Intervention in autoimmunity

As a clearer picture emerges of the precise mechanisms involved in the breakdown of self tolerance, therapeutic approaches for the autoimmune diseases can begin to address the underlying defect, i.e. the specific autoimmunity. At present, when endocrine tissues are destroyed, as in Hashimoto's disease or IDDM, hormone replacement therapy is utilized. Antithyroid drugs, thyroidectomy and radioactive ablation are used in Graves disease rather than elimination of the TSH receptor autoantibody response. The immunosuppressive regimens used for systemic autoimmune conditions such as SLE and rheumatoid arthritis are crude attempts to dampen the whole immune system rather than control the specific autoimmune response. More rational approaches to ther apy are now beginning to emerge based upon, for example, oral or nasal tolerance induction, the use of cytokine antagonists, and intervention using peptide-based therapeutics to directly block T cell activation.

See also: Adhesion molecules; Autoantigens; Autoimmune diseases; Cytokines; Idiotype network; Oral tolerance; Privileged sites; T cell vaccination; Tolerance, peripheral; Tolerance, central; Immunotherapy of autoimmune diseases; Relative risk.

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