Abstract: Acute diseases start with an insult and end when insult disappears. If the trauma induces an immune reaction (which happens in most cases), this reaction must be terminated with some type of resolution mechanism, when the cause of the trauma ceases. Chronicity develops if insult is permanent or if the resolution mechanism is defective. Another way to reach disease chronicity is a positive feedback loop, whereby the immune reaction activates an internal, insult-like reaction. A distinction between chronic states characterized by a persistent, low suppressive effect and those characterized by a persistent, high suppressive effect of regulatory T cells (Treg), is proposed. This two-class division represents two ways to reach chronicity: (a) by maintaining inflammatory reaction long after insult disappears (“low Treg”), or (b) by suppressing inflammatory reaction prior to the disappearance of insult (“high Treg”). This two-class division may explain the strong association between certain pathogens and cancer, on one hand, and between several other pathogens and autoimmunity, on the other hand. The weak association between autoimmune diseases and HIV infection and the relatively weak association between autoimmune diseases and cancer may be elucidated as well. In addition, the model rationalizes why immune-modulating drugs, which are effective in cancer, are also effective in “high Treg” viral infections, while corticosteroids, which are generally effective in autoimmune diseases, are also effective in other “low Treg” diseases (such as asthma, atopic dermatitis, and “low Treg” infections) but are not effective in solid malignancies and “high Treg” infections. Moreover, the model expounds why certain bacteria inhibit tumor growth and why these very bacteria induce autoimmune diseases.

Keywords: Treg cells, cancer, autoimmunity, inflammation, chronic diseases, immune-therapy, corticosteroids


中文翻译：

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慢性病的二元分类


摘要：急性疾病始于损伤，结束于损伤消失。如果创伤引起免疫反应（在大多数情况下会发生），当创伤原因停止时，必须通过某种类型的解决机制终止这种反应。如果侮辱是永久性的或者如果解决机制有缺陷，就会形成慢性病。实现疾病慢性化的另一种方法是正反馈循环，即免疫反应激活内部的、类似侮辱的反应。提出了以持续、低抑制作用为特征的慢性状态与以调节性 T 细胞 (Treg) 的持续、高抑制作用为特征的慢性状态之间的区别。这种两类划分代表了达到慢性化的两种方式：（a）在损伤消失后很长一段时间内维持炎症反应（“低Treg”），或（b）在损伤消失之前抑制炎症反应（“高Treg”） 。这种两类划分一方面可以解释某些病原体与癌症之间的密切关联，另一方面可以解释其他几种病原体与自身免疫之间的密切关联。自身免疫性疾病与艾滋病毒感染之间的弱关联以及自身免疫性疾病与癌症之间相对较弱的关联也可能得到阐明。此外，该模型合理化了为什么对癌症有效的免疫调节药物对“高Treg”病毒感染也有效，而通常对自身免疫性疾病有效的皮质类固醇对其他“低Treg”疾病也有效（例如哮喘、特应性皮炎和“低 Treg”感染），但对实体恶性肿瘤和“高 Treg”感染无效。 此外，该模型还解释了为什么某些细菌会抑制肿瘤生长，以及为什么这些细菌会诱发自身免疫性疾病。


关键词： Treg细胞、癌症、自身免疫、炎症、慢性疾病、免疫治疗、皮质类固醇