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Anderson W, Mackay IR. Fashioning the immunological self: the biological individuality of F. Macfarlane Burnet. JOURNAL OF THE HISTORY OF BIOLOGY 2014; 47:147-175. [PMID: 23341117 DOI: 10.1007/s10739-013-9352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
During the 1940s and 1950s, the Australian microbiologist F. Macfarlane Burnet sought a biologically plausible explanation of antibody production. In this essay, we seek to recover the conceptual pathways that Burnet followed in his immunological theorizing. In so doing, we emphasize the influence of speculations on individuality, especially those of philosopher Alfred North Whitehead; the impact of cybernetics and information theory; and the contributions of clinical research into autoimmune disease that took place in Melbourne. We point to the influence of local experimental and intellectual currents on Burnet's work. Accordingly, this essay describes an arc distinct from most other tracings of Burnet's conceptual development, which focus on his early bacteriophage research, his fascination with the work of Julian Huxley and other biologists in the 1920s, and his interest in North Atlantic experimental investigations in the life sciences. No doubt these too were potent influences, but they seem insufficient to explain, for example, Burnet's sudden enthusiasm in the 1940s for immunological definitions of self and not-self. We want to demonstrate here how Burnet's deep involvement in philosophical biology - along with attention to local clinical research - provided him with additional theoretic tools and conceptual equipment, with which to explain immune function.
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Affiliation(s)
- Warwick Anderson
- Department of History & Centre for Values, Ethics and the Law in Medicine, University of Sydney, Quadrangle A14, Sydney, NSW, 2006, Australia,
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Mackay IR. A 50-year experience with autoimmune hepatitis: and where are we now? J Gastroenterol 2011; 46 Suppl 1:17-28. [PMID: 21072544 DOI: 10.1007/s00535-010-0325-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 08/23/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Autoimmune hepatitis (AIH) as chronic active hepatitis became recognized in the 1940s as a progressive hyperglobulinemic disease affecting younger women attributed to persisting virus infection of the liver: autoimmunity then was barely on the horizon. EARLY OBSERVATIONS The lupus erythematosus (LE) cell reported in 1948 signified the presence of antinuclear autoantibodies, promoting perceptions of autoimmunity in certain chronic diseases. Recognition of LE cells in chronic hepatitis led to the designation of 'lupoid hepatitis', with autoimmunity further substantiated by anti-cytoplasmic autoantibodies detected by complement fixation. Next a serum reactant with smooth muscle of rodent stomach was found to have a wider distribution and became identified as an autoantibody to filamentous (F) actin. Therapy with corticosteroids proved effective, particularly combined with azathioprine. Various trials showed greatly improved survival and established modern therapy of AIH. An HLA-based predisposition (B8, DR3) was the first pointer to a genetic etiology. RECENT ADVANCES Recombinant or purified autoantigenic substrates have led to automated assays, which, together with improved immunofluorescence procedures, allow serological confidence in diagnosis and institution of effective immunosuppressive therapies. The liver-kidney 'microsomal' autoantigen reactive with cytochrome P450 2D6 distinguishes two serological types of AIH that appear pathogenetically distinct. Molecular characterization of antigens and epitopes remains wanting in type 1 AIH. FUTURE PROSPECTS The challenge remains with both types of AIH to elucidate in molecular terms the genetic and environmental basis of pathogenesis from initiation to ultimate progression and cirrhosis (when inadequately treated). Advancing technologies are bringing this goal closer to being attainable.
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Affiliation(s)
- Ian R Mackay
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, 3800, Australia.
