Endocrinology and Metabolism – serie

Bilateral Communication Between the Endocrine and Immune Systems, Volume 7 in the Springer-Verlag Endocrinology and Metabolism Series, offers the most current information and recent advances in the area of communication and regulation between the Immune and Endocrine Systems. Immune-Endocrine Interactions are reported to play pivotal roles in both activation and down-regulation of immune responses and this volume provides the most up-to-date research and findings on the immune-endocrine relationship. The contributing authors are internationally recognized experts in this area and have written chapters on such diverse topics as Interactions between the Pituitary and Immune Systems, Effects of Estrogens and Androgens on Immune Response, The Role of Sex Steroids in Immune System Regulation, and Neuroendocrine and Thymus Interactions During Development and Aging. This volume is a must for all endocrinologists and endocrinology residents.

Omnis cellula e cellula, "every cell from a cell," was dogma to the 19th­ century cellular physiologist and the cornerstone of Virchow's Cellular­ pathologie. "Spread out a cell into a layer and you will find that, in ceasing to be a cell, it has ceased to act as such," wrote the British 1 physiologist G . R. Lewes more than a century age. "The cell remains vital as long as its wall remains intact . . . " keeping its content "pure and clear" and thus preserving the "vital principle" within, echoed Claude 2 Bernard a few years later. The notion of the cell membrane as a pro­ tecting envelope held sway until it became clear that it could not account for the "coalescence" of poorly differentiated embryonic "vesicles" and for their transformation into "cell-like structures" capable of auto­ regulation and yet subject to what the grandfather of one of us defined as the "federal obligations imposed by the whole organism. ,,3 A new concept was needed, and soon the membrane was described as a structure capable of uniting as well as separating adjacent cells. Morphologic evidence for this dual function was obtained several years later when the electron microscope revealed the existence of tight and gap junc­ tions which, acting as intercellular bonds and channels, allowed the cells to communicate with one another and thus coordinate their biologic activities.

Bilateral Communication Between the Endocrine and Immune Systems, Volume 7 in the Springer-Verlag Endocrinology and Metabolism Series, offers the most current information and recent advances in the area of communication and regulation between the Immune and Endocrine Systems. Immune-Endocrine Interactions are reported to play pivotal roles in both activation and down-regulation of immune responses and this volume provides the most up-to-date research and findings on the immune-endocrine relationship. The contributing authors are internationally recognized experts in this area and have written chapters on such diverse topics as Interactions between the Pituitary and Immune Systems, Effects of Estrogens and Androgens on Immune Response, The Role of Sex Steroids in Immune System Regulation, and Neuroendocrine and Thymus Interactions During Development and Aging. This volume is a must for all endocrinologists and endocrinology residents.

It has been a challenge for us to edit this volume of Endocrinology and Metabo­ lism: Progress in Research and Clinical Practice. The topic of the pathogenesis of insulin-dependent, type I diabetes mellitus is particularly appropriate for this series, since advances in this area have been made, to a large extent, by applying state-of-the-art laboratory techniques to clinical samples. Over the last several years, a number of lines of evidence have been gathered, suggesting that classic type I diabetes mellitus results from the autoimmune des­ truction of pancreatic beta-cells in genetically susceptible individuals. This hypothesis is particularly appealing because it offers a rational approach to the prevention of diabetes by immunosuppression. We have tried to present a balanced, authoritative summary of the information currently available to support the autoimmune hypothesis for the pathogenesis of human type I diabetes, to place this information in historical perspective, to include relevant information from animal models of type I diabetes in which more invasive experimentation is ethical, and, finally, to update the reader on the current status of attempts to intervene in the progression of diabetes with immunosuppressive drugs. New York, New York Fredda Ginsberg-Fellner Robert C. McEvoy Contents Preface.. . . .. .. .. . . . . . . . . . . . . ... . . . . . . . . . . . .. . . . . . . .. . . . . v Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xl . . . . . . . . . . . . . 1. The Autoimmune Hypothesis of Insulin-Dependent Diabetes: 1965 to the Present . . . . . . . . . . . . ..................... . . . . . .

In the middle of the 17th century, the great French philosopher Rene Descartes wrote (L'Homme, J. Le Gras, Paris, 1669) that a suitable stimulation of the brain results in two types of "movements": exterior movements, designed to seek desirable ends and to avoid undesirable or harmful ones and interior movements or "passions" which through the release of "animal spirits" regulate the heart, the liver, and other organs. When it appears appropriate to meet a threat with force, the passion of rage causes the release of strong spirits, whereas when avoidance appears to be the better choice, the passion of fear causes the brain to release weak spirits. We do not know what influence, if any, Descartes had on the thinking of Walter B. Cannon (Bodily Changes in Pain, Hunger, Fear and Rage, Appleton and Co. , New York, 1920), of Hans Selye (The Story of the Adaptation Syndrome, Acta, Inc. , Montreal, 1952), ofG. W. Harris or of R. Guillemin (Hypothalamic-Hypophysial Interrelationships. A Sym­ posium. c. c. Thomas, Springfield, 1956), but it is interesting to reflect upon the durable value of great ideas which constantly resurface even if modified by other ideas and by new techniques, as if propelled by a preordained intellectual imperative.

As I read this unique volume on diabetes and pregnancy edited by Lois Jovanovic, I was struck by two themes that run throughout these collected chapters. First, this volume provides an excellent assessment of past problems, present management, and future challenges presented by dia­ betes in pregnancy. Orury's unique, longitudinal experience with diabetes iIi pregnancy provides the reader with an important overview, as does Coetzee's discussion of gestational diabetes. Current problems-deter­ mining the etiology and prevention of congenital malformations in infants of diabetic mothers (10M), assessment of antepartum fetal condition, management of pregnant patients with diabetic retinopathy, recognition of thyroid dysfunction in the pregnant diabetic woman, and understanding the multitude of metabolic sequelae observed in the 10M-are thoroughly reviewed. Finally, important considerations for future treatment and ther­ apy such as the adaptation of the fetal pancreas to the disordered intra­ uterine environment often seen in maternal diabetes, the use of fetal pan­ creatic tissue for transplantation, the application of exercise in the management of the pregnant woman with diabetes, and the long-term con­ sequences for the 10M provide an exciting glimpse into the future. The second important theme that emerges is the critical role the problem of diabetes in pregnancy has played in our understanding of maternal and fetal physiology. Clinical observations supported by basic research have emphasized the role of fetal fuels in teratogenesis.

Endocrinology and Metabolism: Progress in Research and Clinical Prac­ tice is a new series that has been designed to present timely, critical reviews of constantly evolving fields; to provide practical and up-to-date guidance in the solution of pertinent clinical problems; to offer an alterna­ tive to the laborious search of the literature (and the often frustrating reading of highly technical articles); and to translate the language of the laboratory into that of the practice of medicine. We think that this volume and those to come will prove useful to physi­ cians (and to physicians in training), as well as to investigators in a wide variety of specialties; in short, to anyone who seeks answers to questions in endocrinology and metabolism. The first chapter of this volume could well serve as a general introduc­ tion to the entire series. It points out how our growing understanding of the molecular basis of biologic communication has led to the discovery of a growing number of clinical syndromes, as well as to the realization that phenotypically similar diseases may have radically different pathogenetic mechanisms and thus may require radically different therapeutic strata­ gems.