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Autoimmune disease & the Th1/Th2 paradigm

July 30, 2016

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During my pre-university days of research and trying to bio-hack my way out of the autoimmune conundrum, I became fascinated by an area of research that was gaining momentum in the world of functional medicine and how chronic inflammatory illnesses were treated. It highlighted the importance in re-establishing “Immune balance” when treating autoimmune disease in order to re-balance all arms of the immune system to break the cycle of damage.

My aim with this post is educate you with an overview of immune system function, what goes wrong in autoimmunity and how botanical medicine can modulate and help restore immune balance!

The immune system is such a vast area it requires hours of discussion, but for the purpose of this blog piece, we will focus on the role of T Helper cells. There are various subdivisions of T Helper cells, with each group containing different “cytokines”. Cytokines are hormonal messenger proteins triggered in response to different sources of stimulation and communicate to other cells of the immune system. Cytokines are stimulated in response to viruses, bacteria, fungus, parasites, and as part of environmental and food allergies.

In an ideal scenario, a person’s immune system responds appropriately through exposure to stimulation and cell memory is gathered throughout life to form “antibodies” for future reoccurrence. A proper functioning immune system will deploy its troops appropriately and rein them in when the enemy is dealt with, and return to regular surveillance. Most importantly, the difference between a legitimate foreign threat and it’s own host is well established and distinguished by a proper functioning immune system.

In any autoimmune condition, this innate ability known as “self-tolerance” becomes lost. The immune system loses its ability to distinguish between friend and foe. In continuing to respond against actual foreign threats, it mistakenly attacks various proteins of the body. This phenomenon is known as “molecular mimicry”. It is thought that certain proteins in the body may resemble proteins of pathogens so closely that the immune system creates antibodies (or auto-antibodies) and launches an inflammatory attack against both the threat as well as the tissue resembling the threat – as it views them as one the same. Depending on what tissue or organ is targeted distinguishes one autoimmune disease from the next.

For example:
*Hashimotos thyroiditis (Auto Antibodies progressively destroy the thyroid gland resulting in hypothyroidism)
*Systemic Lupus Erythematosus (Auto Antibodies progressively destroy connective tissue eg. Joints, skin, organs)
*Coeliac disease (Auto antibodies progressively destroy the epithelial tissue of the small intestine causing malabsorption)

The below image displays the various arms of immunity along with their various cytokines
t-cell-subsets

The crucial point here is this – in any autoimmune disease state, there is ALWAYS immune dysregulation in the subdivision of T-Helper cells (TH1, TH2, TH3, TH17). This results in an exaggerated pro-inflammatory response of one subdivision (varies with each individual) and usually an inverse deficiency in another. This results in immune dysfunction and leads to unchecked inflammation throughout the body.

So then what?

Well… The modern medicine REACTIVE strategy to many autoimmune conditions is to use steroids and immunosuppressants. These pharmaceuticals tend not to discriminate, and their role is reduce ALL immune activity to squash any areas of inflammatory response in the process. Theoretically this might help to alleviate autoimmune symptoms, but hey – we still need our immune system right? We still need to defend from pathogens and keep cancer cells in check?

Time and time again we see autoimmune sufferers on prescription immunosuppressant medications whom experience not only minimal relief, but usually fall prey to repeat infections, increasing the need for antibiotics due to their completely reduced immune response. This can lead to a perpetual cycle, which over time not only opens the gates to viruses, bacteria and fungi, but reduces commensal gut bacteria (the good guys) whom have been shown to protect us from developing autoimmunity in the first place!

Take a second to read that again!

Additionally, the causative factors (which are becoming more and more well established in peer reviewed research as contributors to the evolution of autoimmunity) are not even considered or dealt with by the Western approach.
Such factors include;

  • Physiological and emotional stress & trauma
  • Intestinal permeability; allowing for the escape of undigested proteins and pathogens through gut wall and directly into the blood stream evoking prolonged inflammatory immune responses
  • Alterations in gut microflora
  • Hormonal imbalances
  • Diet & nutritional deficiency
  • Genetics
  • Heavy metal toxicity

Each of these concepts deserve their own blog entry, but for the sake of this piece, lets keep going.

