnson Space Center, said at a health tech conference in March 2018. “A typical scenario might be a newbie, somebody who just got up there, trying to Superman through a hatch and not quite making it. So we get a call for a little bump on the forehead and we help them figure out how to take care of that.”

A doctor on Earth can walk an astronaut through how to use and read a modified ultrasound machine on the ISS, for example, or give them additional training in response to a specific medical condition occurring on board. That happened with spaceflight-associated neuro-ocular syndrome, a condition in which ISS astronauts developed visual and structural changes in their eyes during space missions. They were subsequently trained to conduct a series of eye tests on themselves.

FROM EVACUATION TO SURGERY

If there’s anything too serious to deal with on board, astronauts can get back to Earth via the the Soyuz spacecraft that brought them to space—there’s always one docked at the ISS in case of emergency. Medical evacuation has only happened once, in 1986, when a Soviet astronaut named Vladimir Vasyutin had to leave the Salyut-7 Orbital Lab [PDF] because of a prostate infection. His trip back to Earth took about six hours; these days, astronauts can land in less than three and a half.

In the case of a true medical emergency—one that requires surgery—evacuation to Earth is currently the only way for astronauts to get treatment. Surgery in zero gravity isn't yet possible; blood would float straight out of a wound and contaminate the whole cabin. As deep space travel gets more feasible, however, it’s possible that one day a space O.R. might be necessary, and technology is being developed to make potential surgeries easier and cleaner. Scientists are testing a device called the aqueous immersion surgical system (AISS), a saline filled dome that, when placed over a wound, could keep blood and bodily fluids in place.

As humanity pushes further into deep space, medical technology will need to become even more sophisticated. When it comes to deep space missions, NASA representative Stephanie Schierholz tells Mental Floss, “NASA is specifically looking at five hazards of human space travel: space radiation, isolation and confinement, distance from Earth, gravity fields (or lack thereof), and hostile/closed environments that pose the greatest risks to the human mind and body in space.”

Currently, NASA is working on several research and development projects to address the hazards posed by deep space travel, including no-drill dentistry and emergency wound closure, which would need to be usable by astronauts with no formal medical or dental training. And because not all potential illness is physical, Mars settlement simulation projects are helping researchers understand what the psychological, emotional, and social effects of long-term isolation might be on astronauts.

14 Facts About Clara Barton

Mathew Brady, National Archives and Records Administration // Public Domain
Mathew Brady, National Archives and Records Administration // Public Domain

To call Clara Barton just a nurse insults her legacy, despite what your history teacher may have taught you. She was a woman of numerous accomplishments, and in some ways, she was all too human. Here are 14 facts you probably didn’t know about this great American icon.

1. SHE ALMOST DIED WHEN SHE WAS 5.

Barton, the youngest of five siblings, was born Clarissa Harlowe Barton to Stephen and Sarah Stone Barton on Christmas Day in 1821, in North Oxford, Massachusetts. (Her name came from the novel Clarissa: or the History of a Young Lady by Samuel Richardson.) Her father was a militia captain and natural storyteller; her mother was well-known for her eccentricities: For example, she would bake pies for the family that she did not intend to share, preferring that they instead grow moldy.

But the pie situation wasn’t the most traumatic part of Barton’s youth. In her memoir The Story of My Childhood, she recounts being stricken with bloody dysentery and convulsions at the age of 5. Her family assumed she would not survive, and a report went out that she had died. Thankfully, she went on to make a full recovery, and later, as a nurse, she’d help soldiers suffering from the same illness.

2. ONE OF HER FIRST JOBS WAS AS A PAINTER’S ASSISTANT.

When her family moved to a new home in the 1830s, Barton became fascinated with the house painter’s technique and talked her way into being his helper. “I was taught how to hold my brushes, to take care of them, allowed to help grind my paints, shown how to mix and blend them, how to make putty and use it, to prepare oils and dryings … So interested was I, that I never wearied of my work for a day, and at the end of a month looked on sadly as the utensils, brushes, buckets, and great marble slab were taken away,” she wrote. The experience may have sparked her lifelong love of the arts. She also liked to play the piano, dance, draw, go to the theater, dress up in high Victorian fashion and jewelry, and collect books for her extensive library. Her favorite color was red.

