Drug-Induced Autoimmunity and Autoimmune Disease

Abstract

Autoimmunity and autoimmune disease are two different things. Autoimmunity can be physiologic (natural autoantibodies), is a normal consequence of aging, and is potentially reversible (as in drug-induced autoimmunity which disappears when the offending drug is eliminated). Autoimmune disease is a pathologic attack by a self-destructive hostile immune system for reasons unknown, although genetic, possibly viral, hormonal, and environmental factors are all involved. Autoimmune disease has been likened to a civil war in which “friendly fire” does much of the damage.

A new development in autoimmunity is its relationship to apoptosis or Programmed Cell Death (PCD). Abnormalities of PCD occur in autoimmune mice and in autoimmune patients. Autoantibodies may be produced in response to DNA and nucleoprotein fragments that arise during PCD.

Over 70 drugs are capable of inducing a lupus-like syndrome with antinuclear factors, arthritis, skin rashes, and pleurisy. Autoimmunity and autoimmune disease in these patients represents a form of immunotoxicity, perhaps an immune deviation related to cytokine imbalance and/or abnormal PCD in which the autoimmune potential that exists in all of us attains a level of serologic and clinical expression.