Autoimmune Endocrine Diseases by Anthony P. Weetman (review)

BOOK REVIEWS Autoimmune Endocrine Diseases. By Anthony P. Weetman. New York: Cambridge University Press, 1992. Pp. 260. $59.95 (cloth). The essence of immunology, tolerance of self-proteins and elimination of foreign pathogens, is also the fundamental issue in the study of autoimmune endocrine diseases. With this consideration of the basic science, Dr. Weetman has summarized how recent advances in immunology have cast new light on our understanding of those ailments that comprise much of the practice of endocrinology. The first two introductory chapters of the book are a current review of basic concepts in immunology and immunogenetics. Newer fields of interest such as antigen presentation, T and B cell activation, co-stimulatory molecules, selfnonself -discrimination, and T and B cell ontogeny are discussed. Issues such as the development of self-tolerance mechanisms for maintaining nonreactivity to self-proteins and initiating events of autoimmune disease are given particular attention. There is also a background discussion of effector mechanisms, which have been postulated to be responsible for tissue destruction. The chapter on immunogenetics and autoimmunity concerns itself with the trigger of autoreactivity and includes structure/function relationships of MHC molecules as well as a discussion of statistical methods used in the analysis of genetic linkage. The data presented in these chapters represent a thoughtful summary of material from the basic science literature that is directly relevant to the study of autoimmune endocrine disease. The organization of these introductory chapters is used in the remainder of the book which deals with specific autoimmune endocrine diseases. Individual chapters are devoted to autoimmune thyroid diseases; insulin-dependent diabetes mellitus; adrenal, pituitary, and gonadal diseases. In each case, experiments from animal models are presented; and genetics, T and B cell responses, and effector mechanisms are discussed. The human diseases are then discussed in a similar framework, but also include data from treatment trials such as the use of immunosuppressives to treat new-onset insulin-dependent diabetes mellitus. The book is unique in a number of important ways. Most prevalent discussions of this subject included a laundry list of immunologic phenomena or conjecture about triggering events of disease without insight into disease mechanisms. Instead , the first two chapters of this book provide a succinct, insightful, and easy-to-comprehend review of fundamental concepts in immunology which Permission to reprint a book review printed in this section may be obtained only from the author. Perspectives in Biology and Medicine, 36, 4 ¦ Summer 1993 | 679 form a basis for approaching experimental data from disease systems. The material is presented at a level appropriate for the uninitiated, but investigators interested in further detail would more appropriately consult the original publications . This thoughtful distillation is a welcome addition to the field. It shows how earlier phenomenological data might be reinterpreted based on new findings in basic immunologic mechanisms, and it illustrates how new insights into the pathogenesis of autoimmune disease can be developed from current experimental methods. The sections dealing with specific diseases use, in general, the same mechanistic approach. Because most of the material is phénoménologie, it is often difficult to use it to understand mechanisms of pathogenesis. Where appropriate, Dr. Weetman has provided these insights, but in many cases, the significance of findings remains unknown. Unfortunately, the sections also tend to get bogged down because of the large amount of material reviewed. However, as a compendium of work in these fields, the book is comprehensive. For example, the references alone for the section dealing with autoimmune thyroid diseases are 31 pages long. It is hard to find omissions in these discussions. Both early, seminal work and the most recent findings, such as experiments with transgenic mice, are presented. The book is a valuable resource for investigators working in the field. The endocrinologist interested in developing his or her understanding of this rapidly evolving area will also find it a valuable, up-to-date resource, but the exhaustive review of the literature may be more than most individuals care to tackle. However , the discussions of mechanisms and reviews of the immunologic literature are particularly noteworthy and are essential reading for anyone interested in autoimmune endocrine diseases. Kevan C. Herold Department of Medicine University of Chicago 680 Book...