The Mosaic of Autoimmunity: Prediction, Autoantibodies, and Therapy in Autoimmune Diseases - ד"ר אוריאל כץ, Yehuda Shoenfeld, Miri Blank, Mahmoud Abu-

There has been a lot of development in the area of predicting autoimmune diseases in past decade. The autoantibodies found in serum are used for diagnosing and classifying autoimmune diseases. Thus some autoantibodies serve as reliable markers and have high positive predictive value. The appearance of the clinical symptoms might come much later, sometimes after 10 years of diagnosing the autoantibodies, thus making this screening a very useful tool. Autoantibodies to molecules like RNP, dsDNA, Sm, Ro, cardiolipin, and La are reliable markers for systemic lupus erythematosus (SLE) disease. Anti-thyroid peroxidase antibodies and antibodies against proteins like insulin, pancreatic islet cells, tyrosine phosphatase-like (IA-2) protein and glutamic acid decarboxylase etc. are good predictive markers of thyroid dysfunction and type I diabetes. Thus the type of antibody, its level in serum, and the number of antibodies present can clearly predict the progression of a given autoimmune disease. As the mechanism of autoimmune diseases has been worked upon and described in last two decades, various biological therapies were tried and some were successfully implemented. The knowledge of the chemicals called as cytokines and the roles of different cells of immune system boosted the process of development of therapeutics against autoimmune diseases. For example, three molecules against an inflammatory protein called as TNFa; infliximab, etanercept, and adalimumab are used for the treatment of arthritis, spondylitis, psoriasis, vasculitis, and inflammatory bowel disease. Autoimmune diseases have been treated with hormones and immunosuppressive drugs and recently peptide immunotherapy is also being used against these diseases. Intravenous immunoglobulins are also used for the treatment of various autoimmune diseases and immune deficiencies. The modulation of cells of immune system like T cells etc. also has been proved to be benificial against autoimmune diseases. Thus these different factors can be used forsuccessful prediction and best possible treatment of autoimmune diseases. Also, in case of cancer, such predictions can prove very useful in patients who do not show clinical symptoms.