Predictive medicine in autoimmune diseases: from the identification of genetic predisposition and environmental influence to precocious immunotherapy.

Early therapy made possible by the predictive tests discussed above, using selective or even antigen-specific therapy, opens the way to more radical and much more innocuous therapeutic approaches of major AIDs. It should be realized, however, that before the putative autoantigens have been identified, immunotherapy must be based on nonantigen-specific agents. The results recently obtained in NOD mice indicate that the goal of nontoxic, long-lasting immune protection from the disease is feasible if treatment is started early enough. In some cases (anti-T cell monoclonal antibodies), it appears that specific unresponsiveness can be induced even in the absence of a concomitant administration of the autoantigen. In the case of IDDM, one must convince clinical diabetologists, patients, and their families that immunoprevention of the disease will only be achieved if research on both prediction and immunotherapy proceeds hand in hand: prediction programs are difficult to run without proposing access to preventive therapy, and the search for therapy cannot be successful without access to prediabetics or patients with preclinical diabetes and they can only be identified in prediction clinics. In brief, the two research approaches, prediction and specific therapy, have to be carried out in parallel until their convergence allows the final immunoprevention of the disease.