Zizzle,
Interesting consultation. Thanks for sharing.
Incidentally, regarding this:
Zizzle wrote:If my disease is caused by failure to clear dying/dysfuncional cells
FWIW, all AI diseases are caused by the failure to clear dead or injured cells including those marked for destruction by the process of apoptosis.
In case you might be interested in my views on how healing actually proceeds and how compromised healing relates to AI diseases, here is a discussion of that topic from
Vitamin D and Autoimmune Disease
Healing is the process by which damaged, diseased, or dead tissue is replaced with new, healthy tissue. Healing can occur by two different mechanisms.
1. Damaged cells can be replaced by new healthy cells in a regeneration process, so that the exact original configuration of the tissue is restored
2. The damaged issue can be repaired, and in this case it is replaced by scar tissue
The normal process of healing human tissue seems like a paradox at first glance.
It would seem logical that healing would begin with a calming, soothing process. But instead, healing begins with inflammation. During this initial stage of healing, the area becomes reddened, and tender, and swelling occurs as fluids accumulate in the tissues due to the leakage of serum from nearby blood vessels. In most cases, healing involves both of these methods (both replacement of some cells, and repair of others), especially in the healing of wounds.
The organs of the body are comprised of various types of tissue, and different types of tissue perform different functions. Regardless of its functional purpose, tissue is made up of individual cells, many of them having a specialized design, making them uniquely suitable for the job they are designed to do.
Cells are supported and held in place by either a basement membrane or a network of connective tissue (known as collagen). Normally when cells are damaged, the connective tissue is not destroyed and therefore it will still be functional even if the cells adjacent to it are dead. As long as the connective tissue is intact, cellular damage can be healed by regenerating new cells, identical to the original cells.
Before damaged cells can be replaced however, they must be removed, so they are marked by the immune system for destruction as part of the process of programmed cell death. This is the same mechanism used by the body for normal replacement of cells that are old and are scheduled for routine replacement on a regular schedule. The medical term for programmed cell death is "apoptosis".
Certain cells cannot be healed simply by the regeneration of new cells to replace the damaged ones. They can only be healed by repair (which results in the formation of scar tissue). Such cells include muscles in the heart and neurons used by the central nervous system, or those used by the enteric nervous system (which controls the digestive system and communicates with the central nervous system). In any situation where the connective tissue network of collagen is damaged, such damage must be repaired, resulting in the creation of scar tissue.
If the damage is due to an incision or a wound, the first step in the healing process will be clot formation in order to stop the bleeding. While the loss of blood is typically viewed as undesirable, it is in fact very helpful for washing away pathogens to which the wound may have been exposed, such as bacteria, viruses, and fungi. The clot which forms to stop the bleeding is the next barrier which helps to prevent infectious agents from entering the body or the bloodstream. Lymphocytes (white blood cells) will then infiltrate into the injured tissue to initiate the inflammation process. In the case of a wound or incision, the lymphocytes will typically be neutrophils. These will be followed by macrophages and other cells that are sent by the immune system to clean up any remaining invaders that shouldn't be there (such as bacteria, viruses, and fungi). All of the resulting debris, including any remaining original dead or damaged cells, fluids, and any residues from the destruction of both damaged cells and pathogens, must be removed from the site in order for healing to proceed.
The matrix comprised of connective tissue (made of collagen) that holds all the cells together in the proper shape, contains fibroblasts, which are present in all connective tissue for the express purpose of maintaining and repairing collagen. Fibroblasts are special cells that contain all the raw materials needed to reconstruct the collagen-based matrix. Growth hormones and other chemicals are released during the debriding (cleanup) process, in order to encourage the fibroblasts to produce new collagen to fill the void left by an open wound. When the healing process is complete, a scar will mark the area where the repair was made.
Infection does not actually generate inflammation.
While we normally tend to think that inflammation is caused by an infection of some type, that's not really true. The inflammation is actually due to our body's response to the infection, as our immune system attempts to destroy the invaders, and this is a critical distinction. Normally this process works well. But if the inflammation fails to end the threat, then the inflammation will continue indefinitely and lead to unanticipated consequences — consequences that the immune system is not designed to handle.
Consider the intestinal inflammation associated with inflammatory bowel disease. With an IBD, cellular damage is not a simple discrete event. Instead, the propagation of new damage is perpetuated by the autoimmune process, so that at virtually any instant in time, new damage is continually being generated by the inflammatory reactions that are taking place. As long as new inflammation is being generated, there is always additional debris that needs to be removed. Therefore, the healing process effectively becomes stuck at the first stage, and cannot proceed, because the ongoing inflammatory process associated with an IBD results in a chronic cycle of damage.
Damage caused by inflammation in the intestines heals very slowly.
Even after the inflammation is stopped, healing of intestinal tissue takes much longer than would normally be expected when compared with the healing of other organs in the body.. I'm not aware of any research studies that have been done in an attempt to determine healing times associated with Crohn's disease or ulcerative colitis, but this has been done with celiac disease (which is actually an inflammatory bowel disease). With celiac disease, treatment consists of adopting a gluten-free diet. But even after a gluten-free diet is adopted and clinical symptoms disappear, physical healing of the cells in the mucosa of the small intestine actually progresses very, very slowly.
Kids heal much faster than adults.
Follow-up research shows that except in pediatric cases (kids heal much faster than adults), healing typically requires at least 3 to 5 years, or longer (in adults).1, 2 It's a fact of life that as we age we heal more slowly, unfortunately. And in some cases, the damage never completely heals. It's not known whether this is due to some degree of continuing inflammation resulting from a less-than-perfect diet, or whether the aging process results in a diminished healing capacity. It's also possible that untreated autoimmune conditions that persist for years may result in damage that eventually becomes permanent. Whatever the reason, this suggests that inflammation typically lingers much longer than would be expected (based on the absence of clinical symptoms), under the prevailing circumstances. And the result of course is much slower healing than most people (including many physicians) expect.
This phenomenon whereby the healing process becomes stuck in the first stage, is not limited to the inflammatory bowel diseases. It is apparently true for all autoimmune-associated diseases. The inflammation continues indefinitely because the healing process is prevented from proceeding normally. Some healing occurs, but it is repeatedly disrupted by new inflammation.
And here are the references from that quote:
1. Rubio-Tapia, A., Rahim, M. W., See, J. A., Lahr, B. D., Tsung-Teh Wu, T-T., & Murray, J. A. (2010). Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. The American Journal of Gastroenterology, 105(1), 1,412–1,420. doi:10.1038/ajg.2010.10
2. Bardella, M. T., Velio, P., Cesana, B. M., Prampolini, L., Casella, G., Di Bella, C., . . . Villanacci, V. (2007). Coeliac disease: A histological follow-up study. Histopathology, 50(4), 465–471. Retrieved from
http://www.ingentaconnect.com/content/b ... 4/art00008
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