Anti-Inflammatory Strategies–Achieving Homeostasis
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Alcoholism is a condition in which individuals drink alcohol in excess despite the fact that their habit causes physical and mental health problems, and social, family, and/or job-related issues. Heavy alcohol consumption results in damage to many parts of the body including the brain, liver, digestive system, and  joints. Alcoholics also suffer with dementia, memory loss, depression, emotional instability, and are at increased risk of cancer of the colon, liver, and esophagus.

Immune System Effects

Prolonged, heavy alcohol consumption negatively affects immune cells and their production of cytokines, immune messages.  Alcoholics have significantly higher rates of bacterial and viral infections and when hospitalized remain hospitalized longer than those that do not abuse alcohol.   Alcohol not only kills key immune cells, but excess amounts of alcohol results in an increased risk of autoimmune responses in which the body’s immune cells mistakenly attack the body’s own healthy cells as foreign.

The body constantly strives to maintain immune inflammatory homeostasis; to balance the amount of inflammation it produces to protect the body from infection.  Imbalances of inflammatory responses, loss of immune homeostasis, result from excessive alcohol consumption. For example, white cells, immune cells, search out and destroy and remove pathogens from the lungs.  After alcohol consumption, fewer immune cells respond to the call for “help”.  Those cells that do enter the lungs are unable to kill microbes as effectively as cells from non-alcoholic animals.

The inefficient immune responses of alcoholics lead them to be more vulnerable to viral infections such as hepatitis C, influenza, and HIV and bacterial infections including tuberculosis and pneumonia. Especially after experiencing trauma, e.g., surgery, alcoholics are more likely than non-alcoholics to get pneumonia.

A mouse study is one of many that demonstrates the decreased ability of alcohol-imbibing animals to fend off infection.  Sixty percent of mice that were exposed to the flu after imbibing alcohol for two months died of the flu as compared to a 15% mortality rate of mice that had not been drinking alcohol prior to exposure.

Hormone Effects:

Cortisol, the “stress-response hormone” affects nervous, immune, circulatory, and metabolic systems of the body.  After surgery, chronic alcoholics have higher cortisol levels compared to non-alcoholic patients.  The increased inflammation that accompanies stress also leads to higher levels of depression, other addictions, and mood disorders.

Other hormones effected by alcohol consumption are those a)that may interfere with the a women’s menstrual cycle, b) the ability for men and women to enjoy sex, or c) control blood sugar.

Nervous System Complications:

Alcohol is neuro-toxic to brain cells interfering with the development, repair, and communication of nerve cells. Consumption of large amounts of alcohol leads to shrinkage of white matter in the brain, adding to depression, confusion, short-term memory loss, “fuzzy” thinking, and a greater risk of getting dementia.  Alcohol also directly affects the nervous system in other ways, causing numbness, tingling, and pain in hands and feet.

Additionally, too great a consumption of alcohol, especially over a long period of time, results in problems with absorption of nutrients, the lack of which can become so severe that certain forms of dementia are triggered.

Bone Loss

Alcohol damages osteoblasts, the cells needed to grow and maintain bone.  Destruction of osteoblasts results in decreased bone mass and susceptibility to fractures and other orthopedic problems.  When a bone fracture occurs,  immune cells rush in to start the healing process. They release immune signals, cytokines that start the inflammatory process that recruits more cells into the area. However, when there is too much inflammation, healing, and bone growth is delayed with the result that bones become brittle, thin, or misshapen.

Vitamin B12, vitamin D,  phosphate, and magnesium are needed to grow bone.  Excessive intake of alcohol is associated with low or subnormal levels of these elements, further inhibiting the growth of and repair of bones.

Skin and Injuries

The cells in the skin help defend the body from pathogens, and keep the skin healthy, youthful, and supple.  The immune cells in the skin interact with the microbes that live on the surface. Although the numbers of bacteria on healthy skin stays constant, the types of bacteria that exist change depending on environmental and immune interactions

Heavy use of alcohol significantly slows the movement of immune cells, upsetting the balance, the homeostasis of the skin. Alcoholics experience a greater number of severe skin infections than individuals that drink responsibly.

Almost half of all patients coming into an emergency room with an injury, trauma cases, have high levels of alcohol in their blood.  Drunken patients have more severe symptoms, and take longer to recover.  They also have higher rates of death as compared to non-intoxicated patients.

