THE IMMUNE SYSTEM
Function of Immune System Protection against: • Bacteria • Virus • Fungus/ multicellular parasites • Cancer • Toxins
Refer to page 530: • What do you understand by the term autoimmunity? • How does it differ from autoimmune disease? • In what ways are these diseases multifactorial? • Put into your own words the new paradigm regarding the underlying pathogenesis of autoimmune disease.
The Spectrum of autoimmune Diseases Organ specific Systemic Refer to page 531, table 28.1 and put the autoimmune disease under the appropriate heading.
THEORY OF AUTOIMMUNITY(Bone, K.) This can be called a dual signal hypothesis. There are 2 parts of this process: • The primary lesion or trigger that targets an organ or tissue for a state of hyperactivity to occur and can be caused by: • Infection • Acute rheumatic fever and associated heart lesions follow a pharyngeal infection with streptococci. • An inflammatory cardiomyopathy (Chagas’ disease) can occur after infection with the protozoan trypanasomacruzi .
Infestation • Worm children who have juvenile arthritis. • Chronic tissue destruction or excessive apoptosis (Prasad,KV & Prabhakar,BS. 2003, Autoimmunity, vol.36, no.6-7,pp.323-330) • In type 1 diabetes, studies from several animal studies suggest that a wave of cell apoptosis takes place in the early stages of postnatal life, resulting in vast amounts of self antigens. • Excessive apoptosis has also been linked to lupus and possibly Crohn’s disease.
Immune dysregulation: A state of hyper-reactivity or imbalance in immune response and can be caused by • Infection or infestation • Endotoxin (a potent immune stimulant) • Allergy or chemical sensitivity • Diet • Genetic factors • Injury or foreign body (e.g. breast implants) • Vaccination (?) • Stress • Cancer
THE BOWEL IMMUNITY CONNECTION (Bone, K.) • Bowel flora is a major issue in autoimmune disease • The protective factors of the bowel are • Intestinal wall integrity • Liver integrity • Susceptible to oxidative damage • Phagocytic function in the liver
Possible causes of an increase in gut permeability • Bacterial overgrowth • Starvation and malnutrition • Trauma • Biliary obstruction • Immunosuppression
MYCOPLASMAS AND AUTOIMMUNITY (Bone, K. 2005) • Mycoplasma, which unlike bacteria lack a cell wall, are more evolutionary advanced than bacteria and are known as the ‘next generation pathogens’. • One theory is they can reside inside the cells establishing latent or chronic states. • They are resistant to most antibiotics except the tetracyclines and erythromycins
Their role in autoimmune disease could be • Providing the primary lesion • Contributing to immune dysregulation • Being the pathogen that infects the target tissue causing inflammation • They have been implicated as cofactors in • AIDS • Cancer • CFS • Gulf War Syndrome • Crohn’s Disease • Rheumatoid Arthritis
GENES • Most autoimmune diseases involve a combination of several genetic mutations. • While it is not possible to avoid our genotype, our phenotype (how our genotype actually manifests in an individual) is more malleable, as it takes into account the environment and lifestyle factors. • In a Danish cohort study involving 37,338 twins, genetic factors were found to be less important than environmental factors
ENVIRONMENTAL FACTORS • From your texts explain the role of the following in the further aetiology of autoimmune disease: • Molecular mimicry (page 532) • Dietary antigens (page 532-533) • Exposure to superantigens (page 532)
INFLAMMATORY MECHANISMS • Explain the role of cytokines • Explain the T helper 1 and T helper 2 hypothesis • Explain T regulatory cells
RISK FACTORS From your texts summarise: • Altered immune function (pages 538-539) • Exposure to chemicals (page539) • Diet and lifestyle (page539) • Hormones (page539) • Stress (page540)
PRIORITIES FOR TREATMENT • Break into two groups and take 30 minutes to prepare a summary outline of the: • Naturopathic Treatment Aims (page 542) • Dietary considerations (page 544) • Each group is to prepare a reason for each point in the summary e.g. • Regulate cytokine biology (reason) • Reduce oxidative stress (reason) • Reduce and prevent chronic infection (reason) • And so on ………… • This summary will then be outlined for the other group and then copied so that everyone has a copy of it.
HERBAL TREATMENT PROTOCOL Treating the cause in autoimmune disease involves the use of herbs with the following properties: • Immune modulating • Antimicrobial • Anti-viral • Anti-inflammatory • Break the cycle of sustaining inflammation
Demulcents • Soothing • Can balance gut dysbiosis and increase gut flora • Relevant trophorestoratives • Depending on the organs involved • If needed, immunosuppressive herbs
Immune Supporting Herbs • Echinacea spp. • Enhances immune surveillance, making echinacea a good preventative which can modulate overall immune function • Rehmannia glutinosa • Modulation of the immune response • Adrenal depletion
Eleutherococcussenticosus(Braun & Cohen 2005) • More immune modulating than either stimulating or suppressing • Stimulation of non-specific resistance and has an influence on T-lymphocytes, natural killer cells and cytokines • Adaptogenic and modulates the stress response • Hemidesmusindicus (page 555) • Autoimmune diseases due to immune suppressive effect. It suppresses both cell-mediated and humoral components of the immune system after oral dosing(Bone 2003)
Tylophora (page 554) • Only for short term intermittent treatment, up to 4-weeks at a time. It is recommended to prescribe between 20 to 50 drops of a 1:5 tincture for the first 10 to 14 days of each calendar month. (Bone 2003)
Treat the inflammation • Anti-inflammatory herbs • Harpagophytum procumbens (page 552) • Boswellia serrata (page 552) • Curcuma longa (page 554) • Tanacetum parthenium (page 554) • Urtica doica(page 554) • Tylophora indica • Evening Primrose Oil (Bone 2004) • Inflammatory disorders generally • Corrects omega-6 essential fatty acid deficiency
Treat the leaky gut wall • Demulcents and healing herbs • Hydrastis candensis • Works on the mucus membranes of the gastrointestinal system (Mills & Bone 2000) • Mucoprotective effects allowing tissue and gut repair in the gastrointestinal system (Braun & Cohen 2005) • Ulmus rubra(Braun & Cohen 2005) • The large amount of mucilage soothes irritated and inflammed tissues • A nutritive demulcent • Free radical scavenging activity
Treat dysbiosis • Camellia sinensis • Inhibits the growth of pathogenic bowel flora • Antioxidant protection • Antimicrobial function • Curcuma longa • Poor digestion, liver dysfunction, to improve hepatic detoxification (Bone 2004)
Antiviral herbs • Hypericumperforatum • Viral infections involving enveloped viruses (Bone 2004) • Anti-inflammatory and analgesic activity (Braun & Cohen 2005) • Thuja occidentalis • Active against viral infections that may have caused the original lesion that lead to the autoimmune disease • Echinacea spp.
Antibacterial herbs • Berberine containing herbs especially • Hydrastis candensis • Berberis vulgaris • Allicin containing herbs especially • Allium sativum • Onion • Echinacea spp.