When Expert Review of Clinical Immunology was launched in May 2005, G. Walter Canonica introduced the new journal with an editorial article titled ‘Expert Review of Clinical Immunology: a breakthrough in the future’. The key issues that he envisioned for this new journal were to ‘target a wide range of healthcare professionals’ with its innovative and user-friendly, concise, and highly informative online format, and to provide articles written by proven experts in the field providing analysis of new drugs, promising therapeutic strategies and emerging themes in clinical immunology’ Citation[1].
In its first decade of existence, Expert Review of Clinical Immunology has accomplished all of that and much more. Up to the writing of this introduction, the journal has published more than 1000 articles covering a wide range of topics at the intersection of immunology and clinical medicine. More than 1200 authors have contributed to the writing of these articles, including countless senior authors and proven experts in their fields. Since its launch, the impact factor of the journal has steadily risen and is currently at 3.342 (2013), indicating that the journal has achieved wide recognition and acceptance as a reputable source of information in the field of clinical immunology. We, the Senior Editors, are delighted to celebrate the past 10 years of Expert Reviews of Clinical Immunology with our colleagues, and are honored in cutting the ribbon for the next decade of its existence and significant contributions to this field. We will be joined in this endeavor by a distinguished group of authors covering important and timely issues in clinical immunology in this special edition of Expert Reviews of Clinical Immunology. Featured articles are:
Islet transplantation for Type 1 diabetes: where are we now? Citation[2]
Clinical management of multiple sclerosis and neuromyelitis optica with therapeutic monoclonal antibodies: approved therapies and emerging candidates Citation[3].
Primary immunodeficiencies: a decade of shifting paradigms, the current status and the emergence of cutting-edge therapies and diagnostics Citation[4].
Autoimmune disease in the epigenetic era: how has epigenetics changed our understanding of disease and how can we expect the field to evolve? Citation[5].
STING, nanoparticles, autoimmune disease and cancer: a novel paradigm for immunotherapy? Citation[6]
Biologicals for the treatment of systemic lupus erythematosus: current status and emerging therapies Citation[7].
The evolution of our understanding of macrophages and translation of findings toward the clinic Citation[8].
The evolution of allergen and nonspecific immunotherapy: past achievements, current applications and future outlook Citation[9].
Body fluid biomarkers in multiple sclerosis: how far we have come and how they could affect the clinic now and in the future Citation[10].
Down the line from genome-wide association studies in inflammatory bowel disease: the resulting clinical benefits and the outlook for the future Citation[11].
Virus-driven autoimmunity and lymphoproliferation: the example of HCV infection Citation[12].
The topics covered by these articles range from immunotherapy of autoimmune diseases, allergic conditions and cancer, all the way to basic immunologic research translated into the clinics, including genetics and ‘omics’ as modern tools for diagnosis and mechanistic insights. The common thread shared by these articles is the fundamental role of clinical immunology in shaping the future of a wide range of clinical conditions, be it via immunotherapy or by providing novel insights into disease etiology and pathogenesis. The 19th century has pointed to immunology as the gateway to prevent or cure many dreaded human disease conditions, and the 20th century has opened the door. However, in our view, it will be the 21st century that will find cures for diseases, such as Type 1 diabetes, MS, allergies and maybe even treatment of cancer. Now, more than ever, clinical immunology is at the forefront of medicine and the outstanding review articles presented in this issue make this abundantly clear. As editors, we have helped shape this special edition. As editors, researchers and clinicians, we would like to look into the crystal ball toward the coming decade and point out key areas where we foresee critical needs and important developments. The editors of the next 10-year edition (in 2025) will then have the opportunity to praise our insights, or to wag the finger at us, hopefully in good spirit. So what then are the key issues and developments of the coming decade from our individual perspectives?