Because these patients have imbalances of inflammatory response, it takes them longer to heal, and wounds may become more severe, more quickly. Alcohol damage to the skin continues even after they stop drinking. Alcoholics experience longer hospital stays, especially if they are patients in an intensive care unit.

In a study of two groups of animals with burns, 50% of the animals that had not consumed alcohol survived, compared to 20% of the alcohol-consuming animals.

Summary:

Although not discussed in this post, moderate intake of alcohol has a beneficial effect on inflammatory markers.  However, heavy drinking results in uncontrolled amounts of inflammation leading to a myriad of health consequences.  Controlling the amount of inflammation the body produces will make a major difference in the quality of life of an individual.

Some steps abusers of alcohol can take to help their body modulate inflammation are:

  •  Limit the number of drinks consumed*
  •  Exercise 30 minutes/day for 5 days a week (150 minute minimum/week)
  •  Have smaller food portion sizes.
  •  Consume more fruits and vegetables.

*It is recommended that women limit their alcohol intake to one drink** per day, and men to two drinks/day. [Women absorb and metabolize alcohol differently from men and are more susceptible to alcohol-related organ damage and trauma than men.]

**One drink is defined as 1.5 fluid ounces of 80-proof distilled spirits, 12 ounces of beer, or 5 ounces of wine (a pinot noir wine glass about 1/4 full).

Dr. Greenblatt  looks forward to assisting you in reaching your goals:   http://drhellengreenblatt.info/contact-dr-hellen or 1.302-265.3870 [USA, ET].

 

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From 70-85% of the immune system and immune-like cells are found in the lining of the gut. This complex network of cells helps the body discriminate between helpful, commensal bacteria, and pathogenic bacteria that cause illness.

There is significant cross-talk between the immune cells and the organisms living in the intestines.
The immune system in the intestines is constantly balancing the kinds and numbers of bacteria and other organisms that live in the gut. And the bacteria are changing the population of immune cells. Both work to try to achieve balance, immune homeostasis.

Chronic inflammation of the digestive tract may be a reaction against specific bacteria found among the trillions of microorganisms living in the intestines. Inflammatory bowel diseases, IBDs, are characterized by unhealthy levels of inflammation occurring in different sections of the intestine. The bacterial strains found in the GI tracts of IBD patients differs from those seen in healthy controls and IBD patients have the most amount of inflammation in the areas of the GI tract with the highest concentration of bacteria.

Many of the cells in the gut directly recognize and attack infectious organisms. Upon exposure to pathogens, intestinal immune cells are stimulated to generate immune molecules such cytokines and natural antibiotics called defensins. Defensins kill microorganisms by punching holes in their membranes, or linking up small proteins into a “net” that stops pathogens from crossing the gastrointestinal barrier. These molecules also help the immune system control the types and numbers of beneficial microbes populating our intestines, and help in the recruitment of additional immune cells.

Individuals with IBD have imbalances of immune cells and intestinal microbes and without a sufficient immune response intestinal microbes invade the mucosa and an inflammatory response is triggered.

The intestines strive to achieve and maintain a delicate homeostatic balance. Complex interactions between the microorganism and immune components keep the beneficial bacteria “content” while simultaneously using inflammatory processes to keep infectious agents in check.

The key in recovery is to help the body limit unhealthy inflammation. Probiotic bacteria have been the first therapeutic agents for IBD shown to induce the production of defensins. Other agents such as worms, worm eggs, vitamin D, specific bacteria, and omega-3 appear to modulate inflammatory cytokines in test systems, yet these approaches have failed to correlate strongly with reducing IBD or its symptoms.

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Shirley Wang published an article in the WSJ titled “New View of Depression: An Ailment of the Entire Body”. Her lead-in stated: “Scientists are increasingly finding that depression and other psychological disorders can be as much diseases of the body as of the mind. People with long-term psychological stress, depression and post-traumatic stress disorder tend to develop earlier and more serious forms of physical illnesses that usually hit people in older age, such as stroke, dementia, heart disease and diabetes”.

Ms. Wang reported that Dr. Owen Wolkowitz at the University of California, San Francisco thinks of depression as “a systemic illness”, rather than a mental or brain disease. Dr. Wolkowitz found that
“[D]epression is associated with an unusually high rate of aging-related illnesses and early mortality”, or “accelerated aging”. He also points out that individuals who are aging more rapidly and/or are ill, have shorter telomeres than expected.

