Functional lab tests to evaluate immune competencies in chronic illness and chronic infection

Townsend Letter for Doctors and Patients,  Jan, 2006  by Russell Jaffe

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Aspects of immune function of clinical importance: Brief overview

This article addresses the following question: What immune defense and repair system (IDRS) functional tests evaluate individual health status in a way that allows diagnostically predictive and therapeutic outcome monitoring?

First, let us explore what we mean by functional tests. Lab tests that lead to specific clinical actions or that monitor specific outcomes qualify as functional. Practitioners who use functional tests include those who identify themselves as integrative, comprehensive, wholistic, predictive, or functional. As the conventional, mechanistic and reductionistic view has been well reviewed, this article will focus on functional, predictive tests as performed by integrative practitioners.

Second, our IDRS accounts for approximately 1% of our body's 100 trillion cells. These trillion immune competent cells are divided between dendritic and lymphocytic cells. Dendritic cells include macrophages and monocytes, granulocytes and fibroblasts, endothelial cells and Kupfer cells, Glial cells and sinusoidal cells in the spleen. Dendritic cells are the 'engulfers and recyclers' of the human body. Dendritic cells prevent us from developing an infection when they are robust and functional.

Immune competent defense and repair cells originally come from our bone marrow and mature in the thymus, spleen and lymph glands, particularly along the intestinal lining. The 'Peyer's patches' were considered vestigial until the 1980s when science rediscovered what they had been doing all along.

Third, photo-stimulated lymphocytes mature on traffic through the skin. This is essential for healthy immune cell development. Since many people do not get even 15 minutes of sunlight daily, this is an endemic and commonly overlooked cause of immune dysfunction. With a 1-mile walk outside each day or equivalent, this issue is easily resolved.

Fourth, the different cell lineages that develop all share one common objective; to identify and destroy all substances, living or inert, that are recognized as not being part of what our body "knows as itself" and is therefore tolerant and non-reactive toward.

In good health we are tolerant and homeostasis is active. This means we can neutralize any foreign invaders while keeping up with daily repair needs. Repair needs are based on wear and tear plus distress effects. This also means we can return to 'equilibrium' after the effects of the day during our time of restorative rest. The role of healthy immune system is to repair and keep the body resilient, flexible, and resistant. While most of us acknowledge this, our lack of attention in practice makes more difficult cases that would otherwise be easily resolved.

Homeostasis refers to systems that oscillate around a healthy mean with the capacity to restore and reset following stress or perturbation. Healthy human organ systems express homeostasis in, for example, PR interval variability, FEV1, oscillation of resting membrane potentials, temperature after rest, biorhythms, and hormonal responses to challenge (stress). The change induced by the 'stress' is easily modulated back to healthy equilibrium when we are in homeostatic balance.

In ill health we are reactive and homeostasis is lost. This is true when foreign invasion exceeds that capacity of our dendritic cells to engulf and recycle foreign invaders. Similarly, the rebalancing of our systems following a stress may be lost and we become 'stuck' in a non-restorative, reactive state. This is what is means to lose homeostasis.

The marvelous array of deftly interacting cells that defend our body against microbial invaders arise from a few precursor cells that first appear about 9 weeks after conception. From that point on, in healthy people, the cells of the immune system go through a continuously repeated cycle of growth and development and become fully competent at 6-9 months of age. The parent cells of our immune system are referred to as stem cells and these are the cells upon which the immune system depends--to both reproduce itself and give rise to the many specialized lineages that spring from it, the B cells, macrophages, killer T cells, helper T cells, etc.

Virtually all severe or chronic diseases have, to a greater or lesser degree, an element of immune dysfunction that is central to the disease process. The immune system is one of our primary and most critical systems and, among other things, helps to regulate our internal environment. It exerts its control by virtue of circulating components capable of acting at sites far removed from their points of origin. The complexity of this system rivals that of the nervous system, and in fact, the embryologic, physiologic, and functional similarities between the two are quite real. The more we learn about them, the clearer it is becoming that both systems share the same information transmitters and cell receptors.

Indeed, the data suggests that there is a common control system in the body made up of the integration of neurochemical, hormonal, and immune systems. There may be 3 aspects of one integrated control system for the body that appear to me to be integrated as what TCM describes as the 'governing vessel' or 'governing circuit.'