Autoimmune Diseases: Therapy

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.