Can Autoimmune Disease Be Detected Early?

Study: Antibodies can foretell problems long before symptoms

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HealthDay Reporter

FRIDAY, May 7, 2004 (HealthDayNews) -- For many autoimmune diseases, such as type 1 diabetes, lupus, multiple sclerosis, Addison's disease and rheumatoid arthritis, antibodies to the diseases appear years before symptoms.

Knowing that antibodies are present before the disease develops, doctors can alert patients to symptoms to watch out for, and researchers may be able to develop early treatments, according to a report in the May 8 issue of The Lancet.

Antibodies are specific proteins made by the body's immune system to fight infection or harmful foreign substances.

However, in autoimmune disease, the body makes autoantibodies that attack the body itself, said study author Dr. Hal Scofield, an associate member of the Oklahoma Medical Research Foundation.

"It is now clear that these antibodies, which are markers of autoimmune diseases, appear in people's blood long before the clinical illnesses begin," he added.

These autoantibodies are preclinical markers to the disease, and that appears to be true for almost every autoimmune disease, Scofield explained.

"It may be possible to identify people with the potential of developing these diseases before they get sick," Scofield said. "As we can identify many of these diseases before people get sick, you can imagine prevention trials taking place."

This approach is being done now in a trial of type 1 diabetes in children with autoantibodies that are markers for the disease. The children are being administered nasal insulin to try to prevent diabetes from developing, Scofield said.

In addition, Scofield believes, if patients knew they were at risk for an autoimmune disease, they could be told what to watch out for. They might also be able to avoid some of the most serious complications, such as diabetic coma or Addisonian crisis, a life-threatening condition that happens when the adrenal gland fails to produce enough of the hormone cortisol.

The next step, according to Scofield, is to study large groups of people with autoantibodies to various diseases to see how predictive these autoantibodies are in determining who develops a disease and how long it takes for symptoms to appear.

Scofield cautioned that right now the benefit of identifying autoantibodies has little practical application. "There is the potential in the next few years to identify people who go on to get an autoimmune disease, and that kind of identification may lead to preventive therapies," he said.

"I am very enthusiastic about this approach," said Dr. Noel Rose, director of the Center for Autoimmune Disease Research at Johns Hopkins University. "This is an extremely important report."

"These autoantibodies are a warning sign of impending disease, and it opens the possibility of predicting disease and possibly benefiting patients by early treatment or even interrupting the autoimmune responses," he added.

"Antibodies in diseases such as lupus, rheumatoid arthritis, multiple sclerosis, diabetes and others can be measured and should allow the development of patient-specific therapies," said Dr. Paul J. Utz, an assistant professor of medicine at Stanford University School of Medicine.

"As newer technologies are developed, we will be able to measure thousands of unique antibodies at one time. Their measurement will be an important component of future drug development for biotechnology and pharmaceutical companies," Utz said.

"This paper really shows the importance of early screening, particularly in people with early symptoms," said Virginia Ladd, the president of the American Autoimmune Related Diseases Association.

Earlier diagnosis will lead to preventing major organ damage, she added.

Today, even when patients have autoantibodies, doctors dismiss them, Ladd said, "but this paper says that it is important to follow patients who have low levels of autoantibodies."

More information

The American Autoimmune Related Diseases Association can tell you about autoimmune disorders.

SOURCES: Hal Scofield M.D., associate member, Oklahoma Medical Research Foundation, and professor, medicine, University of Oklahoma Health Science Center, Oklahoma City; Noel Rose, M.D., Ph.D., director, Center for Autoimmune Disease Research, Johns Hopkins University, Baltimore; Paul J. Utz, M.D., assistant professor, medicine, Stanford University School of Medicine, Palo Alto, Calif.; Virginia Ladd, president, American Autoimmune Related Diseases Association, Detroit; May 8, 2004, The Lancet

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