Autoimmune polyglandular syndrome type 1

Autoimmune polyglandular syndrome type 1

Autoimmune polyglandular syndrome type 1,
also called APS type 1, or autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy, also called APECED, is a rare,
genetically inherited condition. Autoimmune means that the body’s immune
system begins to attack its own tissues, and polyglandular means that multiple hormone-producing
organs are affected. Normally, your body should only react to things
that are foreign or not-self. This is maintained by a process called immune
tolerance where only non-self-reactive B-cells and T-cells, are allowed to mature, whereas
self-reactive ones aren’t. For T-cells, this process takes place in the
thymus, where a gene called AIRE, or autoimmune regulator, is expressed by thymic medullary
epithelial cells. When T-cells are developing, this gene leads
to the production of thousands of the body’s proteins, and this serves as a test to see
whether the T-cells react to self proteins. If one does, that T-cell either undergoes
apoptosis and dies, or it becomes a regulatory T-cell, or T-reg, that helps to eliminate
other immune cells that react to self antigens. In APS type 1, there’s a genetic mutation
in AIRE that’s usually inherited in an autosomal recessive fashion. This means that the thymic medullary epithelial
cells lose the ability to display the body’s different self-proteins. Since they can no longer test whether T-cells
are self-reactive or not, the process of immune tolerance does not occur normally, and self-reactive
T-cells are allowed to live. Regulatory T-cells are no longer produced
normally either, so the body loses a second mechanism for destroying autoimmune cells. This allows for the production of antibodies
and lymphocytes that target normal tissues of the body. It is still unclear why, but certain glandular
tissues, including the adrenal glands and parathyroid glands, are particularly targeted. There are multiple characteristic signs and
symptoms of APS type 1. One of them is polyendocrine malfunction resulting
in hypoparathyroidism, characterized by low calcium and elevated phosphorus in the blood
that can cause muscle cramping and seizures, and primary adrenal insufficiency, also called
Addison’s disease, which can reduce cortisol and aldosterone levels. These hormones normally help to maintain blood
pressure among many bodily processes and their loss can be life-threatening. In addition, chronic mucocutaneous candidiasis
is an infection with the yeast Candida that affects the skin and nails, as well as mucous
membranes, like the mouth, esophagus, and genital mucosa. There’s also ectodermal dystrophy which
leads to skin abnormalities like vitiligo which causes areas of hypopigmentation, nails,
corneas, reduced dental enamel, and alopecia which is where there’s hair follicle destruction
causing bald spots. Finally, some non-endocrine organs like the
liver, intestine, lungs, kidney, salivary glands, and spleen can get inflamed as well. Recognizing the clinical pattern early is
particularly important in terms of making a diagnosis and starting treatment early. Diagnosis of APS type 1 is based on the presence
of at least two of the three characteristic manifestations, namely, chronic mucocutaneous
candidiasis, hypoparathyroidism, and primary adrenal insufficiency. It also includes DNA testing to look for mutations
in the AIRE gene and lab tests for autoantibodies toward interferons, which are common in this
condition. Treatment depends on treating the manifestations
of the condition that are present in each person. This can include hormone-replacement therapy,
immunosuppressive medications in those with non-endocrine organ damage, and calcium and
vitamin D supplementation in those with hypoparathyroidism. All right, as a quick recap…APS type 1 or
APECED is a rare genetically inherited condition caused by mutations in the autoimmune regulator,
or AIRE, gene that results in a defect in the development of immune tolerance. Signs and symptoms include the malfunction
of multiple glands such as the parathyroid and adrenal glands, chronic mucocutaneous
candidiasis, and ectodermal dystrophy and autoimmune damage to non-endocrine organs. In individuals that are thought to have the
disease, the diagnosis includes the clinical detection of these manifestations along with
DNA testing and blood tests to look for interferon-targeting autoantibodies. Treatment includes hormone-replacement therapy,
immunosuppressive medications in those with end-organ damage, and calcium and vitamin
D supplementation in those with hypoparathyroidism.


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