Why Autoimmune Diseases Cause the Body to Attack Itself

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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."

Illinois Becomes the First State to Require Insurance Companies to Cover EpiPens for Kids

Joe Raedle/Getty Images
Joe Raedle/Getty Images

The ever-changing landscape of the U.S. healthcare system has created difficulties for people who may no longer be able to afford potentially lifesaving medications like EpiPens. The Illinois government decided it was time to step in: Beginning on January 1, 2020, health insurance companies will be required to cover EpiPen costs for children in the state with severe allergic reactions. Tonya Winders, president and CEO of the Allergy & Asthma Network, told CNN that Illinois is the first state to pass such legislation.

CNN reports that Governor J.B. Pritzker officially signed the law, House Bill 3435, which mandates insurance coverage “for epinephrine injectors for persons 18 years of age or under.” Pritzker also tweeted that “this legislation takes a big step forward in protecting our children and families.” Illinois Senator Julie Morrison, who sponsored the initial proposal, echoed the governor’s sentiment in her own statement.

“We should be doing everything we can to expand access to affordable lifesaving drugs and medicines,” Morrison said. “No child with a serious allergy should be without an epinephrine injector because they cannot afford one.”

In 2009, the purchase of two EpiPens would have set you back about $100; by 2016, that number had skyrocketed to $600. During that time, the situation became so dire that some people were opting to fill their own syringes with epinephrine instead, making it more difficult to measure the dose and also administer the injection. Thankfully, the FDA approved a generic version of the EpiPen last year, providing market competition for pharmaceutical company Mylan, which has been manufacturing EpiPens thus far.

EpiPens work by injecting a high dose of epinephrine, or adrenaline, into your bloodstream, which reduces the rapid swelling of your airways during anaphylactic shock. Since allergic reactions can happen so quickly, your life could be seriously threatened if you don’t have an EpiPen nearby at the time of the attack. Wondering what anaphylactic shock looks like from the inside? Find out here.

[h/t CNN]

Marathon Karaoke Session Lands Man in Hospital With a Collapsed Lung

cookelma/iStock via Getty Images
cookelma/iStock via Getty Images

While over-imbibing is the usual culprit behind a fun night out gone wrong, it turns out that too much karaoke can be bad for your health, too. According to Newsweek, a 65-year-old man from eastern China was hospitalized with a collapsed lung after singing 10 high-pitched karaoke songs in a row.

“I was very excited in the heat of the moment and after singing a few songs with very high notes, I found myself having breathing difficulties,” the man, who was identified only by his last name, Wang, said in a video posted to the Chinese platform PearVideo.

Since Wang had belted out the same tunes plenty of times before, he decided to ignore the pain that he felt in his left lung as he was performing and simply sing through it. After his condition worsened over the next day, Wang was taken to the hospital.

In the same video, Dr. Peng Bin-fei confirmed that the injury was most likely a direct result of the man’s energetic commitment to hitting the high notes, and advised that karaoke enthusiasts should limit their performances to a maximum of two hours. (For everyone's sake.)

A collapsed lung, or pneumothorax, happens “when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse,” according to the Mayo Clinic. Medical professionals can suck out the air with a needle or small tube, but the condition can be life-threatening.

Since sometimes a pneumothorax can occur on its own, it’s always a good idea to seek medical attention if you suddenly experience uncharacteristic chest pain or shortness of breath. Often, it’s the result of a blunt-force injury to the chest or damage from a lung disease. Newsweek mentioned a recent pneumothorax case that was caused by yet another perhaps unexpected culprit: electronic cigarettes. Doctors found black spots and a hole in the collapsed lung of a Florida teenager.

Unlike electronic cigarettes, there’s no compelling reason to quit karaoke altogether, as long as you’re doing it safely. But if you feel like your lungs are straining against that High C, maybe pass the microphone off to the nearest soprano.

[h/t Newsweek]

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