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Abstract
Australia has had a proud and enviable record of seminal contributions to hepatology, with many contributors. Thus, any attempt to summarize these contributions ab initio in a brief review article is a significant challenge, primarily because it is so easy to overlook or underestimate particular aspects. In this article, I have confined my comments primarily to the areas where the contributions have had a significant global impact and have clearly been recognized internationally. This means that many worthwhile Australian additions will be omitted if there was less apparent international impact. The first significant interest in liver disease in Australia was from the Melbourne group at the Walter and Eliza Hall Institute (WEHI) and Royal Melbourne Hospital, leading to seminal contributions to the description, diagnosis, aetiopathogenesis and therapy of autoimmune hepatitis and primary biliary cirrhosis. Others from Royal Prince Alfred Hospital in Sydney contributed substantially to the effects of immunosuppression of autoimmune hepatitis and to early descriptions of primary sclerosing cholangitis. Other areas where Australians have contributed significantly include steatohepatitis, iron metabolism (and in particular hemochromatosis), viral hepatitis (both at the molecular and clinical level), portal hypertension, and transplant immunology. The remarkable contribution of Professor Dame Sheila Sherlock to Australian hepatology is also summarized.
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Affiliation(s)
- Lawrie W Powell
- University of Queensland, Centre for the Advancement of Clinical Research, Royal Brisbane, Queensland, Australia.
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Mackay IR. Historical reflections on autoimmune hepatitis. World J Gastroenterol 2008; 14:3292-300. [PMID: 18528926 PMCID: PMC2716583 DOI: 10.3748/wjg.14.3292] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 02/29/2008] [Accepted: 03/07/2008] [Indexed: 02/06/2023] Open
Abstract
Autoimmune hepatitis (AIH), initially known as chronic active or active chronic hepatitis (and by various other names), first came under clinical notice in the late 1940s. However, quite likely, chronic active hepatitis (CAH) had been observed prior to this and was attributed to a persistently destructive virus infection of the liver. An earlier (and controversial) designation in 1956 as lupoid hepatitis was derived from associated L.E. cell test positivity and emphasized accompanying multisystem features and immunological aberrations. Young women featured prominently in early descriptions of CAH. AIH was first applied in 1965 as a descriptive term. Disease-characteristic autoantibodies were defined from the early 1960s, notably antinuclear antibody (ANA), smooth muscle antibody (SMA) and liver-kidney microsomal (LKM) antibody. These are still widely used diagnostically but their relationship to pathogenesis is still not evident. A liver and disease specific autoantigen has long been searched for but unsuccessfully. Prolonged immunosuppressive therapy with predisolone and azathioprine in the 1960s proved beneficial and remains standard therapy today. AIH like many other autoimmune diseases is associated with particular HLA alleles especially with the "ancestral" B8, DR3 haplotype, and also with DR4. Looking forwards, AIH is one of the several enigmatic autoimmune diseases that, despite being (relatively) organ specific, are marked by autoimmune reactivities with non-organ-specific autoantigens. New paradigms are needed to explain the occurrence, expressions and pathogenesis of such diseases.
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Abstract
The diagnosis of AIH depends on the finding of several suggestive features together with careful exclusion of liver diseases of other etiologies. Wherever possible, the diagnosis should be confirmed histologically by an experienced hepatopathologist. Seronegativity for the conventional autoantibodies at presentation does not exclude a diagnosis of AIH. It is important to test for anti-LKM1 antibodies to avoid missing a diagnosis of type 2 AIH, with potentially serious consequences. Although the syndrome is associated with characteristic biochemical abnormalities, and biochemical parameters are commonly used for monitoring response to therapy, it should be borne in mind that neither these nor autoantibody titers are completely reliable indices of disease activity. Although the various systems that have been promulgated for classification of the disease may identify different groups of patients on pathogenetic or clinical criteria and are useful for research purposes, none is yet sufficiently exclusive in terms of defining prognosis or planning treatment strategies to be applicable to the individual patient seen in the clinic. Clinical management should therefore continue to be individually tailored.
