Looking into the Future Disease

The scientist’s tone was professorial; his voice muted, stentorian. It would have been easy to ignore him in that vast lecture hall where three hundred fidgeting, yawning specimens of Studentus universitae tried to fight the glacial blasts of air from ten overenthusiastic aircons with their tepid cups of coffee. But I could not take my eyes off the scientist’s face. My mind clutched on to every word he spoke, as my subconscious worked feverishly to make sense of the enormity of his findings and the impact it could have on the world.


If you were asked to name one thing that currently rules your life, what would it be? Would it be family, friends, or perhaps love? Would it be money, sex, or fate? Never mind. It doesn’t matter which of these you’d choose because you’d be wrong. It’s health! Health rules all our lives, but it’s very easy to underestimate its value until we lose it – and then it becomes the most important thing in the world.


Scientists are far more foresighted, though. They’re always on the lookout for those tiny signs of illness that we tend to overlook. But sometimes, even when they detect the early stages of a disease, it’s too late to save the patient from a lot of pain, if not death. Perhaps now there’s a way to change that.


The scientist standing at the head of our freezing lecture hall was a doctor of medicine who worked on autoantibodies. What are autoantibodies; to understand that, we need to go back and recognize certain anomalies in our immune system.


Normally, when our body is invaded by bacteria or viruses, our immune system jumps into action and deploys its elite Black Cats forces, comprising of those defenders-of-justice – the antibodies. The Black Cats antibodies scope out the enemy forces and – in an interesting simulation of most Bollywood movies – beat them to a pulp and eject them from the body in humiliation.


But in certain special kinds of diseases called autoimmune disorders, the immune system turns traitor and begins to target the person’s own tissues. Seriously, I never had an inkling that my body was capable of such thrilling games of intrigue. I’ve gained a whole new level of respect for it.


Anyway, scientists have identified about 40 different diseases as autoimmune conditions – including type 1 diabetes and rheumatoid arthritis. Altogether, they constitute the third leading cause of sickness and death – a staggering figure no matter which way you look at it. Think about the terror of hundreds of thousands of people just like you and me who woke up one day to find that their defensive system had begun to turn against their own nerves, eroding their ability to control basic body functions or even move. Now think about how it could have been you.


That’s why the recent findings that the scientist was bringing to light in the dimmed plush lecture theatre had my attention arrested. In the past decade, he told us that more and more studies were revealing that the body makes certain antibodies directed against itself – otherwise known as autoantibodies that appear in a healthy person’s blood years, sometimes a decade, before the actual symptoms of the disease start to show up. Any doctor will tell you how valuable this information would be – like an alarm system that rings several years before the asteroid strikes, so you can nuke it out of space even before it starts thinking of moving towards the earth. Enticing vision, isn’t it?


One of the more deadly killer diseases in India is Type 1 diabetes. India is predicted to have the most number of people with the disease in the world. Studies of patients with type 1 diabetes provided the first clues that autoantibodies could be valuable for predicting later illness. In studies conducted by various laboratories, investigators took blood samples from thousands of healthy schoolchildren and then monitored the youngsters’ health for up to 10 years. When a child came down with type 1 diabetes, the researchers pulled the individual’s blood sample out of storage to see whether it contained autoantibodies. The vast majority of children destined to become diabetic had the diabetes-related autoantibodies in their blood as long as 10 years before any recognizable symptoms arose.


Was it true that diabetes manifested itself in a person’s body years and years before the person even got a hint of it? Before these studies, type-1 diabetes was thought to develop suddenly, perhaps within a matter of weeks. The new data demonstrated, instead, that in most cases the immune system silently and slowly destroys the pancreas, chips away at it bit by bit over long years, until it kills so many cells that the damage starts to show in the form of symptoms. It scares me because that could mean I already have the first signs of diabetes right now. And here I was swallowing down bagels by the dozen.


But then there was also hope. If the doctors could foretell the possibility of me becoming diabetic 10 years down the line, they could save me a good deal of physical agony and a fortune on insulin shots, simply by telling me to start using Equal and to cut down on the layered pastries. It was a miracle. They were like fortune-tellers and palm-readers, only with white coats on (and slightly more dependable prophecies).


It was after the diabetes studies that immunologists unearthed an autoantibody that they found to be present in 30 to 70 percent of patients diagnosed with rheumatoid arthritis, in some cases more than 10 years before the first symptoms turned up. Soon after, similar autoantibodies were found in patients with celiac disease, and then also with multiple sclerosis. So what is common among all these diseases? Just that they’re all autoimmune diseases.


So the obvious solution is to screen against all autoimmune diseases, and then design preventive therapy tailored specifically for each condition. But there are challenges in the way.


Firstly, researchers will have to follow large populations for years to prove conclusively that particular autoantibodies can signal future disease. That is, many thousands of healthy people must be recruited to give blood samples and then tracked carefully for 10 years or more to see if they fall sick. Not only would that pose huge logistical difficulties, it would also require a massive amount of financial resources. Secondly, widespread testing for these diseases will only be worth it if scientists find effective ways to combat the diseases in those extra years gained after the testing. And thirdly, the ability to forecast someone’s life and death raises thorny ethical issues. Not everyone would be happy finding out that they are likely to be suffering from a disease.


Despite the hurdles, it would be well worth it, I think, if we could predict diseases much before they could start harming our bodies. Not only would medicine make great leaps in its understanding of these diseases, many people would be saved from lives of physical suffering and mental degradation. And every single life saved would be the saving of another cricket-playing, Rehman-loving, politics-hating, Chinese food-eating, strange, contradictory, emotion-filled, living, breathing, feeling bundle of joys and sorrows. And every one of these bundles matters to humanity, so we must not let it go.

Joyeeta Biswas

Notkins, Abner Louis. New Predictors of Disease. SCIENTIFIC AMERICAN India (March 2007)

[Image source:http://www.msimmunology.com/msimmunology/images/image4.jpg]