there is an alteration in the intestinal flora in people with autoimmune disease . 6 Probiotics are described as live micro-organisms , and when taken in specific amounts , lead to health benefits . 8 , 9 Probiotics play a significant role in immune health . 9-13
The focus of any management plan is on treating the whole person . 4 , 14 Due to the complexity of autoimmune disease , this article aims to briefly overview autoimmune disease , the microbiome , and the clinical applications of probiotics .
Autoimmune disease
Autoimmune diseases are a multifactorial complex group of conditions caused by the immune system ’ s inappropriate and abnormal attack on the body ’ s own tissues and organs . 1 , 3 Autoimmune diseases are initiated by the loss of immunological tolerance to self-antigens . 3 Immune cells cannot distinguish self-antigens from foreign ones . 2 Autoimmune diseases are characterised by abundant autoantibodies and abnormal dendritic cells , T-cells and B-cells . 2 Pathogenic autoantibodies , along with autoantigenreactive T-helper-1 ( Th1 ) and Th17 cells , react to established host or “ self ” antigens . 15 While autoimmunity is typically regarded as a disorder of adaptive immunity , several critical processes are essential for T-cell activation . These include the interaction between dendritic cells and the presentation of self-antigens by T-cells , the formation of an immunological synapse , and the recognition of antigen complexes by T-cells . 15
Common autoimmune diseases seen in clinical practice include alopecia areata , 3 16 , 17
ankylosing spondylitis , anti-phospholipid syndrome , 6 coeliac disease , 3 Crohn ’ s disease , 3 , 6 dermatomyositis , 2 Grave ’ s disease thyroiditis , 3 , 18 Hashimoto ’ s thyroiditis , 3 multiple sclerosis ( MS ), 3 , 6 , 19-21 myasthenia gravis , 18 pernicious anaemia , 3 psoriasis , 3
2 , 3 , 6 , 18 , 21 , 22 rheumatoid arthritis ( RA ), Sjögren ’ s syndrome , 2 , 3 , 6 , 18 , 23 systemic
2 , 3 , 6 , 18 , 24 lupus erythematosus ( SLE ), systemic sclerosis , 3 , 6 , 18 , 25 , 26 type 1 diabetes , 3 , 6 , 18 , 21 ulcerative colitis , 3 , 6 vitiligo , 3 and autoimmune liver diseases . 27 Autoimmune disease affects approximately 3 % of the population , 28 and depending on the disease , the prevalence ranges from 5 to 500 people per 100,00018 with a higher prevalence in females . 18
Autoimmune diseases do not initiate at the point of clinical manifestation ; instead , they commence several years before the observable onset . 3 , 15 The most common biomarkers of autoimmunity are antinuclear antibodies , which are observed in people with autoimmune diseases . Antinuclear antibodies are also seen in the general population where they have been associated with demographic factors such as older age , female sex , genetic factors , and various environmental exposures , including chemicals , infections , and medications . 29 The presence of antinuclear antibodies has increased over the last 30 years . 29
Furthermore , research shows that autoantibodies can be present in the blood from 3 months to 19 years before the development of different autoimmune diseases . 15 This implies that autoimmune diseases are chronic diseases . 15
The clinical presentations and manifestations of autoimmune diseases exhibit considerable diversity and atypical characteristics , which render laboratory tests less sensitive and nonspecific . 1 This often results in delays in obtaining an accurate diagnosis or the occurrence of misdiagnosis . 1 The exact mechanisms underlying autoimmune diseases are not fully understood , but they are believed to involve genetic factors , 1 environmental factors , 1 , 15 microbiome , and overall immune dysregulation . 1SAVE THE DATE