From the Guidelines
Lysis and autoimmune conditions are distinct biological processes, with lysis referring to the rupturing of a cell membrane and autoimmune conditions involving the immune system mistakenly targeting the body's own cells and tissues. The process of lysis can occur through various mechanisms, including osmotic pressure changes, enzymatic activity, or attack by immune system components like complement proteins or cytotoxic T cells 1. In contrast, autoimmune conditions, such as those seen in patients with Common Variable Immunodeficiency (CVID), develop when the immune system produces autoantibodies that attack specific self-antigens, leading to inflammation and tissue damage 1. Some key points to consider in the context of lysis and autoimmune conditions include:
- The importance of distinguishing between lysis as a cellular destruction process and autoimmune conditions as a specific type of immune system dysfunction 1
- The role of autoantibodies in triggering complement-mediated lysis of target cells in autoimmune conditions 1
- The need for vigilance in monitoring patients with autoimmune conditions, such as CVID, for possible autoimmune diseases and lymphoproliferative disorders 1
- The potential for lysis to occur in various contexts beyond autoimmunity, including normal physiological processes, infections, and disease states 1 Overall, understanding the distinctions between lysis and autoimmune conditions is crucial for properly conceptualizing cellular damage mechanisms in different pathological conditions and providing appropriate management and treatment for patients with these conditions 1.
From the FDA Drug Label
Azathioprine suppresses disease manifestations as well as underlying pathology in animal models of autoimmune disease The mechanisms whereby azathioprine affects autoimmune diseases are not known. Azathioprine is immunosuppressive, delayed hypersensitivity and cellular cytotoxicity tests being suppressed to a greater degree than are antibody responses
Azathioprine is used to suppress autoimmune diseases, but the exact mechanisms are unknown. It has been shown to be immunosuppressive, affecting delayed hypersensitivity and cellular cytotoxicity more than antibody responses 2.
From the Research
Lysis and Autoimmune Hemolytic Anemia
- Autoimmune hemolytic anemia (AIHA) is caused by auto-antibodies directed against self red blood cell (RBC) surface antigens, leading to intravascular or extravascular hemolysis 3.
- The pathogenesis of AIHA involves defective antigen presentation, insufficient T-lymphocyte tolerance, and induction of autoantibody production by B-lymphocytes 3.
- The diagnosis of AIHA is based on direct and indirect antiglobulin tests, with the first-line therapy for warm AIHA being administration of corticosteroids 3, 4, 5, 6.
Treatment Options for AIHA
- For non-responding patients, second-line treatment includes rituximab or splenectomy, with a combination of other immunosuppressive drugs as a third-line treatment 3, 4, 5, 6.
- Rituximab is a treatment of choice for patients with cold agglutinin disease (CAD) 3, 5, 6.
- Additional therapies for AIHA include intravenous immunoglobulins, danazol, and plasma exchange, with alemtuzumab and high-dose cyclophosphicide as last options 5, 6, 7.
- Alemtuzumab has been shown to induce complete remission in AIHA patients refractory to other treatments, including corticosteroids, splenectomy, and rituximab 7.