This week in BMC Medicine: autoimmunity, atherosclerosis and adjuvants

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Systemic lupus erythematosus (SLE), commonly known as “lupus”, is an autoimmune disease that can affect any of the body’s organs or tissues. The symptoms of SLE are very diverse, ranging from skin rashes to kidney failure, and patients experience flares followed by periods of remission. Steroids are commonly used to treat SLE flares, but as long-term use leads to serious side effects, newer treatments aim to reduce or stop steroid use altogether. In a review article published in BMC Medicine, David D’Cruz and colleagues from St Thomas’ Lupus Trust review the novel therapies in clinical development for SLE treatment. The authors discuss how conventional treatments are not appropriate for all patients due to problems with resistance and toxicity, and describe the exciting future prospects of using biologic agents to target the overactive immune system and treat SLE.

Immune dysregulation is also thought to be involved in atherosclerosis and cardiovascular disease. While a number of factors, such as a high-fat diet, smoking and high blood pressure, are known to accelerate the development of atherosclerotic plaques, increasing evidence points towards inflammation as a process that can be targeted therapeutically. Johan Frostegård from the Karolinska Institute describes the inflammatory processes involved in atherosclerosis in a review article, and explains the underlying mechanisms. Surprisingly, no immune modulatory agents are currently used to treat atherosclerosis; Frostegård discusses a number of therapies targeting inflammation that have potential to ameliorate atherosclerosis, and concludes that more studies are required to show whether such treatments are effective and to confirm the link between immunity and CVD.

As with atherosclerosis, chronic stimulation of the immune system is being linked to an increasing number of conditions, and many diseases of unknown etiology are believed to be of autoimmune origin. In a video Q&A, Yehuda Shoenfeld from Tel-Aviv University talks to BMC Medicine about “Autoimmune (Autoinflammatory) Syndrome Induced by Adjuvants”, or ASIA. Shoenfeld describes how siliconosis, Gulf war syndrome, macrophagicmyofasciitis syndrome and post-vaccination phenomena are all linked to previous adjuvant exposure; in 2011 this observation led Shoenfeld to propose these conditions should be grouped together as a common syndrome, ASIA. Shoenfeld recommends that ASIA should be treated as an autoimmune disease, and that clinicians should consider prescribing biologic immune modulatory therapies to patients with the syndrome.

Further research and reviews on autoimmune disorders can be freely accessed in our new article collection, Cutting edge: issues in autoimmunity, guest-edited by Yehuda Shoenfeld and Nancy Agmon-Levin. This collection aims to cover the issues at the forefront of autoimmunity and highlight new research in the field. If you would like your work to be considered as part of the series please send a pre-submission enquiry to bmcmedicineeditorial@biomedcentral.com.