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Your immune system is an omnipresent, terrifying
entity made of billions of nuclear weapons
and kamikaze bombers, saturating every
little tissue, bone and fluid in your body.
It scans, patrols, and when it finds an enemy — it kills.
But what if it suddenly decides
that you are the enemy?
This is the betrayal of autoimmunity
– diseases like Type 1 diabetes,
multiple sclerosis, celiac disease,
lupus and Crohn's disease and many more.
Literally every tissue can be affected, from
your nerves to your thyroid or joints.
They are all unique and different kinds of bad,
from manageable to life changing to deadly.
All share one fundamental property: Your immune
system thinks some healthy part of you is the enemy.
It’s like a country attacking itself:
fighter jets bomb roads,
snipers hunt doctors and baristas,
artillery levels daycare centers.
While there is usually a certain amount
of genetic risk for autoimmunity,
to get an actual autoimmune disease you also need
a colossal case of bad luck on top of that.
How does this work?
The Shape Of Life
The fundamental building blocks of life are proteins.
Like ultra complex lego blocks
each of them has a precise shape,
allowing them to perform highly specific tasks,
like breaking down food or transcribing DNA.
In total your body produces
about 100,000 different proteins, or shapes.
Your immune system evolved to constantly check
the proteins of your cells and look for shapes
that are not you – and to kill whatever is
attached to them violently and brutally.
Autoimmunity is when your soldier
cells suddenly think that your own
healthy and natural proteins
belong to an enemy.
We explained this in more detail
in this video – but in a nutshell:
This is such a critical danger to your survival
that your body created an entire murder university
to prevent this from happening.
Here, young immune cells go
through ruthless training:
if they recognize the shapes of your own
proteins, they are executed immediately.
But sometimes through sheer, dumb
luck one makes it through.
Right at this moment you probably have
a few million cells patrolling your body
with the potential to trigger
an autoimmune disease.
Another way to trigger autoimmunity
is through our enemies:
Some bacteria and viruses have evolved proteins that
are extremely similar to the ones in your own body.
Because they just have to if they want to
interact with your cells – and to stay hidden.
We see this everywhere in nature, from moths that look
like bark or crocodiles that disappear in muddy water.
For bacteria your tissue is a hostile jungle
full of angry predators looking for them.
So they try to cover themselves in shapes
that are very similar to your proteins.
But both of these things are not enough,
the final ingredient is a trigger event.
And a colossal case of bad luck.
The War That Never Ends
The trigger can be anything
that activates your defenses.
A common cold, the flu, a tiny wound.
Any sort of infection floods
your body with cytokines,
signals that tell your body “this is a
real fight, take this seriously”
which truly wakes up your immune system.
Intelligence cells start to gather
proteins – shapes – from the battlefield.
These shapes are the physical information of what
is going on and are carried to your lymph nodes,
information distribution centers.
Here, your heavy weapons – T cells – pass through,
taking a look at the shapes that are being presented here.
If they recognize the shape of an invader
they activate the whole immune system and
a few days later the attacker will be wiped out.
But this time the worst things
happen in the worst kind of way.
Maybe an intelligence officer picked up a piece of
one of your healthy cells that died in the battle,
or maybe a bacteria had a protein pretty similar
to one of yours. And by sheer, extremely bad luck,
a few months ago a single T cell that can
recognize this shape survived the murder university.
And today exactly this T cell happened
to pass exactly this lymph node and is activated.
This single T cell now starts a big
immune reaction against your own body.
It clones itself thousands of times, gathers other
cells for support and streams into your tissue.
When the misguided immune cells arrive
they see nothing but enemies!
The proteins they are looking for are everywhere!
Which can only mean that there
is a full on invasion going on!
They spread out and start
attacking and killing your tissue.
How bad is this?
Well, it depends.
There are more than 100 different autoimmune
diseases and basically any tissue can be affected.
In Multiple Sclerosis your immune cells are
attacking the insulation of your nerve cells,
making them sort of short circuit or
slow down dramatically.
Causing numbness, muscle cramps, problems
with your vision and concentration.
In Type 1 Diabetes your immune system kills the
cells that produce your insulin in your pancreas,
starving your cells of glucose and
turning your blood into acid.
In Rheumatoid Arthritis angry cells invade your
joints and literally start to dissolve cartilage and bone.
Lupus is a body-wide Blitzkrieg that attacks literally
every part of your body causing painful,
unpredictable and widespread destruction
with a variety of bad symptoms.
And almost all autoimmune diseases come
with crushing fatigue and exhaustion.
Because when you are sick, your immune system
tells your body to shut down and rest.
Even if the immune system is itself the attacker,
it still sends out the same orders.
It feels like you have the flu but
the real enemy is your own body.
The worst part about autoimmunity
is that it never stops.
Your immune system is a
self enforcing machine of destruction.
The more “enemies” your initial autoimmunity cells
encounter the more cells they clone and activate.
So its nature prevents lasting peace.
Why is your Body allowing this?
Most, if not all, autoimmune diseases have a
genetic component but this is kind of weird.
If some variants of genes are actively harmful to us,
evolution should weed them out and make them less common.
But up to one in ten people
in the industrialized world suffers from them.
So why did they stick around?
Well when it comes to genes, we often
have to work with trade offs –
at their core autoimmune diseases always mean
that your immune system is more aggressive –
and while this is mostly bad, until
recently in human history, this was pretty great.
In the past infectious diseases were the
most common cause of death.
Terrible pandemics ravaged our cities
regularly, sometimes decimating communities.
Researchers analyzed DNA samples
from London cemeteries before,
during, and after the Black Death pandemic
that killed about half of the population.
They found that individuals with gene variants
that increase the risk for Crohn’s disease,
seemed to have died at a much lower rate.
What helped them against a deadly disease back then
might make us vulnerable to autoimmunity today.
Evolution doesn’t care about perfect solutions,
it is only looking for good enough.
If variants made it more likely to
survive the deadliest diseases,
why care if down the line this
might lead to something else?
If you have an autoimmune disease you may only be
alive because your ancestors carried these genes
and survived a pandemic that
wiped out their neighbours.
And then a hot second ago
we changed our world.
Hygiene, antibiotics, vaccines and modern
medicine revolutionized our lives and how we die.
So much so that most of us don’t even think a lot
about infectious diseases – and this is great.
But now we are left with genes that make our
immune systems more aggressive for no good reason.
Add a bit of bad luck and all these billions of nuclear weapons and kamikaze bombers take aim at the wrong target:
You.
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