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Pain and Promise | |
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Autoimmune diseases lack the sledgehammer impact, and therefore the instant recognition, of our other great medical afflictions such as cancer and heart disease. But as the vivid patient testimonies on pages 6-15 illustrate, they are worthy of notoriety. Insidious and nasty, difficult to diagnose, perplexing to treat, bewildering for patients to understand, and painful to live with, autoimmunity presents a series of daunting challenges. First, there's the sheer number of conditions - roughly 80 separate autoimmune disorders each with a unique genetic-environmental trigger, each working through a specific pathological mechanism, and each generating a characteristic set of symptoms. Second, there's the number of patients and the associated costs. Up to eight percent of the population - even more by some estimates - suffer from autoimmune disease. The overall price tag for treating autoimmune diseases approximates that of cancer and heart disease. What is more, the chronic nature of autoimmune diseases drags whole families into crisis. Third, there's the scientific uncertainty. We know that a disordered immune system mediates mayhem on patients' bodies, but the origin of that mayhem isn't fully understood - and won't be until the immune system gives up all of it's closely guarded secrets. Now, there's also progress in confronting these challenges. On the mechanistic front, an understanding of T-cell tolerance and how it is broken is emerging, a surprising role for B cells in pathogenesis has recently been identified, and the interplay between genetic and environmental factors is being interrogated rigorously. And that confounded complexity even offers an upside: a wide range of potential therapeutic targets. A panoply of innovative treatments, based on targets ranging from T cells to B cells to cytokines, are emerging. Many of them are biologics. In large part, these treatments are aimed at resetting immune balance, either by blocking specific receptors or incapacitating toxic cells. This supplement covers the topic in three sections: The Diseases, The Mechanisms, and Innovative Treatments. We accept sole responsibility for the content, but wish to acknowledge the gracious contributions of time and expertise from scientists around the world, notably the insight of Jonathan Weitzman at the Pasteur Institute in Paris. Thanks also to our sponsor, F. Hoffmann-La Roche Ltd, for their vision and support in funding this supplement. There is a long, hard slog ahead if the pain of autoimmunity is to be tamed. But there is promise: The alignment of mechanistic insights, new therapeutics, patient and clinician education, and progress in health economics provides a real basis for optimism. Mike May |