oa South African Medical Journal - Auto-antibodies in the pathogenesis of disease : a preliminary study of auto-sensitization of red cells in various diseases



It has been suggested that auto-antibodies are concerned in the pathogenesis of many diseases. These autoantibodies develop against various tissues, the cells of which have been made auto-antigenic by being altered by the action of toxins, chemical and physical agents or by the presence of intracellular parasites. It is difficult to detect auto-antibodies against tissue cells. Auto-antibodies against red cells can be detected directly by determining whether auto-agglutinins or isoagglutinins are present in the patients' serum or by the application of the Coombs test or other tests for detecting the sensitization of red cells by immune globulin. It was considered possible that auto-antibodies to various tissue cells might involve the red cells as well as the tissue cells primarily affected. Accordingly the blood of patients with various conditions has been systematically tested for sensitization of red cells. It was found that the majority of cases of syphilis gave a positive Coombs test but most cases of other acute and chronic infective diseases gave negative results. Most cases of acquired acholuric jaundice, acute rheumatic fever, acute disseminated lupus erythematosus also gave positive results in the Coombs test. These findings suggest that auto-antibodies may be concerned in the pathogenesis of these diseases. Three cases of subacute pneumonitis, two of which ended fatally, also gave a positive result in the Coombs test. This suggests that this condition, which apparently is a clinical entity not descriptionbed before, has an auto-allergic basis. It is noted that the administration of ACTH and Cortisone is probably harmful in infective diseases unless the infection can be controlled by the prior or simultaneous giving of drugs or antibiotics which can control the infection. On the other hand the administration of these hormones is beneficial in the hypersensitivity and autoallergic diseases. It is therefore important to distinguish clearly between the infective diseases and the hypersensitivity states.


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