Autoimmune diseases: When your body becomes the enemy

00:00:00: Pain, weak muscles, gastrointestinal or breathing problems, always, sometimes more, sometimes

00:00:10: less.

00:00:13: Can you imagine that?

00:00:15: In Germany alone there are 6 million people for whom their own immune system is the enemy,

00:00:19: and maybe even you are one of them.

00:00:22: The immune system is directed against its own tissues.

00:00:29: And for autoimmune diseases involves drugs that suppress the immune system.

00:00:35: This means that the permanent symptoms are more or less under control, but it is also

00:00:39: very dangerous.

00:00:41: Because when the immune system is paralyzed it logically cannot fight off anything that

00:00:45: is really hostile.

00:00:47: As a result, harmless infections can become life-threatening, and vaccinations offer no

00:00:52: protection.

00:00:54: Dr. Teresa Grahlman's mission is to change this and make life more bearable for people

00:00:59: with incurable diseases.

00:01:01: She is head of the translational immunology research group at the Twin Core in Hanover,

00:01:06: a joint research site of the Helmholtz Center for Infection Research and the Hanover Medical

00:01:11: School.

00:01:12: Here, research can be carried out very close to patients to find out exactly what mechanisms

00:01:18: are behind certain autoimmune diseases and how drugs and vaccines for patients can be

00:01:23: improved.

00:01:25: With me is Dr. Dr. Teresa Grahlman.

00:01:29: Hi, Teresa.

00:01:30: Hi, Teresa.

00:01:31: You and your group, you are researching autoimmune diseases.

00:01:36: These are diseases in which the immune system fights the own body.

00:01:42: Is this simply like this?

00:01:44: And why does the immune system actually do this?

00:01:47: Yes, we can say that the immune system really starts to fight against the own body.

00:01:53: And this is particularly against so-called antigens, so parts of cells or even different

00:02:00: organs which are then destroyed by inflammation.

00:02:04: Why this?

00:02:05: You already asked why this happens?

00:02:07: This is a very difficult question actually to answer.

00:02:09: We don't know exactly.

00:02:11: It depends a lot on the different diseases.

00:02:16: What exactly happens there?

00:02:18: We know that at least partially there is a genetic predisposition.

00:02:22: We cannot say single genes that are affected.

00:02:25: For some diseases we can say that, but this is rather not very common.

00:02:32: In most cases it is really rather a polygenetic polymorphism that takes place.

00:02:37: And then there is most probably some inflammatory responses throughout the lifespan that then

00:02:46: kind of trigger the outbreak of the autoimmunity.

00:02:50: And what are the most common autoimmune diseases?

00:02:54: There are many different ones.

00:02:55: An example, a very well-known is the type 1 diabetes.

00:03:01: Then there are of course a lot of chronic inflammatory bold diseases.

00:03:06: There are neurological diseases like multiple sclerosis.

00:03:11: But I don't have too much knowledge about those actually.

00:03:14: So I'm working on chronic rheumatic diseases and they consist in particular from the rheumatoid

00:03:23: arthritis, which is the most common one.

00:03:26: Rheumatoid arthritis affects 1% of the worldwide population, which is actually not a rare disease.

00:03:32: But there are also a lot more chronic rheumatic diseases, particularly the connective tissue

00:03:38: diseases that can affect basically every organ.

00:03:42: They are rather rare diseases, but they are very interesting because they are kind of

00:03:46: diverse and we are really looking into those.

00:03:50: There is for example the systemic sclerosis, which is better known, the lupus eritimatrodus.

00:03:56: Many people heard about that one.

00:03:58: All of those diseases really can affect different organs of the body.

00:04:02: And how are autoimmune diseases treated?

00:04:04: And maybe what's the problem of this treatment?

00:04:08: So first of all, when it comes to an autoimmunity, we have to act rather fast.

00:04:13: And the most broad immunosuppressive treatment are glucocorticoids like cortisone.

00:04:20: And this is used for many, many different diseases because it acts super fast and it

00:04:25: can be used for really most of the diseases.

00:04:29: There are just very, very few one where we cannot use glucocorticoids.

00:04:33: And since it's act super fast and also rather strong and broad, we always use it in the

00:04:39: beginning.

00:04:40: Afterwards, we would like to switch to a therapy which has less side effects first of all and

00:04:47: which is more specific.

00:04:48: And therefore we have a whole bunch of immunomodulatory drugs.

00:04:52: We even call them immunomodulatory because they are not really broad immunosuppressive.

00:04:57: And there we have really many different ones which can basically target single cytokines

00:05:05: so like substances with which the different immune cells communicate.

00:05:12: We have drugs that can deplete complete cell types and we have drugs that really affect

00:05:18: the mode of action of the cells which are really, really specific.

00:05:22: Where is your focus of research in this?

00:05:26: We are focusing actually on to understand why patients with chronic rheumatic diseases

00:05:33: suffer from more infective diseases.

00:05:36: What I have not told yet is that not only the immune modulator retracts of course affect

00:05:42: the response to infections when the patients are treated, but already the primary disease

00:05:48: of the autoimmunity really makes the patients more prone for common infections also like

00:05:56: for bugs that we are normally not really susceptible to.

00:06:00: And we don't know exactly why the autoimmunity also needs to reduce response to infections

00:06:10: and this is actually the part that we are looking for because those infections really

00:06:14: affect the patients on a daily basis.

00:06:17: They suffer from more infections, more severe infections, more hospitalization, but also

00:06:23: every infection can again trigger the autoimmunity and worsen the primary disease.

00:06:28: Therefore it is a big problem for them.

00:06:30: I can imagine.

