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Immune system function: Sculpting a figure out of a block of stone.

Previously I have described the immune system as an orchestra with 1,000 instruments playing, and all playing in a certain pattern, timing, amplitude, etc - like instruments in an orchestra. All of those features matter- otherwise you go from Beethoven';s 9th symphony to atonalism. T cell regulation to T cell dysregulation.

Another model to describe the action is carving a sculpture (like Michelangelo's David, or the ancient Greek master of Venus de Milo) out of a block of stone. It requires precise action of destruction (carving out chunks of stone) and refinement (fine-tuning polishing the final surface), but both functions, which require many tools are going on at the same time together, but in different amplitudes and with different tools.

The same thing is true of the immune system, destruction and construction are happening essentially together- at the same time - for instance in response to a skin cut, or a bone break, or an infection... But with a 1,000 moving parts (and not 5 different hammers and 10 different chisels, and 10 different files), ongoing balanced destroying and creating, the yin yang of healing.

So in the immune system Tcells are facilitating/driving the destruction (strongly assisted by members of the Tcell Helper and effector groups) and construction (strongly facilitated by the Tcell suppressor group). These need to be in balance and their choreography seamless, as they are working at the same time, but in different strengths/amplitudes. It is not clear how this organization is happening, I do not think it is on the basis of a master conductor, but more like those huge flocks of small birds that can fly in the most remarkable rhythmic patterns, but without a conductor... innate recognition of patterns in systems.

T cells in regulation/harmony can create a magnificent sculpture out of a block of stone. Tcell dysregulation and the results vary from an unattractive abstract sculpture (chronic Lyme disease; Lupus; GDD) to a pile of stone chips (massive destruction cytokine storm).

How does one then try to help an immune system in trouble with dysregulation (Gd on board - not knowing what to do). The simplest things possible: because there are perhaps 10,000 things going on (including the hundreds of enzyme actions). If it is a metal: get it out with the most effective (highest stability) chelator available, but simultaneously dampen the host immune reaction. Provide nutrients in a way that the immune system can pick and chose what it needs (this generally means oral route preferred) as there are likely 100s of enzyme and other actions involved in the picking and choosing, and no one likes to be forced into receiving a truck load of someone's horded items, that they then have to figure out how to get rid of what they don't need/want (the equivalent of iv delivery). Sometimes simple helping with the ability to pick is needed in some individuals: methylated forms of vitamin Bs in MTHFR deficiency genetics. Overall though, less is more, as the likelihood of causing harm is probably greater than the likelihood of causing help. Like me arriving with a jack hammer and starting to hammer away at the block of stone Michelangelo is working on (with the intent of helping him): more harm than good.

Doing things well involves knowledge of many things, deft work, nuance, and careful consideration: with a general prevailing consideration: less is more. It seems easy: how hard is it to use a hammer, and to use a file... but it is not as easy as it looks. One of the expectations though if you are an artist running a large studio (Rembrandt, Van Dyke, Dale Chihuly), is that the various members of the school are doing what they are instructed to do. Unfortunately there is often an enormous tendency for humans to do what they think they should do (following unschooled gut instincts). One has to resist the tendency to purely self-treat. Although GDD does require a good collaboration between practitioner, and the subject involved, as a number of the treatment measures have to be modified for the particular individual as a team approach.

Richard Semelka, MD