The Autoimmune Journey

Exploration of How Your Body Attacks Itself

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What Happens Inside?

When the immune system mistakes self for enemy

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Tolerance Breakdown

Your immune system loses its ability to distinguish "self" from "non-self." Central tolerance (thymus screening) and peripheral tolerance (regulatory T cells) both fail, allowing self-reactive immune cells to escape destruction.

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Cellular Assault

T cells, B cells, neutrophils, and dendritic cells orchestrate coordinated attacks on your own tissues. Th1 and Th17 cells drive inflammation while regulatory mechanisms fail to suppress the response.

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Tissue Destruction

Autoantibodies, immune complexes, and cytokine storms cause progressive damage. Complement punches holes in cells, enzymes digest cartilage, and chronic inflammation leads to permanent fibrosis and scarring.

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Self-Perpetuating Cycle

Epitope spreading exposes new targets, damaged tissue releases danger signals (DAMPs), and inflammatory feedback loops amplify the response—creating a vicious cycle that sustains itself.

The Cellular Players

Hover over each cell to learn its role

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Neutrophils

Rapid-response shock troops that flood tissues, release toxic enzymes, and form DNA "nets" (NETs) that trap microbes but also damage your own tissues and expose nuclear antigens that become autoimmune targets.

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T Cells

Orchestrate autoimmune destruction. Th1 cells produce inflammatory cytokines (IFN-γ, TNF), Th17 cells secrete IL-17 driving tissue inflammation, while regulatory T cells fail to suppress the response.

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B Cells

Produce autoantibodies that recognize self-tissues, present antigens to T cells, secrete inflammatory cytokines, and form ectopic germinal centers—factories that churn out more autoreactive B cells.

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Dendritic Cells

Critical orchestrators that capture self-antigens from damaged tissues and present them to T cells in an activated, inflammatory context—triggering full autoimmune responses instead of tolerance.

The Three Stages of Progression

From silent autoimmunity to clinical disease

Stage 1: Silent Autoimmunity

The Hidden Beginning

Autoantibodies and autoreactive T cells appear in your blood without noticeable symptoms. Your immune system has begun targeting self-tissues, but damage hasn't reached clinical thresholds.

  • ✓ Autoantibodies detectable in blood
  • ✓ No symptoms or functional impairment
  • ✓ Can last 1-19 years before progression
  • ✓ Many people never leave this stage
Stage 2: Autoimmune Reactivity

Early Warning Signs

Tissue damage accumulates and early symptoms emerge, though organ function remains largely intact. You feel something is wrong but don't yet meet diagnostic criteria.

  • ⚠️ Fatigue, brain fog, mild pain
  • ⚠️ Intermittent flares and remissions
  • ⚠️ Subtle lab abnormalities
  • ⚠️ Frustrating "pre-diagnosis" phase
Stage 3: Autoimmune Disease

Clinical Manifestation

Substantial tissue damage and impaired organ function meet diagnostic criteria. This stage triggers formal diagnosis and disease-modifying treatment.

  • 🔴 Clear, persistent symptoms
  • 🔴 Measurable organ dysfunction
  • 🔴 Meets formal diagnostic criteria
  • 🔴 Requires disease management

What Triggers the Transition?

From silent autoimmunity to active disease

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Infections

Viral or bacterial infections provide inflammatory signals and molecular mimicry—microbial proteins resemble self-proteins, triggering cross-reactive immune responses. EBV infection linked to MS onset.

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Smoking & Lung Exposures

Strongly linked to ACPA-positive RA progression, especially with susceptible HLA alleles. Drives citrullination and post-translational modifications in lung tissues that become autoimmune targets.

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Obesity & Metabolic Stress

Creates chronic low-grade inflammation, alters adipokines and cytokines, lowers threshold for clinical autoimmunity. Particularly impacts RA and metabolic autoimmune conditions.

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Genetic Predisposition

HLA genes strongly influence susceptibility. Specific variants efficiently present self-antigens to T cells. Over 80 genes implicated in lupus alone. Explains familial clustering and sex differences.

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Epitope Spreading

Initial tissue damage releases new self-antigens not previously accessible. Immune system expands targets, recruiting fresh waves of autoreactive lymphocytes—amplifying the autoimmune response.

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Inflammatory Amplification

Cytokines (IL-6, TNF, IL-17) create positive feedback loops. Inflammatory environment overrides regulatory mechanisms, preventing Tregs from suppressing the autoimmune response.

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Gut Microbiome

Alterations disrupt immune tolerance through effects on T cell differentiation, dendritic cell function, and cytokine production. Dysbiosis linked to multiple autoimmune conditions.

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Environmental Toxins

Trichloroethene, silica, mercury, pesticides linked to higher autoimmune risk. Climate change, pollution, and chemicals may confuse immune system in susceptible individuals.

