Abstract :
[fr] L'objectif de cet ouvrage est d'illustrer l'importance de l'immunoendocrinologie pour la compréhension de la pathogénie et le traitement des endocrinopathies auto-immunes, et des maladies inflammatoires, infectieuses, allergiques et néoplasiques, de même que le processus d'immunosénescence. Des experts internationaux de chaque domaine ont rédigé des chapitres à propos de maladies chroniques qui ont un impact majeur tant émotionnel qu'économique sur la société humaine.
Commentary :
Immuno(neuro)endocrinology was recognized as a scientific field early in the 20th century,
soon after immunology was identified as a specific domain of investigation. In the 1930s,
Hans Selye provided experimental evidence for and introduced the concept of stress–induced,
adrenal cortex–mediated immunosuppression. In the 1940s and 1950s the discovery
and chemical synthesis of glucocorticoids, and their introduction in the treatment of rheumatoid arthritis, represented a major advance in modern medicine recognized by the 1950 Nobel prize in medicine or physiology. However, the deciphering of the intricate cellular
and molecular interactions between the neural, endocrine, and immune systems was only
initiated in the 1970s and has received acceptance by immunologists and other scientists
gradually and somewhat reluctantly. Recently, the field of immunoendocrinology has been
expanding exponentially. This book covers some of the fundamental aspects of immunoendocrinology and its numerous and diverse clinical implications.
Interestingly, it is endocrinology, the science of cell-to-cell signaling and the medical
specialty dealing with the pathological consequences of disturbances in intercellular communication, that performed the first convincing studies in immunoendocrinology. Endocrinologists did not hesitate to open the door to this field and provide the first robust experimental evidence of its importance as a legitimate area of physiology. In retrospect, it should have been evident and utterly logical to have hypothesized such an intricate communication between the three major systems—the immune, nervous, and endocrine systems—that are responsible for maintaining resting and stress-related homeostasis within multicellular, complex organisms. Both the stability of the internal milieu and the adaptation to forces of the environment depend on these systems. It is also interesting to see this in the context of the evolutionary histories of the neuroendocrine and immune systems. In invertebrate species, the foundations of both the neuroendocrine system and innate immunity have coexisted seamlessly over the eons. Some 300 million years ago, adaptive immunity emerged in the first cartilaginous agnathan fish. Since then, a progressively evolving somatic gene recombination machinery appeared that is responsible for an increasingly complex generation of diverse immune receptors (B- and T-cell receptors) able to recognize and react to an almost infinite number of nonself antigens.
The emergence of an extremely sophisticated adaptive immunity defense system
exerted potent pressures for the creation of structures and mechanisms necessary to impose
self-tolerance, the inability of the immune system to attack the host organism. Together
with diversity and memory, self-tolerance is a fundamental intrinsic property of the immune
system. The progressive rise in the level of immune diversity and complexity may
explain why so many failures in self-tolerance (systemic and organ-specific autoimmune
diseases) are increasingly detected during evolution, with the maximum observed in the
human species. The first thymus appeared in cartilaginous fish (e.g., sharks and rays),
concomitantly with rudimentary forms of adaptive immunity. This organ stands at the
crucial intersection between the immune and neuroendocrine systems. Among all lymphoid
tissues, the thymus is unique in that it is the place where there is a constant confrontation
between ancient immune mechanisms and neuroendocrine principles, as well as a more
recently evolved system equipped with a machinery that stochastically generates adaptive
immune diversity. Because the program of intrathymic T-cell education is complex, mistakes
easily occur, leading to thymic output and enrichment of peripheral self-reactive
T-cells oriented against molecular and/or cellular components of the neuroendocrine system
and other systems. Thus, autoimmunity appears to be the tribute paid by mankind for
the complexity and efficiency of its immune defenses.
The immunological self-tolerance of the neuroendocrine system was an obvious
necessity, as explained in the first part of this volume. Many hormones and neuropeptides
influence the immune and inflammatory response through binding with and activation of
neuroendocrine receptors expressed on target immunocompetent cells. Physiologically,
neuroimmunomodulation plays a central role in the adaptation of immune defenses in
infectious, inflammatory, allergic, and neoplastic diseases, as well as during stress and
the process of aging. If self-tolerance to neuroendocrine ligands and receptors were not
firmly established, then the risk of developing autoimmune phenomena would be very
high and the integrity of the organism and the survival of the species would be seriously
compromised. The importance of coordinated neuroendocrine–immune interactions for the
harmonious development and function of the endocrine glands is thoroughly documented in
the first part of this book.
Our goal is to illustrate the clinical importance of immunoendocrinology in the
understanding of the pathogenesis and treatment of autoimmune endocrine disorders, as
well as of infectious, allergic, inflammatory, and neoplastic diseases, and the process of
natural senescence. In the second part of the book, prominent experts have written up-todate
chapters dealing with chronic diseases and conditions that have a tremendous emotional
and economic impact on human society.
It is our sincere hope that the fundamental and clinical perspectives of immunoendocrinology
offered in this volume will convince readers that this is a field of science useful
to both basic scientists and clinicians of most specialties. Indeed, endocrinology and
immunology have greatly contributed to better knowledge of the physiology of living
beings and the pathophysiology of many endocrine, immune, and other diseases. Endocrinologists should consider their specialty as embracing various fundamental aspects of
human life, including the immune and inflammatory reaction and its aberrations. Even if
they are not in charge of patients seen by experts of other specialized fields of medicine
or surgery—for instance, rheumatologists or intensivists—they should continue to play
an important integrative role by bringing new rational ideas and therapeutic options for
the final choice of their clinical management. The time for integrative science and medicine
has arrived and is here to stay. This volume is only a first glimpse of what is coming!
