These are pieces written to desribe what immunolgy is about and what it is like working in science.
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Autoimmune disease occurs when an immune response attacks a previously healthy tissue. Like all adaptive immune responses, it is focussed on specific targets by T cell receptors and B cell receptors. In contrast to infection, the antigens that these cells recognise are processed from proteins within the target organ and this drives a chronic inflammatory process that disrupts the normal function of the tissue.
In human diseases such as Multiple Sclerosis the trigger for this process cannot usually be determined. There is evidence that autoimmunity can follow infection, but that more than one infection can initiate disease. Other environmental factors are also relevant but are not well defined.
There has been a lot of recent progress in understanding the influence of inheritance on autoimmune disease. A key observation is that susceptibility to autoimmune disease is influenced by a large number of polymorphic genes. These have small effects on their own, but in aggregate they determine an underlying susceptibility to autoimmunity. Many of these genes are clearly implicated in setting a threshold for an immune response, but clarifying the detail of these processes in on ongoing challenge.
The clinical course of autoimmunity is often marked by a relapsing and remitting course. This arises because there is both an continuing pro-inflammatory, disease causing drive, in the form of persistent antigen and opposing this an anti-inflammatory regulatory aspect. The natural regulation of the autoimmune process is known to involve antigen specific regulatory cells as well as anti-inflammatory cytokines such as IL-10 and TGF-beta. To date, therapies that exploit natural immune regulation have been less successful in the clinic than treatment that blocks the immune response. Blocking the immune response can be effective in autoimmunity, but is accompanied by adverse effects due to immunosuppression. This can allow the reactivation of latent infection and reduce the immunosurveillance of transformed cells. Therefore antigen specific immune therapy, targeted at a specific immune response, rather than general therapies targeted at the whole immune system, remains a critical goal for the treatment of these chronic debilitating diseases. ing of this process underpins much of research into autoimmunity today.
Lindsay Nicholson.