SHORT FEATURES and FACES ARTICLE
Synopsis of the Book
The Origin of Chronic Inflammatory Systemic Diseases and Their Sequelae
by Rainer H Straub
Chronic inflammatory systemic diseases (CIDs) are a burden to humans because approximately 10% of the population is affected by long-standing chronic inflammatory illness. The numbers would be extensively higher if one adds in the chronic smoldering inflammatory process of aging to the group of CIDs. Importantly, prevalence of CIDs continuously increased in the last decades.
While classical textbooks usually explained these diseases on the basis of caprices of the immune system and closely related hematopoietic pathways, other whole-body explanatory models are often omitted.
In this monograph, the author offers a new understanding of CIDs on the foundations of PsychoNeuroEndocrinoImmunology. The book starts with a historical summary of the classical findings in immunology that add to the understanding of CIDs.
This part of the book is followed by the current discussion of known psychoneuroendocrine immune pathways that are relevant in CID pathophysiology. While the demonstration of these novel pathways demonstrates proximate causal reasoning, thereafter, the book switches to more ultimate causes of chronic inflammation.
First, energy regulation and energy demand of the immune system are put into the CID context, which is followed by bodily volume regulation that is important for all cellular energy processes. Second, evolutionary medicine is introduced to help the reader comprehend ultimate causes of CIDs.
This part summarizes that genes and their programs used in CIDs are derived either from acute, highly energy-consuming situations, which are terminated in short time, or from programs that protect energy stores. With these two columns of ultimate explanation, the reader is guided through the chapter on systemic disease sequelae of CIDs, which nowadays determine mortality of affected patients.
It is demonstrated in detail how energy requirements, volume regulation, and evolutionary medicine explain appearance of many unwanted problems as demonstrated in the following list: sickness behavior, fatigue, depressive symptoms, sleep disturbances, anorexia and malnutrition, muscle wasting, cachexia, and cachectic obesity, insulin resistance, dyslipidemia, increase of adipose tissue in the proximity of inflammatory lesions, alterations of steroid hormone axes, disturbances of the hypothalamic-pituitary-gonadal axis, elevated sympathetic tone and local nerve fiber loss, hypertension, decreased parasympathetic tone, inflammation-related anemia, bone loss, hypercoagulability, circadian rhythms of symptoms, pregnancy immunosuppression and postpartum inflammation, and – finally – how mental stress influences CIDS.
This clinically applicable part of the book is continued by a short description of very similar sequelae during aging, where the same explanatory models are applied. Finally, the book ends with a theoretical chapter on perpetuation of CIDs. Here the author delineates the classical immunological pathways for perpetuation of CIDs, but it also adds a novel psychoneuroendocrine immune explanation that respects elements beyond the immune system.
The book has a vast list of more than 1800 references, and it provides an extensive word index. The book shows many novel aspects that are open-ended to leave much room for further definition and precision.
Dimidium facti qui coepit habet (he who has begun has the work half done).