in increased severity and prolonged duration ; they can trigger a relapse ; or they may contribute to the development of chronic progressive disease . 31
In individuals diagnosed with autoimmune disorders , there exists a negative correlation between DNA methylation levels and both disease activity and severity , indicating its potential role as a biomarker for disease status . 2 DNA demethylation and hydroxymethylation represent biological mechanisms that reactivate or restore the activity of previously silenced genes , and these processes have been associated with the development of autoimmune diseases . 2
Autoimmune diseases are increasingly recognised as a significant health issue among individuals who were exposed to the September 11 2001 attacks on the World Trade Centre . The particulate matter released during the collapse of the World Trade Centre has been linked to the onset of systemic autoimmune disorders . 32
The microbiome
The human body hosts a vast and varied array of microorganisms , collectively called the microbiome . 7 The microflora of the gastrointestinal tract represents a highly complex ecosystem . Microflora are believed to be composed of over 500 different species . 33 The adult human gastrointestinal tract is estimated to contain 100 trillion viable microorganisms . The number of microflora equals 10 times the number of
11 , 33-36
eukaryotic cells in the human body . There are approximately 1,000 species and over 7,000 strains . 34 Microbiota can be seen as symbionts , which are mutual health promoters . 6 , 37 The gut microbiota within the human body serves as a protective barrier against the invasion of pathogenic bacteria . It plays a crucial role in the
synthesis of essential nutrients , including proteins and vitamins . 38 Alterations in the composition of the intestinal microbiota can compromise the functionality of the intestinal mucosal barrier . 38
The microbiota is crucial in the initiation , development and functioning of the immune system . 7 The microbiota maintains the homeostasis of the immune system 38 and plays a crucial role in modulating the immune system by synthesising essential nutrients and regulating immune responses to various antigens . 21 An imbalance in the gut microbiome , known as dysbiosis , is strongly linked to tissue damage and inflammatory processes in predisposed individuals . 21 In the context of autoimmune diseases , alterations in the microbiome are significant in influencing inflammation and facilitating the breakdown of immune tolerance . 21
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