PRO - EVIDENCE FOR A PRIMARY LESION IN THE TARGET ORGAN IN AUTOIMMUNE-DISEASE

Despite nearly 40 years of organ specific autoimmunity research, a que stion of whether the immune response in autoimmunity is due to dysregu lation of the immune system or to a primary lesion in the target organ remains unresolved. Strength in the immune dysregulation argument, fo r which there has never been direct evidence in man, has largely deriv ed from failure to identify a primary lesion to account for it. That i s, until recently. Just as inflammation was considered a primary cause of disease until microbes were discovered, so autoimmunity was looked upon as a state of immune dysregulation until the equivalent of micro bes were discovered. The microbe equivalents are viral particles, expr essed on the surface of target organ cells under certain circumstances , and often encoded in the host's genome. These neo-antigens induce a protective, rather than aggressive immune response and account for the very singular target specificity observed, for example in the beta ce ll destruction of type 1 diabetes.