Damping Down Diabetes

PrevalenceSRxA’s Word on Health was very excited to learn of some amazing new research coming out of UC San Francisco.  Scientists there have identified a new way to manipulate the immune system and keep it from attacking the body’s own molecules in autoimmune diseases such as type 1 diabetes, rheumatoid arthritis and multiple sclerosis.

More than 100 different autoimmune diseases have been discovered and they disproportionately affect women.  Of the 50 million Americans living and coping with autoimmune disease  more than 75% are women.  Autoimmune diseases are one of the top 10 leading causes of death of women under the age of 65 and are responsible for more than $100 billion in direct health care costs annually.   Crohn’s disease, ulcerative colitis, lupus, multiple sclerosis, rheumatoid arthritis, psoriasis and scleroderma by themselves account for > $50 billion.

eTACBut now, researchers, led by immunologist Mark Anderson, MD, PhD, a professor with the UCSF Diabetes Center, have discovered a type of immune cell called an extrathymic Aire-expressing cell (eTAC), which puts a damper on immune responses.  eTAC’s are a type of  dendritic cell – which make up less than 3% of the cells in the immune system. And, eTAC cells themselves account for a small fraction of all dendritic cells. eTACs reside in lymph nodes and spleen in both humans and mice.

In this study, Anderson’s team determined that eTAC’s can counteract the overactive immune response in autoimmune diseases and, in a mouse model of diabetes, can be manipulated to stop the destruction of the pancreas.

By displaying “self” molecules to T cells that target them, and permanently turning off these T cells, eTACs help the immune system tolerate the molecules naturally present within us.  “The mouse model we are working with involves using T cells that normally attack the islet cells of the pancreas, specifically by recognizing a molecule called chromagranin A that is present on islet cells,” Anderson said. “But if the eTACs can get to the T cells first and display chromagranin A, they can prevent T cells from attacking the islets.”

mouse diabetesAnderson aims to exploit eTACs therapeutically by finding out how to grow them in large numbers outside the body. “We need to figure out how to grow a lot of these cells, to load them up with whatever molecule it is that we want to induce tolerance to, and then to load them back into a patient,” he said. “Such a strategy could help selectively shut down an unwanted immune response, such as the anti-islet immune response in type 1 diabetes.”

Dendritic cells work with T cells a bit like a sheriff working with a bloodhound.  But instead of presenting an article of clothing, dendritic cells present a specific molecule. If the molecule displayed by the dendritic cell matches the one the T cell was born to target, then that T cell would be activated to expand its numbers and to attack cells or tissues where the molecule is present.

When the interaction is between eTACs and T cells, however, the targeted T cell instead is turned off forever, and never seeks its molecular prey.

Diabetes wordcloudGiven that the prevalence and incidence of and type 1 diabetes and other autoimmune diseases, such as Crohn’s, lupus and celiac disease are on the rise, this new research is extremely important, both from a public health and economic perspective.  With as many as three million Americans having type one diabetes and the incidence growing by more than 3% per year a cure is desperately needed.

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Bullseye! Lyme Disease Without the Rash

Lyme disease BullseyeWith the weather finally starting to warm up, if you’re anything like me, you probably can’t wait to get outdoors and get active. However, and with apologies for being a Debbie Downer, we want to remind you that warmer weather also means that ticks become more active and are more likely to bite you, your kids and your pets. Just being outside in the garden could put you at risk of tick-borne diseases such as Lyme.

Should you contract Lyme disease, quick diagnosis and treatment are essential to avoiding long term complications. However, the diagnostic process may be delayed if the skin rash caused by Lyme disease does not have the typical bull’s-eye appearance.

A Research Letter just published in the CDC journal Emerging Infectious Diseases, shows that Lyme disease has been identified in patients with skin lesions that more closely resemble the classic signs of conditions such as contact dermatitis, lupus, insect or spider bites.

Based on these findings they urge doctors to consider Lyme disease when presented with patients complaining of such lesions, particularly when they have been in an area where Lyme disease is endemic.

The research team led by Steven E, Schutzer, MD, Professor of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, studied 14 patients.

borrelia_burgdorferiAn advanced diagnostic technique, based upon polymerase chain reaction (PCR) testing was used to identify Borrelia burgdorferi, the bacterium that causes Lyme disease. Unlike existing methods, the new technique is able to detect evidence of B. burgdorferi early, even in cases where the bacterium is still at low levels in the bloodstream, and sooner than traditional antibody tests, which may require several weeks before becoming positive. It also is able to distinguish between new infections and prior exposure to B. burgdorferi.

