1. Immunity and Diseases Scientific background to autoimmune diseases
Dr Michael F. Ofori
Noguchi Memorial Institute for Medical Research
College of Health Sciences
University of Ghana

2. Autoimmune diseases result when the immune system attacks the body's own organs, tissues and cells.
Physicians and scientists have identified a number of different autoimmune diseases.
Some are well known,
Others are less familiar,

3. Tolerance and Autoimmunity
The Immune system could go awry and instead of reacting only against foreign antigens, could focus its attack on SELF ANTIGENS
This can result in a number of chronic and acute diseases including
Rheumatoid Arthritis
Multiple screlosis
Lupus Erythematosis
Certain types of Diabetes

4. Types Of Autoimmune diseases
Physicians and scientists have identified more than 80 different autoimmune diseases.
Some are well known,
rheumatoid arthritis,
multiple sclerosis,
type 1 diabetes
systemic lupus;
others are less familiar,
autoimmune hepatitis,
Sjögren's syndrome
pemphigus

5. WHY THIS?
The results of the failure of the host’s humoral and cellular immune system to distinguish SELF from NON-SELF
This will result in the attack of self cells and organs by Auto-antibodies and self reactive T-cells.

6. Autoimmune reactions can cause serious damage to cells and organs
WHAT IS AUTOIMMUNITY?
This is referred to the inappropriate response of the immune system against self components .
Autoimmune reactions can cause serious damage to cells and organs

7. Examples

8. Organ specific Autoimmune Diseases
Hashimoto’s Thyroiditis
Frequently seen in middle aged women
X’terised by infiltration of thyroid gland by lymphocytes, macrophages and plasma cells
The ensuing inflammatory response causes GOITER or visible enlargement of thyroid gland – a physiological response to hypothyroidism (decreased production of thyroid hormones
Hypothyroidism is caused when Abs are formed to a number of thyroid proteins including thyroglobulin and thyroid peroxidase – both involved in iodine uptake
Autoimmune hemolytic anaemia

9. Systemic Autoimmune Diseases
Here the response is directed towards a broad range of targets and antigens and also involve a number of organs and tissues
Systemic Lupus erythematosus (SLE)
Appears in women b/n 20 and 40 years of age
Ratio of females to males is 10:1
X’terised by fever, weakness, arthritis, skin rashes and kidney desfunction
It is more common in African American and Hisponic women than Caucasians
Reasons?

10. Multiple sclerosis Rhematoid arthritis
Attacks the CNS and causes neurological disabilities
IT could be mild such as numbness in limbs or severe such as paralysis or loss of vision
Genetic influence is important here
Risk is higher in women than men 2 - 3X higher
Rhematoid arthritis
Attacks the joints
Most often common in women b/n the ages of 40 – 60
Main effect being the inflammation of the joints
But can also cause hemolytic, cardiavascular and respiratory systems

11. Economic Importance
The social and financial burdens imposed by these chronic, debilitating diseases include:
poor quality of life,
high health care costs
substantial loss of productivity
In addition, the majority of autoimmune diseases disproportionately affect women,

12. Why are women more susceptible than men to Autoimmunity?

13. Reasons put forward so far includes;
Differences in Antibody production
Females produces more Ab than males
They also mount more vigorous immune response than males
Sex hormones also play important role
Studies have shown that estrogen can stimulate auto-antibody production
Demonstrated in SLE-prone mice
Testosterone seems to be protective against several types of autoimmune diseases, eg.SLE, diabetes,MS etc
Ability of pregnant women to modify their immune system during pregnancy to keep the fetus
The presence of fetal cell in maternal circulation for decades – this can also lead to the development of autoimmune diseases

14. Major research Areas Causes of Autoimmune Diseases
The Burden of Autoimmune Diseases
Diagnosis, Treatment and Prevention
Training, Education and Information

15. POSSIBLE CAUSES Of Autoimmune diseases
Genetic, Environment, Infections etc
Recent reports have shown a marked association between 2-nonynoic acid, a cosmetic ingredient and primary biliary cirrhosis (PBC), a disease 9 times more likely to occur in women.
Other suspected triggers of Autoimmune diseases include
smoking,
bacterial & retroviral proteins,
hormone replacement therapy,
use of nail polish.
It’s thought that chemical degradation in the liver causes a loss of immune tolerance that predisposes Individuals to autoimmune diseases.

16. Research In Ghana Study Conducted between 1983 and 1989 - 6yrs Period.
Korle Bu Teaching Hospital
They recorded 23 cases of Connective tissue disease during the period out of 4,507 admissions
Age ranged from 26 – 63 yrs (mean = 44yrs)
16 (70%) were females
11 had SLE
8 had R.A
SLE 2.4 per thousand
RA. 1.8 per thousand
They then concluded that SLE and RA are NOT COMMON
Affram RK and Neequaye AR, (1991). Systemic Lupus erythematosus and Other Rheumatic Disorders: Clinical Experience in Accra:, Ghana Medical Journal Vol 25:

17. Other studies
SLE is most prevalent in women of African Origin – This has been demonstrated in a number of studies
McCarthy et al 1995
Symmons,1995,
Houcgberg,1985,
Siegel et al 1970

18. SLE IN AFRICANS Population studies unavailable up to date
Most studies done are on case reports or series of reports of hospitalized patients.
Some of the countries in which these studies has taken place include:
South Africa, Zimbabwe, Ghana, Nigeria, Guinea, Cote D’ voire, Gabon, DR Congo, Senegal
From all these published reports, SLE appears to be RARE in Africa

19. SLE IN AFRICANS Cont’
Recent Studies from South and Central African suggest SLE to be increased in these regions whilst that in West African remain to be RARE
This can be explained by the reporting BIAS

20. Treatment of Auto-immune Diseases
Current therapies include
Treatment with immunosuppressive drugs
Thymectomy and plasmapherisis for diseases involving immune complexes
TNF alpha Blockers
For controlling RA and Crohn’s disease
Treatment of human autoimmune diseases poses special challenges

21. Challenges
Use of Immunosuppressive drugs does not leave the other immune system Intact
Immuno suppressive drugs such as:
Corticosteriods,
Azathioprine
Crclophosphamide
are capable of depressing the immune response but also puts the patient at a greater risk of infection and development of cancers
Most current Therapies are not for cure but only reduces symptoms

22. THANK YOU FOR YOUR ATTENTION!!