Welcome to the 13th International Congress on Autoimmunity interactive program

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Coronavirus Disease 2019 (COVID-19) is a heterogenous disease with a high variability of clinical symptoms and complications. Here, immune perturbation is a hallmark with ambivalent roles of the involved immune compartments. Among other cell lineages, the plasma cell compartment, responsible for antibody production, is affected by this dichotomy between mounting fast immune defence and potentially deleterious autoimmunity: while neutralizing antibodies against protein structures of SARS-CoV-2 were produced as part of the physiological immune response, growing evidence hints towards a broad activation of plasma cells. Therefore, we have performed a systematic screening for abs confirming induction of diverse functional abs by SARS-CoV-2 infection, targeting several immunomodulatory proteins such as cytokines/chemokines and their respective receptors, which belong to the group of G-protein coupled receptors (GPCR). Abs against GPCR have been linked before to chronic diseases such as systemic sclerosis, sharing many clinical features with COVID-19, or to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), one of the most common symptoms in post-COVID-19 syndrome. In addition, as also shown before in autoimmune diseases, these abs reveal specific correlations with other antibodies and these correlations became disrupted with the severity of Covid-19 infection. We have identified several antibodies discriminating mild from severe live-threatening COVID-19 such as abs directed to the angiotensin receptor type-1 (AT1R). As recently identified, AT1R abs are involved in the development of interstitial lung disease as well as in skin inflammation and in fibrotic pathways. AT1R abs act on immune cells such as monocytes and induce a signalling via their Fab fragment to produce profibrotic and inflammatory cytokines and chemokines. In HEK cells, they only act synergistically with their natural ligand angiotensin II. We found a disruption of ab correlations depending on the severity of COVID-19. Other interesting anti-GPCR abs in COVID-19 infection are abs directed to the thrombin receptor PAR-1, which are linked to alterations in the coagulation system. COViD-19 infection is also characterized by increased abs directed to the chemokine receptor CXCR3, which were linked before to the presence of interstitial lung disease in systemic sclerosis. Taken together, our studies support our hypothesis that natural IgG abs cause and modulate diseases in general and not only autoimmune diseases. The identification of their individual function could explain physiology as well as pathophysiology and should be a focus to develop better therapies.

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Hippocrates stated, "Life is short but art is long". Contemporary physicians can diagnose disease conditions portrayed in old paintings.

More than 500 years ago, Dutch painters such as Jan van Eyck and Frans Hals painted excellent portraits showing people with Heberden’s nodules that were only described by William Heberden the Elder in 1802. In 1793, a Dutch physician, Eduard Sandifort, described osteoarthritis of the hip, whereas John Haygarth described in 1805 the polyarticular nature of osteoarthritis (OA). Until then, all forms of arthritis were regarded as manifestations of gout.

This is just one example of what doctors can learn from painters: artists are good observers and by studying the human body very carefully they painted diseases that were not even described in the medical literature. Furthermore, some patients with severe diseases were excellent artists and I propose that Art therapy may work as a good pain killer,

In my presentation, I will try to convince you that Learning Medicine through Art is a great joy. Moreover, I will try to convince you that training the eye may improve your skills to diagnose various diseases. Or as William Osler phrased it: "There is no more a difficult art to acquire than the art of observation".

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Autoantibodies are important parameters in the diagnosis of autoimmune diseases. Since the discovery of the first autoantibodies, many researchers and laboratories aimed to measure multiple antibodies simultaneously which led to the invention of several unique methods. During early days, countelectrophoresis became a popular tool followed by the introduction of westernblots and line immunoassays. Later on, planar and particle-based arrays were developed and deployed for multi-analyte testing as an integral part of autoimmune research and diagnostics. Although it seems intuitive to test multiple antibodies simultaneously, multiplex assays are not without challenges and drawbacks which include the pre-test probability and reimbursement limitations as well as technical roadblocks. Consequently, fully automated, random access, single analyte tests were developed and deployed to autoantibody testing. Due to the need for patient stratification in autoimmune diseases, the demand for more efficient and highly reliable multi-analyte assays continues. Here we provide a historical journey and important aspects of autoantibody profiling as part of autoimmune research and diagnostics.