[Division is essential for most healthy cells. Telomeres are the protective tips of chromosomes that guide the chromosomes during cell division. Every time a cell divides, the telomeres shorten in length. Eventually there is little or no telomere resulting in an inability of the cell to divide efficiently. Eventually the cell dies. Some investigators are of the opinion that the length of telomeres is a predictor of longevity.]

There appears to be a strong association of inflammation with shorter telomeres. Senescent cells, which are unable to divide any longer and have almost non-existent telomeres, produce high concentrations of immune factors, cytokines, that regulate genes that result in inflammation.

Chronic inflammation is found in a myriad of diseases including cardiovascular disease, stroke, diabetes, cancer multiple sclerosis, dementia, as well as depression. Heightened levels of inflammation are found in smokers and the obese. Each pack of cigarettes smoked results in a 18% shortening of telomeres, and the telomeres of obese women are shorter than those of lean women. Using other biomarkers, both smokers and obese individuals have higher levels of inflammation in their bodies than the general population.

Depression results in inflammation and inflammation “feeds” depression. The same cytokines that cause inflammation, pro-inflammatory cytokines, under other circumstances may be anti-inflammatory.
Data from studies demonstrate that depressed individuals have an imbalance of pro- and anti-inflammatory factors.

Some practitioners suggest that depressed patients need to “boost” their immune responses. Instead, “boosting” the immune response, i.e., inflammation, may only exacerbate the disease.

Because of the complexity of immune responses, it is important to let the body find its own “set” point. This is why achieving immune homeostasis, immune balance, is essential for good health.

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Gut-associated lymphoid tissues are found in the walls of the intestine and contain billions of immune cells.  The white blood cells control the levels and types of bacteria that naturally populate the intestines.  The bacteria help to digest food that provides energy to the body,  and are part of the immune/bacterial ecosystem of the intestine.

 Interestingly, both immune cells and bacteria, protect the intestines from attack by pathogenic microorganisms, and cancer cells, and help heal the intestines when they are damaged.  Cross talk between the bacteria, and immune cells help the intestines maintain homeostasis, balance.  Each keeps the other in check.

 CELIAC DISEASE
Celiac disease is an intestinal, inflammatory, autoimmune (against oneself) disorder.  Individuals with celiac disease suffer from a wide-range of symptoms including diarrhea, fatigue, weight loss, inability to focus, skin and neurological issues, constipation, a feeling of being “bloated”, gas, anemia, headaches, osteoporosis (loss of bone density), and depression. 

 Ingesting grains, such as wheat, rye, and barley, which contain a component of protein called gluten, reportedly stimulate celiac disease.

 The presence of gluten stimulates sensitive immune cells to produce proinflammatory cytokines.  These immune messages drive inflammation, resulting in the destruction of the intestinal wall and symptoms.   Genetic, environmental, dietary, neuroendocrine, and immunological factors all contribute to disease progression.

 Currently, the primary guidance that celiacs get, is to go on a “gluten-free” diet.  Although it may be effective for some people,  such diets are restrictive, expensive, and do not work well for everyone.  In one study, every patient, 100% of those surveyed, in a cohort of 300 individuals, hoped for another option.

 OTHER APPROACHES
I often hear from people with autoimmune challenges such as celiac disease, “it’s genetic”.  Fine, so your genes are partially to blame. Meanwhile, what will you do? Continue to be uncomfortable?  So I ask those with inflammatory issues, why not consider short-term approaches until researchers discover longer-term solutions?  In three words: limit excessive inflammation.

 I like to describe inflammation as a way that the body “burns” out pathogenic microorganisms and cancer cells. The body must produce enough inflammation to protect itself from disease, and help the healing process, but not so much that healthy tissue, for example the intestinal lining, is damaged.

 Nutritional Approaches
Vitamin C and omega-3 fatty acids, from fish oil, inhibit the production of proinflammatory cytokines. (There is however,  evidence that vitamin A increases inflammatory processes.).

 Medical Approaches
Antibodies against specific inflammatory cytokines reduce intestinal injury in celiac disease, and the administration of corticosteroids, along with a gluten-free diet, was reported, in a small clinical trial, to provide benefit to celiac patients.

