Immunostimulation in the era of the metagenome

Abstract

Microbes are increasingly being implicated in autoimmune disease. This calls for a re-evaluation of how these chronic inflammatory illnesses are routinely treated. The standard of care for autoimmune disease remains the use of medications that slow the immune response, while treatments aimed at eradicating microbes seek the exact opposite-stimulation of the innate immune response. Immunostimulation is complicated by a cascade of sequelae, including exacerbated inflammation, which occurs in response to microbial death. Over the past 8 years, we have collaborated with American and international clinical professionals to research a model-based treatment for inflammatory disease. This intervention, designed to stimulate the innate immune response, has required a reevaluation of disease progression and amelioration. Paramount is the inherent conflict between palliation and microbicidal efficacy. Increased microbicidal activity was experienced as immunopathology-a temporary worsening of symptoms. Further studies are needed, but they will require careful planning to manage this immunopathology.

Figure 1

ANAs in a 58-year-old female with rheumatoid arthritis. ANA, antinuclear antibody.

Figure 2

BASDAI, ESR and CRP in a 50-year-old male with ankylosing spondylitis. BASDAI, bath ankylosing spondylitis disease activity index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

Figure 3

Kidney metabolites in a 56-year-old male with sarcoidosis. BUN, blood urea nitrogen; GFR, glomerular filtration rate.