Laboratory Investigation of Autoimmune Endocrine Diseases

It is apparent that all possible approaches are being taken to gain insights into endocrine autoimmunity at the humoral, cellular and genetic levels. Central to the present limitations on understanding in all these areas is the incomplete appreciation of the basis of self-tolerance and its breakdown, although advances are certainly being made. At the practical level, it is therefore necessary to exercise caution in devising clinically applicable investigations. The most useful clinical information is still to be gained from screening for autoantibodies. The introduction of techniques like ELISA is making this screening more rapid, sensitive and quantitative although the nature of these tests and the limitations on availability of appropriate substrates means that IFL on tissue sections has not lost its usefulness. Improvements in autoantibody screening procedures should be possible as more is learnt of the autoantigens recognized through the appropriate applications of cell culture, biochemical techniques and monoclonal antibodies.

The pathogenic role of antibodies against hormone receptors is becoming more fully appreciated. It is therefore essential that simple, widely applicable assays be developed and standardized, bearing in mind that the effects of such antibodies on cell function must be taken into consideration.

Although less readily analysed than serum autoantibodies, cellular immunity is clearly important in autoimmune pathogenesis. Genetic associations are also apparent, but have yet to be clarified. Improvements in techniques in both of these areas should lead to means of analysis which are both more pertinent to the disease process and of greater practical application.