Of the patients analyzed, ten were found to have strong microbiologic evidence of Lyme disease, despite the fact that they had presented with skin lesions that differed markedly from the classic bull’s-eye pattern. In fact, not all patients with Lyme disease will even have a rash.

tick biteBased on this finding, Schutzer says, “Doctors who see a rash in a patient who has been in an area where Lyme disease frequently occurs should be alert to the fact that the Lyme disease rash does not have to look like a bull’s-eye, ring-within-a ring. The rash may look different. Doctors should search carefully both for other signs that might suggest Lyme disease, such as flu-like symptoms, and equally for signs that may point towards other conditions. Early diagnosis of most diseases gives the best chance for a cure. This is especially true for Lyme disease.”

So, this summer, make sure your doctor isn’t in a rush to take any rash decisions about ruling out a diagnosis of Lyme Disease.

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Steroid Side-Effects & Seven-Fold Suicide Risk

Steroids are used to treat a variety of conditions such as rheumatoid arthritis, systemic lupus erththematosus (lupus), myositis (inflammation of the muscles) and vasculitis (inflammation of the blood vessels).  They work by decreasing inflammation and reducing the activity of the immune system, thereby minimizing  tissue damage and organ failure.  At times they can be life-saving.

However, they are always prescribed with caution due to the long list of well-documented physical side-effects such as:

In addition, steroids are known to cause psychological problems such as sudden mood swings, nervousness, restlessness, and depression.

Now a new study reveals another worrisome side-effect.  According to a group of French researchers, patients prescribed oral steroids are nearly seven times more likely to commit or attempt suicide.

In the largest study of its kind, researchers followed 372,696 adult patients treated with oral steroids between 1980 and 2008 and compared them to patients with similar conditions who were not prescribed steroids.

The results of the study were published last month in the American Journal of Psychiatry. They showed that patients taking oral steroids were seven times more likely to commit or attempt suicide compared with those with the same underlying medical disease not treated with oral steroids.

The steroid treated group was also twice as likely to suffer from depression and more than four times as likely to suffer mania.

The authors of the study concluded primary care physicians should educate patients and monitor oral steroids closely. Lead author Dr Laurence Fardet, a consultant in internal medicine at Saint-Antoine Hospital, Paris, called for caution in prescribing oral steroids: “Where it is essential to prescribe a glucocorticoid, patients and their families should be informed about the possibility of these severe adverse events.”

Have you or your loved ones suffered physical or psychological side-effects from oral steroids? Share your stories with us.

Lady Gaga Knows Her Autoimmune Quotient – Do You Know Yours?

Over the last two weeks the Web has been abuzz with questions about Lady Gaga’s health. Turns out, we are informed, that she has a family history of lupus and has tested borderline positive for the disease.

The Lady Gaga story underlines an important message for millions of other Americans who have a history of autoimmune disease in their families. According to Virginia Ladd, President and Executive Director of the American Autoimmune Related Diseases Association (AARDA) “Lupus is one of more than 100 autoimmune diseases and these diseases cluster in families.  Having a family member with lupus could mean you are at increased risk for lupus and other autoimmune diseases.

That’s why it’s important, just as Lady Gaga has done, to know your family history, to inform your doctors, and take proactive steps to ensure your future health.

Evidence suggests that people need to take responsibility for their own autoimmune health. An AARDA study of autoimmune patients found that the average time for diagnosis of a serious autoimmune disease is 4.6 years. During that period, the patient typically has seen 4.8 doctors; and 46% of the patients were told initially that they were too concerned about their health or that they were chronic complainers.

One of the factors that makes getting a correct autoimmune disease diagnosis so difficult is that symptoms can vary widely, notably from one disease to another, but even within the same disease. The medical community’s lack of knowledge of autoimmune disease compounds the problem. Even though these diseases share a genetic background and tend to run in families, most health questionnaires at doctors’ offices do not ask whether there is a family history of autoimmune disease.

AARDA has devised an eight-step plan to help people increase their awareness of autoimmune diseases and calculate their Autoimmune Quotient (AQ):

1. Understand that autoimmune disease constitutes a major U.S. health crisis affecting 50 million Americans.

2. Get educated about the 100+ autoimmune diseases.

3. Be aware that autoimmune diseases target women 75% more often than men.

4. Know that autoimmune diseases run in families.

5. Do your own family medical history and inform your physician if you find that you have a history of autoimmune disease.

6. Keep a “symptoms” list if you believe you may have an autoimmune
disease.

7. Realize that getting an autoimmune disease diagnosis is often
challenging.

8. Hold the power to protect your family’s future health and well-being
in your hands – be proactive about your health.

To find out more about autoimmune diseases, or how to calculate your AQ, visit the AARDA Web Site.