Like a set of falling dominoes, something can go wrong in our bodies that sets off a chain of events leading to autoimmune disease. We know that alopecia areata (AA) is thought to be an autoimmune condition, but it is not well understood, and so Alopecia UK has joined a new partnership called Connect Immune Research, which aims to help researchers working in different fields to collaborate, share ideas and find new solutions.

On 5th May 2021, Alopecia UK’s Research Manager Julie Clayton, and Charity Development Manager Jen Chambers, joined a scientific meeting organised by Connect Immune Research, and supported by the Lorna and Yuti Chernajovsky Biomedical Research Foundation.

The meeting brought us together with our counterparts from the Juvenile Diabetes Research Foundation, Multiple Sclerosis Society, Versus Arthritis, and the British Society for Immunology, to hear some of the latest research on autoimmune conditions (also known as ‘inflammatory diseases’) such as rheumatoid arthritis, type 1 diabetes, psoriasis, inflammatory bowel disease and others. The central theme was that there are biological processes that many different inflammatory conditions have in common, and by understanding these better, there may be quicker routes to developing new treatments and devices that will benefit several conditions.

AA is condition that occurs when our immune system goes out of kilter and attacks hair follicles. But little is known about the details of how and why this happens in some people but not others.

AA has key features in common with other inflammatory diseases, for example, it occurs more often in women than in men (at a ratio of approximately 2:1), and people with AA are slightly more likely to have other autoimmune conditions as well, such as psoriasis. AA also involves cells such as T cells and macrophages which appear to be driving inflammation around hair follicles. And so it’s reasonable to assume that there may be various common mechanisms at play.

Luke O’Neill, Professor and Chair of Biochemistry at University College Dublin, likened autoimmunity to a domino effect, whereby a disturbance in the body – whether from an infection or other event - can lead to a massive imbalance in our immune systems. But frustratingly, “all we’ve done for the past 30 years is identify the dominoes.”

He drew attention to the little known Muckle Wells syndrome, where a new antibody-based treatment called Canakinumab raises hope for other disease areas. The treatment can dampen skin inflammation for at least 3 months per treatment.

“Why can’t all inflammatory disease be like that – with therapy that causes remission?” O’Neill asked.

The meeting heard about a whole range of research projects that could applied to different conditions. One example was the Human Cell Atlas which aims to provide a comprehensive reference map of all the cells of the human body. Sarah Teichmann of the Wellcome Sanger Institute, Cambridge, described it as “next generation pathology”, for understanding what different diseases have in common – the “shared pathways” – as well as what’s specific to each condition. The project has already begun mapping the cells of the lung, and their altered states in asthma, for example; and in skin, looking at the inflammatory conditions of psoriasis and eczema (atopic dermatitis).

Meanwhile, Paul Peter Tak, CEO at Candel Therapeutics, raised the tantalising prospect of harnessing the ‘cross-talk’ between the nervous system and the immune system. Animal studies – and now clinical trials – are beginning to show promise for the treatment of rheumatoid arthritis through electrical stimulation of the vagus nerve, to dampen down inflammation in the joints.

What’s also needed, however, besides great ideas and technologies, are the patients who can participate in clinical trials. Patient representatives spoke at the meeting, each with multiple autoimmune conditions, saying how they would like to take part in clinical research but that ironically, they have sometimes been excluded from clinical studies because they had multiple conditions. Indeed, as noted by Chris Buckley, Institute of Inflammation and Ageing Kennedy Professor of Translational Rheumatology at the Universities of Birmingham and Oxford, only 20% of patients take part in clinical research, often because they do not hear about research opportunities.

The Lorna and Yuti Chernajovsky Biomedical Research Foundation, set up in 2018 on the royalties of sales of interferon beta, a treatment for multiple sclerosis, is soon to launch a new funding programme to support more collaborative research in autoimmunity.

And Alopecia UK will be supporting one of the activities of Connect Immune Research, for researchers in the early stages of their careers to be able to visit and spend time in different laboratories.

“We really believe that everything is better the more connected you are with colleagues working on similar ideas across different tissues,” said Rachel Connor, Director of Research Partnerships at the Juvenile Diabetes Research Foundation.

Alopecia UK's Charity Development Manager Jen Chambers said: 

"When you have more than one condition with an autoimmune function it can be frustrating to see them all viewed in what can feel like a very singular, almost blinkered way.  You can’t help wondering if there is some kind of commonality underlying them all. It was so refreshing to be a part of this meeting and see researchers connecting the dots.  It was also exciting to hear from such a forward-thinking funder. We look forward to developing our relationship with Connect Immune Research over the coming years and helping to get the alopecia story heard, placing it firmly within the research agenda".

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