🎵 Danger Signals Sound & Light Show

Click signals to trigger immune cascades • Compose your inflammatory symphony

DAMP

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PAMP

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Cytokine

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Stress Signal

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NET

Click danger signals to activate immune cascades • Watch the ripple effects

Molecular Mechanisms

How destruction unfolds at the molecular level

Autoantibodies: Direct Attack

Antibodies that recognize self-antigens cause damage through multiple pathways:

  • Receptor blockade/activation: In myasthenia gravis, autoantibodies block acetylcholine receptors causing muscle weakness. In Graves' disease, they activate thyroid receptors causing hyperthyroidism.
  • Immune complex formation: Antibody-antigen clusters deposit in blood vessels, kidneys, joints—activating complement and causing inflammation.
  • Complement activation: Autoantibodies trigger the complement cascade, which punches holes in cell membranes through the membrane attack complex.
  • Antibody-dependent cytotoxicity: Autoantibodies mark cells for destruction by natural killer cells and macrophages.

Cytokine Storms: Chemical Warfare

Pro-inflammatory signaling molecules flood affected tissues:

  • IL-6: Drives acute phase responses, promotes B cell antibody production, and recruits immune cells to inflamed tissues.
  • TNF (Tumor Necrosis Factor): Causes fever, cachexia, promotes inflammation, and in excess leads to tissue necrosis.
  • IL-17: Secreted by Th17 cells, recruits neutrophils, amplifies inflammation, particularly damaging in RA and psoriasis.
  • IL-1β: Recent lupus research shows unconventional production via interferon + inflammasome activation.
  • Interferons: Type I interferons elevated in lupus, driving systemic inflammation and immune dysregulation.

In severe cases, these signals amplify in catastrophic positive feedback loops—a true "cytokine storm" that can be life-threatening.

Danger Signals (DAMPs): Fueling the Fire

Damage-Associated Molecular Patterns released from stressed or dying cells perpetuate autoimmunity:

  • Nuclear proteins: Histones, HMGB1, and DNA released during cell death become autoantigens and activate pattern recognition receptors.
  • Heat shock proteins: Stress-induced proteins can trigger inflammatory responses when displayed on cell surfaces.
  • ATP and uric acid: Metabolic danger signals released from damaged cells activate inflammasomes and drive IL-1β production.
  • Neutrophil NETs: DNA-protein webs expose nuclear antigens that become targets for autoantibodies in lupus and RA.

This creates a vicious cycle: autoimmune attack causes tissue damage → releases DAMPs → activates more immune cells → causes more damage.

Complement Cascade: Collateral Damage

A cascade of 30+ proteins that normally help clear pathogens but in autoimmunity attacks self:

  • Classical pathway activation: Triggered by autoantibodies bound to self-antigens, initiating the cascade.
  • C3 amplification: Central component splits into C3a (inflammatory) and C3b (opsonization), marking cells for destruction.
  • C5 cleavage: Produces C5a (powerful chemoattractant for neutrophils) and C5b (starts membrane attack complex).
  • Membrane attack complex (MAC): C5b-C9 assemble into pores that punch holes in cell membranes, causing lysis.
  • Inflammatory amplification: Complement fragments C3a and C5a are potent inflammatory mediators that recruit and activate immune cells.

Deficiencies in complement regulatory proteins (like Factor H) increase autoimmune risk by allowing uncontrolled complement activation.

Tissue Remodeling & Fibrosis: Permanent Scars

Chronic inflammation causes progressive structural damage:

  • Matrix metalloproteinases (MMPs): Enzymes that digest extracellular matrix, destroying cartilage and bone in RA joints.
  • Fibroblast activation: Chronic inflammation causes fibroblasts to proliferate abnormally and deposit excessive collagen.
  • Tissue fibrosis: Permanent scarring replaces functional tissue—seen in lung, liver, kidney autoimmune diseases.
  • Organ-specific patterns: MS attacks myelin disrupting nerves, T1D destroys beta cells, PBC destroys bile ducts causing liver cirrhosis.
  • Irreversible loss: Once significant structural damage occurs, functional restoration is usually impossible even with treatment.

This is why early intervention is critical—to prevent irreversible structural damage before it accumulates.

Neutrophil NETs: DNA Traps Gone Wrong

Neutrophil Extracellular Traps (NETs) are a double-edged sword in autoimmunity:

  • Normal function: Neutrophils expel webs of DNA coated with histones and antimicrobial proteins to trap and kill pathogens.
  • Autoimmune problem: NETs expose nuclear DNA, histones, and intracellular proteins that become autoantigens.
  • Lupus connection: Impaired NET clearance leads to accumulation, providing sustained autoantigen exposure and anti-dsDNA antibody formation.
  • RA joints: NETs contribute to synovial inflammation, citrullinated protein exposure, and ACPA formation.
  • Vasculitis: NET-associated proteins damage blood vessel walls directly and via immune complex formation.
  • Therapeutic target: Blocking NET formation or enhancing clearance is being explored as a treatment strategy.
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