3. A FAMOUS PHRENOLOGIST THOUGHT SHE SHOULD BECOME A TEACHER.

In 1836, a phrenologist named L.N. Fowler examined Barton and suggested to her parents that she should pursue a career in teaching. After six years teaching in Oxford, Massachusetts schools, Barton opened her own school in 1845 to serve the children of workers in her brother’s mill. She went on to create a free public school in New Jersey; however, it grew so large that local leaders refused to let her run it and brought in a male principal. So Barton left.

4. SHE MADE A SALARY EQUAL TO A MAN’S—BUT HAD A SEXIST BOSS.

Perhaps disillusioned by the experience at the school she founded, Barton temporarily left teaching in 1854 and went on to become a recording clerk in the U.S. Patent Office in Washington, D.C., where her salary—$1400 a year—was the same as her male co-workers’. Unfortunately, Secretary Robert McClelland of the Interior Department—which had jurisdiction over the patent office at the time—didn’t want women as federal employees, and demoted her to copyist making 10 cents per 100 words copied. In 1857, President James “Ten-Cent Jimmy” Buchanan did away with her position, but the next administration—Abraham Lincoln’s—reinstated it.

5. THE CIVIL WAR GAVE BARTON HER FAMOUS NICKNAME.

In 1833, her brother David had fallen off the roof of a barn, and for two years Barton had dedicated herself to his care during his recovery. Her early experience in nursing found an outlet in the Civil War and, at age 39, Clara found her calling—even though nursing was then seen as a man’s profession.

A week after war broke out, Barton discovered injured soldiers from the 6th Massachusetts Infantry housed in the Senate chamber of the U.S. Capitol. She used supplies from her home for their care, and eventually founded her own supply distribution agency. Her ministrations earned her the sobriquet “Angel of the Battlefield.” The first battle where she is known to have assisted was the 1862 Battle of Cedar Mountain in Culpeper County, Virginia. More than 3000 Union and Confederate soldiers were killed or wounded in the two-day fight.

6. SHE HAD A BRUSH WITH DEATH IN THE BATTLE OF ANTIETAM.

Just one month after her first battlefield triage, Barton almost lost her life in the gruesome Battle of Antietam. As she lifted a wounded man’s head to give him some water, a bullet ripped through the sleeve of her dress. She survived, but her patient didn’t: "A ball has passed between my body and the right arm which supported him, cutting through his chest from shoulder to shoulder. There was no more to be done for him and I left him to his rest,” Barton wrote. “I have never mended that hole in my sleeve.”

Another time, she encountered a soldier who had been her former student at her school in New Jersey. “This is the second time you saved my life,” he told her.

7. SHE SUFFERED FROM DEPRESSION.

Away from the intense action of Civil War battles, Barton suffered from depression. In early 1864, the lack of activity, combined with an inability to secure a supply warehouse, got the better of her. “All the world appears selfish and treacherous. I can get no hold on a good noble sentiment any where. I have scanned over and over the whole moral horizon and it is all dark,” she wrote. She thought about killing herself, and it wasn’t the first time. What brought her out of it was having purpose again, notes Barton biographer Elizabeth Brown Pryor in Clara Barton: Professional Angel. Pryor suggests that Barton thrived in scenarios that others would run from.

8. SOME THOUGHT SHE WAS HAVING AN AFFAIR WITH A SENATOR.

In 1861, Barton met Senator Henry Wilson, a Massachusetts Republican, abolitionist, and future U.S. vice president under Ulysses S. Grant. He became a close confidant, someone she felt comfortable talking about her innermost feelings with. He turned out to be a good person to know professionally, too: He procured a railroad pass for her, which allowed her to travel to battlefields free of charge, and she asked him to furnish supplies for soldiers, including “whiskey, brandy, wine, condensed milk, [and] prepared meats.” They shared a strong work ethic and a love of the Republican party. Their closeness prompted some to whisper of romance between them while Wilson was married and after his wife died, but there was no concrete proof. Still, some of Barton’s family members thought that marriage was imminent soon before he died in 1875. (Barton never married or had children.)

9. HER WAR-RELATED EFFORTS DIDN’T END WITH THE WAR.

Lincoln issued the Emancipation Proclamation on January 1, 1863, and that May, Barton resumed her career in education. This time, she taught skills to freed slaves.

