Ciclosporin and Autoimmune Disease — an Overview

We have been treated this week to a tantalizing smorgasbord of acute and chronic inflammatory diseases (generally grouped under ‘suspected autoimmune diseases’) which, with one exception, has been a very selective and anecdotal sampling from a very large menu. Some of these anecdotal studies have impressed on us that we have seen an effect of ciclosporin, and encourage us to go back for more. And to complete the analogy, I have to tell you that some of them have only left a bad taste in our mouths! Overall however, the scientists looking at autoimmune diseases in the human would like to ask the question: “Does ciclosporin cause a significant change in the immune response relevant to the disease?” (Fig. 1). But, as we have seen, in most of these disorders we have a ‘black boxphenomenon’ — that is, we are studying diseases in which the primary clinical measurements are those of effects of inflammation, but for which in the majority of cases we do not know the relevant immune responses or have no reliable in vitro measurements of them.