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Affiliation(s)
- Ian G McFarlane
- Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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TAFT LI, MACKAY IR, LARKIN L. Hepatitis complicated by manifestations of lupus erythematosus. ACTA ACUST UNITED AC 2000; 75:399-404. [PMID: 13576321 DOI: 10.1002/path.1700750218] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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GRAY N, MACKAY IR, TAFT LI, WEIDEN S, WOOD IJ. Hepatitis, colitis, and lupus manifestations. ACTA ACUST UNITED AC 2000; 3:481-91. [PMID: 13559187 DOI: 10.1007/bf02231247] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schvarcz R, von Sydow M, Weiland O. Autoimmune chronic active hepatitis: changing reactivity for antibodies to hepatitis C virus after immunosuppressive treatment. Scand J Gastroenterol 1990; 25:1175-80. [PMID: 2177220 DOI: 10.3109/00365529008998551] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thirty-three patients fulfilling stringent criteria for autoimmune chronic active hepatitis (CAH) were tested for antibodies against hepatitis C virus (anti-HCV) with an enzyme immunoassay. Eleven of the 33 (33%) patients were anti-HCV-reactive in a serum drawn before initiation of immunosuppressive therapy. Anti-HCV-reactive patients had significantly higher median s-IgG level (32.3 g/l) than nonreactive patients (23.5 g/l) (p less than 0.01). When in remission with normalized s-IgG levels as a result of the immunosuppressive therapy, only 1 of the 11 initially reactive patients was still reactive. Sera from patients with acute autoimmune CAH and high s-IgG levels may be nonspecifically reactive for anti-HCV.
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Affiliation(s)
- R Schvarcz
- Dept. of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
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Bradbear RA. Chronic hepatitis: a review. J R Soc Med 1985; 78:391-6. [PMID: 3921709 PMCID: PMC1289721 DOI: 10.1177/014107688507800509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Lindberg J. Clinical and pathogenetic aspects on chronic active hepatitis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES. SUPPLEMENTUM 1978:1-36. [PMID: 276921 DOI: 10.3109/inf.1978.10.suppl-12.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Christoffersen P, Dietrichson O. Histological changes in liver biopsies from patients with chronic hepatitis. ACTA PATHOLOGICA ET MICROBIOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 1974; 82:539-46. [PMID: 4852280 DOI: 10.1111/j.1699-0463.1974.tb00384.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Reed WD, Stern RB, Eddleston AL, Williams R, Zuckerman AJ, Bowes A, Earl PM. Detection of hepatitis-B antigen by radioimmunoassay in chronic liver disease and hepatocellular carcinoma in Great Britain. Lancet 1973; 2:690-4. [PMID: 4125788 DOI: 10.1016/s0140-6736(73)92534-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Thompson WG, Hart IR. Chronic active hepatitis and Graves' disease. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1973; 18:111-9. [PMID: 4345786 DOI: 10.1007/bf01073154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Bulkley BH, Goldfinger SE, Heizer WD, Isselbacher KJ, Shulman NR. Distinctions in chronic active hepatitis based on circulating hepatitis-associated antigen. Lancet 1970; 2:1323-6. [PMID: 4098905 DOI: 10.1016/s0140-6736(70)92356-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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FINCKH ES, SIMPSON GE. Changes in the pattern of cirrhosis after repeated partial hepatectomies in a rat. ACTA ACUST UNITED AC 1963; 86:371-5. [PMID: 14068946 DOI: 10.1002/path.1700860212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
- R. A. Joske
- Department of MedicineUniversity of Western Australia
- Department of PathologyRoyal Perth HospitalPerthWestern Australia
| | - L. R. Finlay‐Jones
- Department of MedicineUniversity of Western Australia
- Department of PathologyRoyal Perth HospitalPerthWestern Australia
| | - E. G. Saint
- Department of MedicineUniversity of Western Australia
- Department of PathologyRoyal Perth HospitalPerthWestern Australia
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TAFT LI. Left lobar biliary cirrhosis and right lobar ischæmic necrosis of the liver due to cholangiocarcinoma. ACTA ACUST UNITED AC 1959; 78:279-81. [PMID: 13836574 DOI: 10.1002/path.1700780130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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