00:01
So we’ve looked at a number of
different autoimmune diseases.
00:06
Let’s now have a look at how
one can treat these diseases.
00:12
So where there is something missing;
so for example, in Hashimoto’s
disease there is a destructive
thyroiditis leading to hypothyroidism.
00:22
That means that the patient does not secrete
sufficient levels of thyroid hormone.
00:26
One can simply give a artificial
form of the hormone to the patient.
00:32
So you’re replacing the thyroxine that
is needed by the patient, as a tablet.
00:39
In type I diabetes, the insulin can be given by
injection or islet cells can be transplanted.
00:50
In pernicious anemia, vitamin
B12 injections can be given.
00:57
Where there is an overproduction of hormones, as we see in
Graves’ disease with the overproduction of thyroid hormones.
01:06
One can use inhibitors
of that process.
01:09
So using thyroid peroxidase inhibitors,
or by giving a radioactive form of iodine.
01:17
Iodine is required for the
generation of the thyroid hormones.
01:21
So dietary iodine is normally taken up and specifically taken
to the thyroid where it’s needed to produce thyroid hormone.
01:29
So if a radioactive version of iodine is given to a patient,
that is also taken straight to the thyroid and the
radiation from that isotope I131, will damage the thyroid
cells preventing excessive production of thyroid hormone.
And a third approach that is used
in Graves’ disease is subtotal
thyroidectomy, where some of the thyroid is surgically removed.
01:56
In myasthenia gravis,
thymectomy can be used.
02:04
Another approach is to use
anticholinesterase drugs.
02:12
In multiple sclerosis, at least in some patients, the use of
interferon-β can be an extremely powerful therapeutic approach.
02:24
And cytokine inhibitors are now used
in a number of autoimmune conditions.
02:30
Anti-TNF specifically is used in rheumatoid arthritis
and similar rheumatological type autoimmune diseases.
02:40
Adhesion molecule inhibitors can be used, for example in
multiple sclerosis - natalizumab which is a monoclonal antibody
against the α4 integrin can the prevent cells of the immune
system crossing the blood brain barrier and entering the CNS.
02:58
Disease modifying anti-rheumatic drugs
(DMARDs) are used in rheumatological
conditions - methotrexate, sulfasalazine, gold salts and so on.
03:10
Nonsteroidal anti-inflammatory drugs are
used in SLE, rheumatoid arthritis, autoimmune
hemolytic anemia, Goodpasture’s syndrome and
a number of other autoimmune conditions.
03:22
In rheumatoid arthritis, one can
use a monoclonal antibody against
the CD20 molecule which is present on the surface of B-cells.
03:31
Anti-mitotic drugs, the variety of which
are listed there, can be used in autoimmune
thrombocytopenic purpura, SLE, myasthenia
gravis and autoimmune hemolytic anemia.
03:43
And pooled normal human immunoglobulin has a beneficial effect
in Guillain-Barre syndrome and in myasthenia gravis.