Autoimmunity research needs

Van Loveren H, Vox JG, Germolec D, et al. Epidemiological associations between occupational and environmental exposures and autoimmune disease Report of a meeting to explore current evidence and identify research needs. Int JHygEnviron Health 2001 203(5-6) 483-95. 

Much progress needs to be achieved before in vitro tests could indeed replace the use of animals in immunotoxicology. Furthermore, there is a need for research to develop in vivo as well as in vitro models to detect autoimmunity and immunostimulation. 

Bee venom, administered in the form of actual bee stings, has been used to treat people with multiple sclerosis, rheumatoid arthritis, and other disease that have an autoimmune basis.48 78 This treatment is supposed to modulate the immune response and suppress the damage caused by the activation and attack of immune cells on specific tissues.30 There is little evidence, however, that bee sting therapy can produce beneficial effects in humans.78 Additional research is needed to determine whether these treatments can promote short- or long-term benefits in persons with various autoimmune diseases. 

Finally there is growing concern that the developing immune system may be particularly vulnerable to xenobiotic exposures and that perinatal and/or in utero exposures may have a lifelong impact on susceptibility to infectious, allergic, or autoimmune disease. As in other areas of toxicology, tests designed to assess the risk of immuno-toxicity for adults may not be sufficient to protect children and research is currently underway to determine how best to meet this need. 

The use of Echinacea is not recommended for patients with autoimmune conditions, such as multiple sclerosis and AIDS, or those taking drugs to suppress immune response (e.g., corticosteroids) (Blumenthal, 1998 Gruenwald et al., 2000). However, these recommendations appear to be based on speculation more than rigorous, peer-reviewed research. Research is needed to further support or refute the claim that individuals with autoimmune conditions should not use Echinacea. 

There is a need for research to develop in vitro models to detect autoimmunity and immunostimulation. 

As described in a highly referenced document (NRC, 1983), important components of this process include hazard identification, assessment of exposure and dose-response relationships, and characterization of the risk. Uncertainty factors are built into the risk assessment process to account for variations in individual susceptibility, extrapolation of data from studies in laboratory animals to humans (i.e. interspecies variation in toxicokinetics), and extrapolation from high-dose to low-dose exposures. In the case of the association between exposure to chemicals and drugs and autoimmunity or autoimmune diseases, much of the information needed to evaluate risk in the context of the traditional United States National Research Council paradigm is not available. The following represents a discussion of issues in chemical-induced autoimmunity relevant to the use of existing data and data needs in risk assessment. 

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