Predicting and Preventing Autoimmunity, Myth or Reality?

Authors

  • MICHAL HAREL,

    1. Center for Autoimmune Diseases, Department of Medicine B, Chaim Sheba Medical Center Tel-Hashomer 52621, Tel Aviv, Israel, and the Sackler Faculty of Medicine, Tel-Aviv University, 69978 Tel-Aviv, Israel
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  • YEHUDA SHOENFELD

    1. Center for Autoimmune Diseases, Department of Medicine B, Chaim Sheba Medical Center Tel-Hashomer 52621, Tel Aviv, Israel, and the Sackler Faculty of Medicine, Tel-Aviv University, 69978 Tel-Aviv, Israel
    2. Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel-Aviv University, 69978 Tel-Aviv, Israel
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Address for correspondence: Yehuda Shoenfeld, M.D., F.R.C.P., Department of Medicine ‘B’ and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer 52621, Israel. Voice: 972-3-5302652; fax: 972-3-5352855.
e-mail: Shoenfel@sheba.health.gov.il

Abstract

Abstract: Many autoimmune diseases are chronic conditions that progress over the course of years, and are characterized by the presence of autoantibodies that precede the overt disease by months or years. As examples, the presence of two islet cell antibodies (ICA) are associated with a 50% risk of developing diabetes mellitus in 5 years, anticyclic citrullinated (anti-CCP) antibodies are found in the sera of rheumatoid arthritis (RA) patients a median of 4.5 years before the overt disease, and in systemic lupus erythematosus (SLE), patients accrue antibodies throughout a foreseen course during the 3–4 years prior to the clinical symptoms. This ability to predict autoimmune diseases, or rather their clinical manifestations, leads to the prospect of screening healthy individuals for autoantibodies. The importance of such a notion lies not only in the ability to prevent life-threatening manifestations, such as Addisonian's crisis and thyroid storm, but also in the ability to treat and even prevent overt autoimmune diseases. Among such documented treatment modalities are administration of aspirin in antiphospholipid syndrome, ursodeoxycholic acid in primary biliary cirrhosis (PBC), vitamin D in SLE and autoimmune thyroid diseases (AITD), and more. Although additional studies are still needed to fully assess these notions, as well as the appropriate screening strategies to apply them, one cannot ignore the prospect of predicting and preventing autoimmunity.

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