The 6th International Academy of Autoimmunity (SPBAA 2020) has ended at St Petersburg University.  It was attended by top-level scientists and clinicians, as well as physicians and students from Belgium, Brazil, Great Britain, Vietnam, Greece, Israel, Italy, Kazakhstan, China, Latvia, Portugal, Russia, Romania, Slovenia, USA, Croatia, Ecuador, Japan, and other countries.

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This conference is a scientific school. It was held at the University for the third time. This year it was timed to coincide with the 25th anniversary of the Faculty of Medicine of St Petersburg University and took place on the birthday of its founder and first dean – Yuri Natochin, a Member of the Russian Academy of Sciences.

The conference was opened with a report by Yehuda Shoenfeld, a Member of Israel

Academy of Sciences and Humanities, Head of the Laboratory of the Mosaic of Autoimmunity at St Petersburg University. He said that several factors can push the development of autoimmune diseases: genetic predisposition; features of neuroendocrine regulation; as well as environmental influences, including both the effect of infections and the effect of adjuvants. These are the substances that non-specifically enhance immune responses.

The inescapable link in the origin of autoimmune diseases is heredity: genetic factors determine whether a person will be prone to developing autoimmune diseases.

Thus, the features of the PTPN-22 gene are associated with a predisposition to more than 30 autoimmune diseases. Also, carriers of the HLA-DRB1 haplotype have a strong, aggressive immune system. This makes them more resistant to a number of infections, but at the same time they have a high chance of developing an autoimmune disease. It can be provoked by hyperstimulation of the immune system, which leads to a violation of immune tolerance to its own antigens and the production of autoantibodies.

In his report, Professor Schoenfeld cited two cases proving that genetic predisposition and long-term stimulation of the immune system by various factors cause the development of pathological autoimmunity and, ultimately, facilitate the growth of lymphomas.

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In 2018, the Nobel Prize in Physiology or Medicine was awarded to James Allison and Tasuku Honjo for their discovery of a new approach to cancer therapy. The scientists proposed to inhibit ‘checkpoints’ – T-lymphocyte receptors that inhibit the activity of the immune system and prevent hyperstimulation. This discovery made it possible to cure more than 20 previously incurable cancers. However, the price paid for it was the development of autoimmune diseases in almost 20% of such patients. Basically, they turned out to be carriers of the HLA-DRB1 haplotype and some other genetic traits of immunoregulation.

Women are more prone to most autoimmune diseases. Their immune systems are more powerful than that of men, and about 83% of all autoimmune diseases are found in them. One of the factors that spur the development of autoimmunity is the installation of silicone implants. About 40 million women around the world have had silicone breast implants. It is the most popular plastic surgery that attracts up to 1.8 million patients a year. But over time, some of them begin to experience: chronic fatigue; cognitive impairment; diffuse musculoligamentous pain; dry eyes; hair loss; paraesthesia; and hearing loss.

Silicone is used because of its consistency, which resembles the human body, and also because it was considered inert towards the immune system. However, this is absolutely not the case. Silicone is an adjuvant. Now we know that it comes out of implants and spreads throughout the body. It is even found in the lymph nodes.

Yehuda Shoenfeld, a Member of Israel Academy of Sciences and Humanities

‘In 2011, our research team described a new syndrome. We called it ASIA - an autoimmune syndrome induced by adjuvants. When we analysed the problems faced by over 300 women, we saw that almost all of them suffered from extreme fatigue, pain and other chronic manifestations, including hearing loss. Previously, physicians had not associated them with the presence of silicone implants and prescribed anti-neurotic and antipsychotic drugs to their patients. However, we managed to solve this puzzle: autoimmune manifestations arise under chronic adjuvant influence in carriers of the HLA-DRB1 haplotype.’

As a result, a number of autoimmune and autoinflammatory diseases, including Sjögren syndrome, scleroderma, sarcoidosis, and lupus erythematosus, are more common among women with silicone implants. Their occurrence is caused by the same mechanism as in patients who have undergone therapy with checkpoint inhibitors: hyperstimulation of the immune system if they have a genetic predisposition.

Environmental factors, in particular many bacterial and viral infections, play an important role in the emergence of autoimmune diseases. They provoke the development of rheumatoid arthritis, multiple sclerosis, polymyositis, Sjögren syndrome, Hashimoto's thyroiditis, and many other health problems. The Epstein-Barr virus (one of the human herpesvirus types) is known to be responsible for over 30 different autoimmune diseases. At present, we can say that one of these viruses is COVID-19. Professor Michael Ehrenfeld, Assistant to Deputy Director General of the Chaim Sheba Medical Center, said that in May 2020, only five immune-mediated diseases caused by the new coronavirus infection were described. However, by November their list had expanded significantly.

For example, antiphospholipid antibodies have been found in the serum of COVID-19 patients. Despite the fact that they can appear during infection as a short-term phenomenon, there have already been cases of limb ischemia, as well as ischemic strokes due to these consequences of COVID-19. The pathogenicity of these antibodies is unknown, as is the likelihood that they will lead to autoimmune diseases in the long term. However, such autoantibodies can be detected many years before these diseases develop.

Michael Ehrenfeld also reported that, in December, an article on the presence of thrombogenic antibodies in the serum of patients hospitalised with severe COVID-19 was published in the journal Science. Their presence leads to a high risk of occlusion of vessels of all sizes. The scientists studied eight types of antiphospholipid antibodies and found out that half of the patients have at least one of them. Thus, autoantibodies can be pathogenic agents and a potential target of therapy in cases of severe COVID-19. Also, an experiment in mice has confirmed this. Data on lymphocytic infiltration of a number of internal organs in victims of severe COVID-19 infection, confirming the role of autoimmune processes in this disease, have also been obtained by St Petersburg scientists.

The International Academy of Autoimmunity is the largest educational event in Russia for physicians who want to learn more about autoimmunity and autoimmune diseases. The objective of the Academy is to provide an opportunity to acquire the latest knowledge about autoimmunity for specialists of various fields: rheumatologists; therapeutists; allergists and immunologists; laboratory research specialists; and students. This year, more than 300 students have become participants in the Academy. This school is formally included by the Ministry of Health of the Russian Federation in the number of events of continuous medical education.