TIME EUROPE
January 15, 2000, Vol. 157 No. 2
The Hunt for Cures
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Such discoveries elate doctors like Barondes. "When you learn more about the biochemical pathways and mechanisms controlled by these genes," he says, "you'll be able to create drugs that can augment or block them." Furthermore, if researchers can spot individual genetic flaws, they may eventually be able to tailor regimens for individual patients while also factoring in differences based on age, sex and race.
For all these advances, however, most experts agree that future treatments won't be reduced simply to tinkering with brain chemistry. Doctors will still have to take into account personal relationships, job pressures and their patients' emotional well-being. As Dr. Keith Kramlinger of the Mayo Clinic in Rochester, Minn., notes, "Most of the time, mental illness is probably a complex interaction of nature and nurture." In other words, you'll need both pills and palaver. And even that old Freudian couch may come in handy.
Autoimmune Diseases
New Ways to Intervene When the Body Attacks Itself
By UNMESH KHER
A healthy immune system is the body's best ally ‹ an automated engine of biological warfare that can destroy almost any microbial parasite it encounters. But, like all other agents of destruction, when it spirals out of control, it is as deadly to friend as it is to foe.
Fifteen million Americans know this in their bones. They are victims of a group of more than 40 disorders that arise when the immune system launches a sustained attack against the body. Ailments as diverse as psoriasis, multiple sclerosis and Type I diabetes are all caused by an immune system run amuck. No one knows what initiates any of these chronic diseases or how they might be cured, but researchers have lately made significant headway in developing drugs to treat them ‹ drugs that arguably represent the first substantial advancement in the field in 50 years.
Most of these drugs are genetically engineered biological molecules, and the majority are designed to treat rheumatoid arthritis and its close clinical relative, lupus. Like many other autoimmune diseases, both disorders strike women disproportionately. In RA, the immune system attacks the joints and eventually weakens the bones, causing excruciating pain, fatigue and daily bouts of fever. With lupus, the attack is far more generalized, affecting blood vessels, joints, skin and several internal organs. In severe cases, it can be lethal.
Both can be treated, but there is a catch: the treatments are nearly as harsh as the diseases. Steroids, for example ‹ a mainstay of lupus therapy ‹ shut down the immune system and suppress inflammation, but they can also promote hardening of the arteries, bone loss, obesity and even psychosis. Steroids are, in fact, among the leading causes of death and morbidity for patients with chronic lupus.
But things are looking up, thanks to advances in immunology that have spurred the creation of a new generation of drugs. It is becoming clear that a cell called cd4, or helper T cell, is a key player in both healthy and autoimmune responses. "T-cell activation ‹ like the branches of government ‹ is controlled by a series of checks and balances," explains Dr. C. Garrison Fathman, a clinical immunologist at Stanford University.
One of those checks is the T cell's dependence on another cellular player: the antigen-presenting cell. The apc is an omnivorous creature whose job, among other things, is to gobble up microbial invaders. To initiate the immune response, the apc coughs up a molecule from the bug it has eaten, latches on to a helper T cell and "presents" it with a target molecule, instructing the T cell to prepare its troops for war. This activation is tightly controlled; it cannot occur without the lockstep interaction of several proteins on both cells ‹ one of which is known as cd4.
Once activated, the T cell becomes a sort of commander in chief of immunity, activating the B cell ‹ which secretes antibodies ‹ and prompting the release of a farrago of inflammatory molecular signals.
Autoimmune responses follow a similar course, but the cells targeted belong to the body. "Biological-response modifiers," as the new drugs are known, tamp down that response by blocking communication between the immune system's soldiers.
The most famous of these are Wyeth-Ayerst's Enbrel, and Remicade, made by a subsidiary of Johnson & Johnson, which have been in use for roughly two years. Both inhibit a messenger in the inflammatory cascade known as the tumor necrosis factor (tnf). The drugs are more effective than traditional medications, and more likely to retard joint degradation. "The idea that biologics could prove effective against autoimmune disease has been firmly established by the tnf story," says Dr. H. Michael Belmont of the Hospital for Joint Diseases in New York City.
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COVER STORY
Special Report: The Future of Medicine
With the mapping of the human genome the process by which new drugs are developed is being turned upside down. These drugs will also change our lives
Brave New Pharmacy
Using high-speed robots and the secrets of the human genome, scientists are changing forever the way they discover new medicine
The Hunt for Cures
Genetic information could lead to treatments for everything from AIDS to obesity
EUROPE
Prague Winter
When Jiri Hodac was named director of state television, Czech journalists saw a return to government meddling in the media
See Vous in Court
France is the latest nation to join the litigation game
Going up in Smoke
Switzerland, land of luxury watches and bank secrecy, has a new growth industry: marijuana
UNITED STATES
The True Blue Bush Cabinet
Its ethnic and gender balance is correct, but can a divided nation deal with the superconservative bent?
BUSINESS
Transparency has its Price
Executives at many German companies are finding it hard to adjust to the more rigorous financial disclosure required by global investors
On Spreading the Word
When it comes to selling merchandise, word-of-mouth marketing may be a company's best weapon
Essay: Meat Matters
Critics of industrialized farming may be forgetting about world hunger, writes TIME's Rod Usher
THE ARTS
Rebel with a Cause
The real-lifestory of an anti-Mafia activist in Sicily makes for a handsome film with a political message
The Upmarketeer's Tale
Bernard Arnault built his house by selling at deluxe prices and in his book he's still giving nothing away
The Art of Noise
For Europe's freely improvised music, the only rule is no rule
DEPARTMENTS
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