00:06:31: And when I'm reading articles for my everyday work, I'm always reading that autoimmune diseases

00:06:39: are on the rise.

00:06:40: Is this true fact?

00:06:42: And if so, why is this the case?

00:06:46: It is actually true and we observe that particularly in populations that get older and are more

00:06:54: industrialized, we observe more autoimmune diseases.

00:06:59: On the one hand, this is simply because people are getting older and the life incidence increases

00:07:04: for those diseases.

00:07:06: And the other point is that also the diagnostics are getting much better.

00:07:10: So we have more often the possibility to really find the patients early or at least we just

00:07:17: find them.

00:07:19: And on the other hand also environmental factors.

00:07:21: definitely can trigger autoimmunity, but we don't even know all of them. One

00:07:26: which we really can point out is smoking and we know that some autoimmune

00:07:32: diseases are really triggered by smoking. So also passive smoking? Yes, actually yes.

00:07:38: This already can trigger inflammation. Of course it's a lot worse if you really

00:07:45: do it yourself and inhale it and into the lung, but yeah you're also inhaling

00:07:50: passively. Okay. What do you want to achieve with your research? So we really

00:07:58: would like to improve patients' life and patients' life quality and this is

00:08:04: actually what motivates us every day to do the research as we are doing it.

00:08:09: We're really looking at the common problems that patients are

00:08:14: focusing, of course with regard to their infections, but also with regard to the

00:08:19: treatments they receive against it and to the side effects they have.

00:08:24: Can you call it that it goes in the direction of personalized

00:08:32: treatment or personalized medicine? Yes, I would say so. So what we try really to

00:08:39: identify mechanisms of inflammation that are different in particular patients

00:08:44: and what we also need and this is something that we are a little bit

00:08:48: focusing as well in our group is to really improve diagnostics because we

00:08:53: already have a bunch of different very specific treatments, but in many cases we

00:08:58: cannot, beforehand, identify the patients that profit best from the

00:09:04: one or the other truck. Therefore it also really needs a better understanding for

00:09:08: the inflammatory processes, particularly also in the different tissues

00:09:12: because different trucks can also work differently on immune cells when

00:09:18: those are localized in different tissues, for example in the lung or in the

00:09:23: skin. And you're working as a clinician scientist at Twincore. What does it work

00:09:29: they look like? What distinguishes you from a pure scientist or a pure doctor?

00:09:35: So like on the daily basis it is really that in the morning I'm seeing patients

00:09:39: in the clinic and the different units or in the outpatient clinic and in the

00:09:43: afternoon I'm going to the lab to do the lab work and see the team and discuss

00:09:48: projects and plan the next experiments. Maybe you can precise what are the

00:09:55: advantages of the combination of the research you do in the lab and the

00:10:01: research center and the medical school. I think what is really the advantage of

00:10:08: clinician scientists is that when you see the patients you already look at them

00:10:14: in kind of a different way. So you're coming from basically two words, the word

00:10:20: of greeting them and the word of doing science for a particular disease. So when

00:10:26: I see patients I already see them with my view how could I scientifically address

00:10:31: a question that would help them to improve their their life quality. And on

00:10:37: the other hand I also know from the lab of course which experiments could be done

00:10:42: or where are also the limits of the experiments that I could do with

00:10:47: particular samples or something like that. So I think it's really the

00:10:51: transition zone. Yeah that's maybe the best word. So we're really working on the

00:10:55: transition zone between the clinic where we see the patients and to the lab

00:11:03: where we have the opportunity and the possibility really to then do address

00:11:09: scientific questions. So I think the twin core where you're working is what is

00:11:14: called translational infection or in translational research. What does this

00:11:20: exactly mean and maybe what advantages does this have actually for our society?

00:11:28: Translationary research really means the combination or the transit to use

00:11:34: the word again the transit from bent to bedside. So really from the lab to the

00:11:40: patient to really let them profit or to really transfer what we found in the lab

00:11:47: into a product that can be used at the patient's side. And I think this is

00:11:54: already the big advantage that it is science that is really focused to lead

00:12:00: to a product that can be applied really then for the patients and not just to

00:12:05: really address questions that can afterwards not be translated into

00:12:10: something that is really helpful in the clinic. At this point I want to mention

00:12:15: two episodes for our listeners in which I talked to two other researchers of the

00:12:21: twin core. Professor Thomas Pietzmann, he's the leader of the research group

00:12:27: experimental virology and it's the episode of May 2024 and professor

00:12:34: Susanna Hoisler. She's the leader of the research group molecular bacteriology and

00:12:40: this episode is from January. Well for us maybe as a take-home message for our

00:12:48: listeners can you summarize what can each or every one of us do for ourselves to

00:12:57: reduce our own risk of getting an autoimmune disease? You cannot completely

00:13:03: prevent it with a living the best and healthiest life ever because there is a

00:13:07: certain genetic predisposition. Nevertheless what you can do is really

00:13:12: to prevent infections, to use vaccines against infections that are

00:13:19: available because every infective trigger might trigger an autoimmune response

00:13:26: and of course what is always very important for every disease to keep

00:13:31: kind of your organs as healthy as you can. Nonsmoking is certainly very

00:13:36: important. Then in terms of dietary there we always recommend Mediterranean

00:13:45: dietary meaning a lot of vegetables and healthy food not so much of meat because

00:13:52: some meats can contain some parts that can be in the body be metabolized to

00:13:59: inflammatory factors and of course moving around so doing sports on

00:14:06: a healthy way that makes absolutely sense for all the anchors and the joints

00:14:12: and the muscles and everything that really can be affected by an auto

00:14:16: immunity. Thank you very much for your time and exciting information. Yeah thank

00:14:23: you it was a pleasure.

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