How to outfox mother nature--autoimmunity: moving from shadows to sunshine

The morbidity and disability associated with autoimmune diseases represent a significant health problem. One in 31 people have one form or another of an autoimmune disease. Despite the avalanche of molecular data, immunogenetic definitions and improvements in serologic diagnosis, we are still far from discovering the etiologies of these diseases. For some autoimmune diseases, there may be a very long latency period between disease onset and clinical presentation. Existing therapies tend to be only partially successful and often accompanied by a variety of serious side effects. However, even in the absence of a complete understanding of the underlying genetic, environmental and coincidental factors that confer susceptibility to autoimmune diseases, we believe that it is possible to devise successful therapies by interfering with one or more of the pathways of destruction characteristic of a specific autoimmune disease. We have prepared a futuristic look at the treatment of autoimmune disease by extrapolation of current research directions as well as thoughts on new methods of delivery of recombinant monoclonal antibodies. We predict that we will "cure" autoimmune pathology long before we understand the etiology. In the case of inflammatory bowel disease, as a model, and taking advantage of what is known on animal studies, we illustrate the progress that has been made in elucidating these pathways of destruction and speculate about possible therapeutic approaches.