 Immunological Homeostasis/Balance
Hyperimmune egg, an ingredient that helps the body return to immunological balance, helps to support gastrointestinal health.  Many individuals with digestive issues report daily consumption of hyperimmune egg leads to major differences in their quality of life.

 LIMIT INFLAMMATION FOR BETTER HEALTH
The key to a higher level of quality of life in celiac and other autoimmune and autoinflammatory conditions, is to help the body limit its excessive inflammatory responses.  Removing gluten from one’s diet, using vitamin C, omega-3, corticosteroids, and hyperimmune egg, may contribute to helping the body regulate run-away inflammation.

Feel free to contact Dr. Hellen at DrHellen@DrHellenGreenblatt.info with questions or to consult with her. A message may also be left at: 1.302-265.3870 or click on: http://drhellengreenblatt.info/contact-dr-hellen/.


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Alzheimer’s and IVIG Rx
Last week John Gever, Senior Editor, MedPage Today brought attention to the results of a small study presented at the 2012 Alzheimer’s Association International Conference held in Vancouver, British Columbia.  In this study, patients with mild to moderate Alzheimer’s were given antibody preparations, immunoglobulin preparations, which were obtained by pooling plasma from numerous blood donors.  This sterile, medical product, IVIG, intravenous immunoglobulin, consists mostly of immunoglobulins, antibodies,  and is administered intravenously (IV). 

After receiving IVIG twice a month for three years, patient’s ‘ ability to function or think, their mood, or memory did not worsen over the three years. [Untreated Alzheimer’s disease patients typically show measurable declines in 3 to 6 months.]

The FDA, The U.S. Food and Drug Administration, has approved the use of IVIG for only six conditions.  However, it has been used “off-label”, to try and treat about 50 other conditions, including infectious diseases, a wide-range of autoimmune conditions, organ transplant and cancer patients, blood, and neurological conditions to mention a few.

When practitioners are asked how s/he thinks IVIG works, the response is typically, except for infectious diseases, “we are not sure”.

 IVIG Contains Immunoglobulins and Smaller Immune Factors
IVIG contains antibodies to organisms such as streptococcus, hepatitis, measles, polio, etc., that can specifically neutralize infectious agents.  Other immunoglobulins may be directed  against specific immunological factors. 

However, viewing reported results in chronically ill populations, I have always been of the opinion that IVIG also contains cytokines, or cytokine-like immune molecules, with potent immune system-modulating properties, which help the body return to immune homeostasis, immune balance. 

 I suggest that the reason that Alzheimer’s patients receiving IVIG saw a stabilization of their symptoms, is that IVIG limited inflammatory responses and thus slowed the progression of disease.

 Alzheimer’s and Inflammatory Cytokine Levels
This supposition is further supported by the fact that animal models suggest that excessive production of inflammatory cytokines, inflammatory messages, are implicated in Alzheimer’s disease. These animals have a condition similar to human Alzheimer’s, and also have higher levels of inflammatory cytokines in their blood.  When a drug was administered that inhibited the cytokines, there was less damage to nerve cells and neurological outcomes in the animals improved.  

 The scientists suggest that blocking production of high amounts of inflammatory cytokines may be beneficial for any number of brain conditions, such as “Alzheimer’s and Parkinson’s disease, multiple sclerosis (MS), motor neurone disease, frontotemporal dementia, and complications from traumatic brain injury.” (1)

 Immune Homeostasis, Immune Balance the Key to Health
Thus improvements, or at least delay in the onset of Alzheimer’s, or other brain –associated conditions, may be associated with the body achieving immune homeostasis.  A body in inflammatory balance controls the immune system’s  inappropriate inflammatory responses which otherwise may lead to damage of bystander tissues.

Feel free to contact Dr. Hellen at DrHellen@DrHellenGreenblatt.info with questions or to consult with her. A message may also be left at: 1.302-265.3870 or click on: http://drhellengreenblatt.info/contact-dr-hellen/.

 


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The concept of epigenetics was first introduced in the 1940s, and its implications on how we modulate inflammation through its processes are intriguing and exciting.

For most of my scientific career, we were taught that biological processes of the body were pre-determined by genes. It was said that DNA’s message was set-in-stone, and except through mutations which might result in cancer, or mutations and recombinations of genetic material that were handed down from one generation to another, the message encoded by DNA was unchanging.

Accumulating evidence suggests that altering our diet, life style, and environment, significantly influences gene expression; the way that the body translates the DNA message. We can change the affect our genes have on our physiological and emotional well-being.