Near the conclusion of the Civil War, many soldiers remained missing. Barton created the Office of Correspondence with Friends of the Missing Men of the United States Army in 1865. Operating out of the Washington, D.C. boarding house where Barton lived, the office received more than 63,000 pieces of correspondence inquiring about missing family members—all of which were answered by the office’s 12 clerks. Barton’s organization was able to locate 22,000 missing soldiers, 13,000 of whom had perished in the Confederacy’s Andersonville Prison. As a result, the government established a national cemetery at Andersonville. (Congress also reimbursed her for the $15,000 it cost to establish the office.)

10. THE OFFICE’S HEADQUARTERS WAS DISCOVERED BY ACCIDENT.

In 1996, a General Services Administration inspector discovered Barton’s long-forgotten headquarters at the D.C. boarding house as he was preparing the building for demolition. Barton’s effects had been lying there for over a century. Construction was halted, and almost 20 years later, the building was re-opened as the Clara Barton Missing Soldiers Office Museum at 437 7th Street NW.

11. SHE SPOKE OUT FOR WOMEN’S SUFFRAGE.

In 1866 Barton embarked on a nationwide lecture tour after the war and shared the stage with Frederick Douglass, Ralph Waldo Emerson, and other thinkers. She also met two leading lights of the women’s rights movement, Elizabeth Cady Stanton and Susan B. Anthony, who supported her interest in women’s suffrage. “I did not purchase my freedom with a price; I was born free; and when, as a younger woman I heard the subject discussed, it seemed simply ridiculous that any sensible, sane person should question it,” Barton wrote in a speech supporting women’s right to vote. “And when, later, the phase of woman’s right to suffrage came up it was to me only a part of the whole, just as natural, just as right, and just as certain to take place.” She encouraged veterans to support a woman’s right to vote, not-too-subtly suggesting that they should help women win that right as she had helped them survive the wounds of war.

12. SHE CO-FOUNDED THE AMERICAN RED CROSS.

After the Office of Correspondence closed down, she went to Europe to relax and recuperate. In Switzerland, she learned about the International Red Cross, which had been founded in 1863 to help victims of humanitarian crises. She soon launched an effort to establish a similar organization in the United States, even trying to enlist then-President Rutherford B. Hayes in its creation. On May 21, 1881, she and Adolphus Solomons, a community leader active in numerous charities, co-founded the American Red Cross. She was appointed its president the following month and served for the next 23 years, and never received a salary.

In addition to helping those affected by war, the American Red Cross stepped in to assist survivors of natural disasters. Its first test was a massive forest fire in Michigan in 1881, which burned more than a million acres in 24 hours and left thousands homeless. In its first couple of decades, the Red Cross provided supplies and relief to victims of the Johnstown flood in 1889 and the 1900 Galveston hurricane.

13. SHE WAS CAT-CRAZY.

Barton grew up on a farm and loved animals. Really loved animals. She could ride a horse by age 5 thanks to her brother David’s instruction. Her first pet, a dog she named Button, was “a sprightly, medium-sized, very white dog, with silky ears, sparkling black eyes and a very short tail,” she recalled in The Story of My Childhood. She was also given animals as gifts: Rep. Schuyler Colfax of Indiana sent her a kitten to thank her for her work at Antietam, and a family friend presented her with two-and-a-half-dozen ducks.

Like another famous nurse, Florence Nightingale, Barton had a soft spot for cats. Her favorite was Tommy, her faithful black-and-white companion for almost two decades. Her friend and fellow nurse Antoinette Margot painted a portrait of Tommy in 1885, which is still on display at the Clara Barton National Historic Site in Glen Echo, Maryland.

14. SHE SHARED A HAIRSTYLE WITH PRINCESS LEIA.

There are some eerie similarities between Barton and Carrie Fisher, the actress who played Princess Leia in the Star Wars films: Barton and Fisher suffered from mental illness; had movies that drew from their lives (Postcards from the Edge in Fisher’s case, Angel of Mercy in Barton’s); were authors; were feminists; and were parts of large, talented families. And as Jake Wynn and Amelia Grabowski point out in a blog post for the Clara Barton Missing Soldiers Office Museum, they also share the same braided and bun hairstyles.

Wynn wrote that that their power isn’t hurt by the fact that they were vain: Though Barton was brave, she was also worried about how the war would affect her hair. “They are both people who are unapologetically in the middle of the action," Grabowski added. "They are risking their lives and making a difference. The guys would be lost without them."

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