Inflammation and disease

AIMEE DORDEVIC: So we can see from the complexity and multifactorial nature of all of these diseases that not all inflammation is equal. And we need to be really mindful of this when addressing a patient’s needs in terms of managing their inflammation. It’s difficult to know which comes first. And we end up with a bit of a chicken and egg scenario. So does inflammation drive disease? Or does disease drive inflammation? With infectious disease, it is clear that pathogen will enter the body. And that’s really the driver of inflammation and the symptoms of the disease. But in the case of metabolic inflammation and the hypersensitivity reactions, such as allergy and autoimmune disease, it’s not always as clear-cut as that.

And sometimes, it’s the inflammation that’s driving the disease itself. What’s really important is to establish a balance in the immune system where we can mount an appropriate inflammatory response when needed, but then also have resolution of that inflammation when the job is done. Occasionally, that balance in the immune system can tip towards a more inflammatory profile and will have inappropriate responses to antigens that are otherwise considered harmless to the body. Factors that contribute to the development of these inappropriate responses and tipping that balance towards a more inflammatory profile– genetics, and lifestyle, and environmental exposures, including diet. Exploring this further, people who experience autoimmune diseases and allergies will have some genetic predisposition to developing those conditions.

But not everybody with genetic susceptibility ends up developing the symptoms to those diseases. For example, in some twin studies, they’ve shown that with two people, one may experience symptoms of hypersensitivity disorders, such as an autoimmune disease or allergy, whereas the other person will not experience that, despite the two people having identical genetic makeup. So these types of studies indicate that there’s some relationship between environmental exposures and the development of inappropriate immune responses and inflammation. In particular, in the case of autoimmune disease, once that adaptive response has been triggered, we’re not sure how to turn it off. The inflammation and immune response will continue to occur and really drive the symptoms of the disease.

The hypersensitivity disorders, such as allergies and autoimmune responses, are perfect examples of the disregulated or unbalanced response of the immune system. The adaptive immune system has been triggered against antigens that otherwise considered harmless to the body. Once the adaptive immune system has been turned on to respond to a particular antigen, we’re still not sure how to actually turn this response off. And inflammation will continue as long as that molecule or antigen is present. Similarly, with metabolic inflammation, there’s an initial trigger that starts that inflammation. But it’s very much that propagation of inflammation that drives the symptoms of disease. Due to the complexity and multifactorial nature of all of these diseases, it’s clear that not all inflammation is equal.

So we need to be really mindful of this when addressing a patient’s needs in terms of inflammation and giving them advice on the management of inflammation.