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Autoimmune DiseasesPage 1 of 2 Autoimmunity, in which the immune system recognizes and attacks the self's own tissue, is not as simple as it seems. Self-recognition appears to be at the heart of health as well as of certain diseases. It is generally assumed that the main job of the immune system is to distinguish between what is "self" and what is "not self". Once the

distinction has been made, "self" is pre-served and "not self" is destroyed. At the most general level, of course, this is true, and human beings remain alive and healthy only because it is so. Recently it has become clear, however, that at a finer level of detail the distinction between self and other is not absolute. One of the paths to this insight has been provided by the autoimmune disorders, in which the immune system attacks normal, healthy tissue. Autoimmune disease, which may be crippling or fatal, can strike any tissue or organ. Its victims are often in the prime of life, and for unknown reasons they are more frequently women than men. Research work on a form of autoimmune arthritis shows that the basis of autoimmunity may be a resemblance between a specific foreign molecule and a molecule of the self. This finding is consistent with a model of the immune system in which the immune system receptors that

perform the work of recognition can themselves be recognized by other receptors. Such "self-recognition," which was strictly outlawed by older models of the immune sys-tem, may form the basis of a network whose equilibrium keeps the body healthy. When it is disrupted, as it is in autoimmunity, disease results. This new picture, in which self and world are no longer absolutely distinct, has already begun to yield practical benefits in the form of vaccines that may ultimately ease the substantial suffering caused by autoimmune diseases. The list of autoimmune diseases is both long and disturbing. It includes multiple sclerosis, in which the tissue attacked is myelin (a sub-stance that sheathes nerves in the central nervous system); myasthenia gravis, in which the target is a receptor molecule for the important neurotransmitter acetylcholine; rheumatoid arthritis, whose target is the peripheral joint; type I (juvenile) diabetes

mellitus, in which the cells producing insulin are destroyed, and systemic lupus erythematosus, in which DNA, blood vessels, skin and kidneys are attacked. In contrast to AIDS, which is marked by an in activation of key cells in the immune system, in all these diseases the immunological response is strong and well focused; it is, however, directed at some essential component of the body. These immunological attacks are detected in clinical laboratory by the measurement of tissue-specific and tissue non-specific antibodies. Continue to page 2 >>

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