It never ceases to amaze me that the medical profession writes off conditions such as arthritis, heart disease, cancer, strokes, Alzheimer’s etc. as being the result of “aging”; basically, saying to their patient, “you have to live with it because you are getting old”.

Instead, health practitioners might better focus on the fact that imbalances of inflammatory and anti-inflammatory responses contribute to health issues. Directing the emphasis on life style changes would enable individuals to take steps towards breaking the inflammation cycle, literally affecting the DNA message, and the resulting quality of their lives.

There are simple approaches that help maintain immune balance, immune homeostasis. Two such changes are: limiting the size of fat cells, and exercise. Fat cells, especially around our abdominal area, produce large amounts of pro-inflammatory cytokines, that trigger inappropriate levels of inflammation.

Exercise is a way to neutralize these molecules since contracting our muscles releases potent anti-inflammatory cytokines.

Additionally, the daily consumption of two or more servings of hyperimmune egg can go a long way toward supporting the body’s natural immune-rebalancing attempts.

In the controversy of genes vs. nurture, we now know that it is a combination of both that makes the difference. We can help regulate what our genes “say” by how we choose to live our lives.

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The body’s cells, especially brain and red blood cells, obtain their energy needs from the glucose (sugar) that circulates in the bloodstream.  There is an optimum amount of glucose that our body needs.  Too high a level of glucose, is just as bad as too little. The body uses insulin, a hormone, to support healthy levels of blood sugar.  Individuals with diabetes cannot properly control their blood glucose levels, and are therefore at risk of cardiovascular disease, stroke, eye, kidney, skin, and nervous system complications.

 The probability of getting diabetes is especially high in obese individuals.  Fat cells, especially those found around one’s waist, release pro-inflammatory cytokines.  The production of these immune factors result in inflammatory responses that destroy insulin-producing cells, making it difficult for the person to control their blood glucose.

 Dr. Umut Ozcan of Children’s Hospital Boston, has stated that “For 20 years, inflammation has been seen as detrimental, whereas it is actually beneficial.”  Research demonstrates that obese individuals have difficulty in maintaining healthy blood sugar levels due to imbalances of inflammatory molecules. Some proteins triggered by inflammation help the body control glucose levels, whereas other types of inflammatory molecules are detrimental to maintaining healthy glucose levels. 

 Dr. Ozcan continues,  “It may be that inflammatory pathways are not working optimally and there could be a resistance to the cytokines that mediate the inflammation.”.

 Restoring immune homeostasis, balance,  by helping the body control excessive inflammation may reduce the symptoms of diabetes or the risk of getting the condition in the first place.    Lifestyle changes, rather than medication, are the best way to regain immune balance.

 Please look for our next posting that will describe ways that one can help correct imbalances between pro-inflammatory (molecules that lead to inflammatory responses) and anti-inflammatory cytokines (cell messages).

 

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Many patients that undergo chemotherapy report lingering effects of the disease, or from treatment protocols. Some individuals report that experience problems with cognition, clear thinking, memory, focus, concentration, and staying organized which they call “brain fog” or “chemo brain.”

The relationship between inflammation and cancer is still under intense study. Immune inflammation plays a major role during different stages of tumor development, from recognition of the cancer cells, to metastasis, to resolution of the disease. There are proven complex interactions between immune and cancer cells during which there appears to be “cross-talk.”

Chemotherapeutic medications are, of necessity, cytotoxic. The medications cause the death of cells (apoptosis) by programming their death or by interfering with certain biochemical processes within the cell.

The relationship of inflammatory immune cells and dead cells is a complex one. Whenever a cell dies because of infection or injury, inflammatory immune cells release inflammatory cytokines, messages that activate immune cells to clean up debris, and start the healing process.

Chemotherapy, in which both healthy and cancerous cells are killed, can have unintended effects. The medications can damage immune cells and their DNA; the very cells that the body needs to stop cancer cells from multiplying, to clean up the dead cells, and heal the body after cytotoxic challenge.

An example of such a possible problem is tumor lysis syndrome. When large numbers of cells are killed by chemotherapeutic agents, the dying cells release vast amounts of inflammatory-triggering compounds. The body is simply overwhelmed by these factors, resulting in significant immunological and chemical disruptions throughout the body.