So what can we do about this?

This is where naturopaths and doctors practicing functional medicine have their advantages. There are many constituents found in herbal medicine as well as some nutritional medicine supplements, which have been shown to favourably skew and re balance ones dominant T-cell pathway. This allows us to be more selective, discriminate and not affect the remaining arms of immunity, as we see can happen with immunosuppressant medications.

Functional diagnostics allow us to be able to use “Cytokine panel testing” as well as symptomatology to work out what ones dominant division is expressing, further guiding treatment. Occasionally, one may be expressing more than one dominant pathway, or both the TH1 and TH2 can be hypo or hyper functioning. This highlights the valuable role of testing and takes out the guess work.

TH17 – The new kid on the block

For years autoimmune dysregulation was put down purely to imbalances in just the TH1/Th2 cytokines and compounds that stimulated a TH1 dominant condition would theoretically worsen a TH1 drive condition, but relieved by those stimulating TH2 cytokines, by balancing the “see saw” (and vice versa with TH2 dominant conditions responding to TH1 stimulating compounds). This hypothesis was challenged as new research evolved over recent years confirming the prevalent role of TH17 cytokines and their strong pro-inflammatory association to autoimmune conditions. This discovery doesn’t discredit the previous hypothesis, but more so enhances a practitioners understanding of the conundrum and allows for a more fine tuned approach. The good news is, many natural compounds have been shown to down regulate TH17 cytokine expression. Herbal medicine to the rescue once again

“REGULATORS, Mount up!”

Lastly, the TH3 arm of the immune system which govern “T regulatory cell” function is without doubt a vital area to target when treating autoimmunity in addition to balancing ones dominant pathway and reducing Th17 cytokine expression. T regulatory cell function helps prevent excessive immune responses from rogue cytokines (eg TNFa, Interleukin 6, NF-kB) and is the immune systems own tool to help maintain balance and “immune tolerance” – which we highlighted earlier, becomes lost in autoimmunity.

Below is a brief overview of both herbal & nutritional compounds shown to promote each subdivision of T helper cells.

TH1 promoters
Medicinal mushrooms, Astragalus membranaceus, Echinacea purpurea, Panax ginseng, Chlorella, Vitis vinifera

TH2 promoters
Curcuma longa (turmeric), Camellia sinensis (green tea), Centella asiatica (Gotu kola), Quercetin, Resveratrol, Caffeine

TH3 promoters
Cod liver oil, Vitamin A (animal source), Vitamin D, Colostrum, Essential Fatty Acids from cold water fish), as well as certain probiotic strains such as;
Lactobacillus rhamnosus (LGG) & Lactobacillus plantarum (LP-33)

Autoimmune disease are currently in the top 10 world leading causes of death. Establishing the root causes of an autoimmune disease (or any chronic illness) is absolutely paramount for remission or recovery. Functional diagnostics allows practitioners to go deeper and look for imbalances in nutrients, gut flora, hormones and much more to work out what tailored approach an autoimmune sufferer requires to correct the causes and begin healing.
If you’re reading this and suffer from a chronic illness, don’t hesitate, come and see me at Endeavour student clinic and I can help you locate the hidden causes of your condition and treat it right at its roots.

REFERENCES:

http://www.ncbi.nlm.nih.gov/pubmed/17127149
http://www.ncbi.nlm.nih.gov/pubmed/21248165
http://www.ncbi.nlm.nih.gov/pubmed/18950596
http://www.ncbi.nlm.nih.gov/pubmed/26703710
http://www.ncbi.nlm.nih.gov/pubmed/15585788
http://www.ncbi.nlm.nih.gov/pubmed/26300591
http://www.ncbi.nlm.nih.gov/pubmed/27051079
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480569/
http://www.ncbi.nlm.nih.gov/pubmed/25652649

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