It is Not Yet Easy to Treat Autoimmune Diseases!

Already the world is suffering from different types of communicable and non-communicable diseases and this burden is further compounded by the incidence of auto-immune diseases. Autoimmune diseases affect nearly 5% of the global population and are of several types affecting different organs. Autoimmune diseases generally reveal through chronic inflammation and are distinct autoimmunity which is a natural mechanism of health maintenance. Autoimmune diseases are genetically predisposed among individuals and they just require an external trigger to get activated, among which infections are most common and occasionally vaccination could also be a reason. While several treatment approaches are in place or are being developed for screening, diagnosis, prevention, treatment and management of several diseases and disorders, the auto-immune disorders are posing certain unique limitations and challenges particularly for prevention.

Autoimmune disorders

Let us get to the crux of the matter. In case of infectious diseases, the vaccines are developed and administered to elicit natural antibody production by the host to counter the invasion of a probable external infective antigen. This is done as a preventive measure. But this is not the case for autoimmune diseases. We never know which autoimmune diseases initiates at what time in the host. Therefore, the approach is mostly therapeutic rather than preventive.  Such vaccines are designed, developed and administered to regulate the ongoing autoimmune response in the host. However, the fundamental mechanism for development of vaccines for autoimmune response remains similar to that for prevention of infectious diseases. The initiators, triggers, antigens, auto-antigens, immunopathology, immunotherapy are common for formulation, in vitro and in vivo evaluations of vaccines.

Rosenthal and coworkers from USA have recently reviewed various parameters for development of therapeutic vaccine for various autoimmune diseases. The condition of autoimmune disease is very complex as it involves several pro-inflammatory immune responses, immunopathology events which are initiated and sustained by auto-antigens. Therefore, the therapeutic vaccine for autoimmune disease needs to be customized for each patient based on major histocompatibility complex backgrounds and this is the major difference and limitation compared to other preventive vaccines. Appropriate personalized vaccine therapy involves analysis of characteristic cytokines, evaluation of cytokine response of their T cells.

In simple terms, even in this 21 century, treating autoimmune disease is pretty much a challenge because we are seeking to selectively regulate or control the immune response without actually suppressing its fundamental function of protecting the body from external invasions.

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