A limited number of studies, still to be replicated, suggest that long after treatment has ended, healthy brain cells continue to die off. And at least one study has shown altered brain structure in individuals that had undergone chemotherapy a year previously. These results however, were not seen in patients that had received chemotherapy three years previously.

The relationship between inflammation, cancer, and cancer therapy, is not understood. However, the available science suggests that limiting excessive inflammatory responses by the immune system, may help minimize the adverse effects of chemotherapy, especially as it relates to the brain.

 

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For some, the holidays, and especially the morning of January 1, is pure misery, since they suffer with nasty hangovers. Alcohol hangovers occur when blood alcohol concentrations (BAC) return to zero. The event is characterized by pounding headache, sensitivity to lights and loud noises, dizziness, drowsiness, nausea, vomiting, dry mouth, sweating, concentration problems, hyper-excitability, and anxiety and/or depression.

The biology of hangovers is complex and surprisingly, has not been well- researched. Dehydration and sleep deprivation may be contributors to the state of being hung over, but biological changes during suggest that, as with a majority of disease, imbalances of immune factors, especially excessive production of inflammatory cytokines, may be the culprit.

Hangovers are reminiscent of “sickness behavior”, the feelings that sick individuals have during the course of fighting an infection. “Feeling poorly” is the effect of increased levels of proinflammatory cytokines, that increase inflammation in the brain.

During inflammation, a great deal of cross-talk, mediated by cytokines, goes on between the immune system, the brain, and the intestines, which stimulates a wide range of physical, hormonal, nervous , gastrointestinal, and emotional responses.

Increased levels of inflammatory cytokines, such as IL-12 and interferon-gamma (IFN-gamma) are found in individuals suffering from hangovers. Additionally IL-10 , which suppresses inflammatory cytokines, is also found at higher levels in hangover subjects.

C-reactive proteins (CRP) are found in the blood and are considered an excellent marker for inflammation in the body. High levels of C-reactive protein are strongly associated with the severity of hangover events. The response may be related to inflammation induced by excessive ingestion of certain alcohol components such as congeners, or alcohol metabolites.

Numerous anecdotal reports suggest that when the body is in immune inflammatory balance, that hangovers will not occur at all, or, will be severely limited in their scope.


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Today, three immunologists, Drs. Ralph Steinman*, Jules Hoffman, and Bruce Beutler, won the Nobel Prize in Medicine/Physiology for adding to our scant knowledge of immune system responses to pathogenic microorganisms and cancer cells. Their studies should also provide a better understanding as to how excessive inflammation leads to autoimmunity, attacks on the body’s own healthy tissues.

Two decades ago Dr. Ralph Steinman and his colleague, Dr. Zanvil Alexander Cohn at the Center for Immunology and Immune Diseases, Rockefeller University in New York City, described dendritic cells, specialized immune cells that interact with other immune cells to define how the body will respond to underlying infection and disease.

Dendritic cells are essential to the body’s ability to control immune inflammatory homeostasis. Immune homeostasis is the delicate balance of all immune responses, especially inflammatory and anti-inflammatory responses, that that the body uses to fight disease. Too little inflammation may result in uncontrolled growth of pathogens or cancer cells, whereas too much inflammation, may result in autoimmune conditions such as diabetes, arthritis, lupus, multiple sclerosis, Crohn’s disease, etc.

Part of the role of immune homeostasis is to determine “what comes next” in meeting immune challenges. Dr. Steinman and his colleagues described an important phase of the immune response, “maturation”, which helps the body determine inflammatory and other responses to infection.

Dendritic cells are also important in helping the body maintain immunological “memory”. This assures a more rapid and thorough immune response if is attacked by the same pathogen another time. [Successful immunization depends on immunological memory.]

Dr. Jules Hoffman and his team, described how the immune system first recognizes invading pathogens and then helps trigger the immune system to go into its protective mode.

Dr. Beutler discovered the inflammatory cytokine, tumor necrosis factor, TNF, and a marker on certain bacterial cells that helps the body recognize that it has been infected, so that it can mount an appropriate inflammatory attack.

www.nobelprize.org/nobel_prizes/medicine/laureates/2011/press.pdf

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*The Nobel Committee has expressed “deep sadness and regret” at the news that Dr.
Steinman died a few days before its announcement.   Typically, the Nobel Prize is not awarded posthumously, but the Committee has decided to proceed with bestowing the award on Dr. Steinman.

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