Autoimmune (AI) diseases affect 30 million women—three times more than men—and diagnoses are rising in autoimmune disorders as varied as lupus, celiac, Sjogren’s syndrome and multiple sclerosis. But science has fixes in store. “We’re learning to detect disease earlier,” says Noel R. Rose, M.D., director of the Johns Hopkins Autoimmune Disease Research Center in Baltimore. “With new treatments, we hope to head off the worst symptoms before they appear.”
Genetics and Family History
If a close relative has an autoimmune disease, you’re more likely to develop one yourself. A mother with Graves’ disease may have a sister with MS and a daughter with type 1 diabetes. “Research has identified more than 150 genes associated with AI disease, but since there’s no one specific gene, it’s hard to determine a single cause,” says Peter K. Gregersen, M.D., of the Feinstein Institute for Medical Research in Manhasset, New York. His next project: a study of women who have lupus and their sisters who do not, to uncover the factors that lead to the development of the disease; if this is you, consider enrolling at SisSLE.org.
Chemicals, viruses—even food—can spark autoimmune disease if you’re genetically inclined. Gluten in some grains, for instance, activates celiac disease. Experts suspect other triggers: The mononucleosis virus, Epstein-Barr, is associated with MS, lupus and rheumatoid arthritis. Industrial chemicals such as PCBs may be associated with type 1 diabetes. And too much iodine (e.g., sodium-loaded processed foods) may play a role in the rising rates of autoimmune thyroid disease. “Understanding these environmental components will be crucial to preventing future disease,” Dr. Rose says.
Why do environmental agents that don’t hurt most of us wreak so much damage in others? The vast majority of people with autoimmune disease have a “leaky” small intestine, which allows foreign substances to penetrate the bloodstream, causing the immune system to overreact, says Alessio Fasano, M.D., director of the Center for Celiac Research at the University of Maryland School of Medicine in Baltimore. His research has proven it is possible to prevent type 1 diabetes in rats by fixing the intestinal barrier. Larazotide, a drug aimed at restoring normal intestine function, is in clinical trials in celiac patients.
“There’s no question hormones play a role in autoimmunity,” says Frederick Vivino, M.D., chief of the division of rheumatology at Penn Presbyterian Medical Center in Philadelphia. Low levels of androgens are associated with Sjogren’s syndrome, a gland-drying condition. Estrogen may play a varying role—lupus often worsens during pregnancy, when estrogen skyrockets, whereas MS and rheumatoid arthritis may improve during pregnancy and then flare up postpartum when estrogen drops. Estriol, a form of estrogen made by the placenta, is currently in early-stage clinical trials as a potential treatment for MS.
What if you could “reboot” your immune system like a laptop? In stem cell therapies, drugs wipe out old immune cells, then doctors replace them with fresh stem cells from your bone marrow or blood, says Richard Burt, M.D., chief of the division of immunotherapy at Northwestern University in Chicago. It’s too soon to know if it’s a permanent cure, but so far, it has put various autoimmune diseases in remission. Also, suppressing B cells, immune agents that identify intruders, can successfully treat rheumatoid arthritis. Benlysta, a drug that starves B cells, may become the first medicine approved to treat lupus in 50 years.