Thomas Forsthuber: From my point of view, one of the key issues holding us back in developing better treatments for autoimmune diseases such as MS, and maybe finding the cure, is the lack of clinical tests to accurately predict disease recurrences, effectiveness of treatment and disease progression in individual patients. I envision that within the next decade, maybe even the next 5 years, we will develop biomarkers and laboratory tests that will allow us to personalize treatment of patients by guiding us to choose the right drugs at the right time for each individual. Development of sensitive and specific biomarkers of progressive disease will allow us to test and develop new drugs or rediscover old drugs to curb disease progression. It is highly likely that along the way we will discover that what we once thought was one disease, such as MS, is in reality comprised of multiple disease entities, possibly with different disease etiologies and different disease mechanisms necessitating different drugs. The second area where I hope we will make significant progress in the next decade concerns specific immunotherapy versus global (more or less) immunosuppression. Although pharmacologically certainly simpler, most current treatments for autoimmune diseases are non-specific and affect many immune- and non-immune cell populations. The ‘holy grail’ of specific immunotherapy has not been realized, despite a century of research in the field of autoimmune disease therapy. The field of allergology is ahead of us in this respect, and I admit I am envious (for our patients). Renewed efforts should be made to selectively eliminate or silence the few ‘bad’, that is, pathogenic autoreactive cells, as opposed to decimating or impairing the function of the entire immune system.
Timothy Radstake: From my angle, the biggest unmet need is the lack of the ability to predict who will get which disease, what therapy is needed for any specific patients and can we predict how long one would need therapy. Being able to know all these assets when seeing patients with chronic inflammation, infectious diseases, cancer and degenerative diseases would be the holy grail to personalized medicine. Currently, much of the research aimed to unravel disease pathogenesis and predict prognosis is very reductionistic in its setup. Although there is nothing wrong with trying to tackle highly specific research questions, understanding of a highly complex system such as our immune system will not be possible by such an approach. To achieve this higher goal, a more holistic approach is obligatory. The systems medicine approach is designed as such. Using various OMICS approaches, one should try to understand the complex interplay of pathways that orchestrates our immune system in an orderly but temporal and spatial fashion. Although the first attempts are underway, it is my general impression that we should really aim at getting all available information from various circulating immune cell subsets by applying high-throughput techniques, such as RNA sequencing, whole genome methylome profiling, identifying histone marks and combining this with data of the genome (whole genome sequencing) and the circulating proteome and metagenome. All this information must be obtained from the same patient. The integration of all of these data layers using computational analysis and computer-based learning approaches is hitherto unprecedented but highly needed to fully understand the disease. I believe that we will obtain many results coming forward from these approaches, and hopefully it will stand the test of experience and lead to more robust and useful data for translation into the clinics. I hope we will see much of this systems medicine approach in this journal in the coming 10 years.
In closing, we would like to conclude that the field of clinical immunology is blossoming more than ever and opportunity waits around every clinical corner. From the field of mucosal immunology to vaccinology, from autoimmune disease research to allergology, from immunotherapy of cancer to prevention and treatment of Ebola, clinical immunology has and will continue to be at center stage. We would therefore like to express our gratitude to the giants of this field on whose shoulders we stand and encourage the current and new generation of researchers to solve the above-mentioned riddles. The immune system is not going anywhere, and harnessing its power with the knowledge gained in the past and coming decades will be more important than ever. Our sincere congratulations to Expert Reviews of Clinical Immunology and its readers for the success of the past decade and our best wishes for the decade ahead!
Acknowledgements
We would like to sincerely thank J Patience, managing editor, for his outstanding and tireless efforts in conceiving and organizing this special edition. Without his help, this would not have been possible. We would furthermore like to thank I Forsthuber for excellent editorial and otherwise help in the writing of this article.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Additional information
Notes on contributors
Thomas G Forsthuber
Timothy RDJ Radstake
References
- Canonica GW. Expert review of clinical immunology: a breakthrough in the future. Expert Rev Clin Immunol 2005;1(1):1-2
- Ahearn AJ, Parekh JR, Posselt AM. Islet transplantation for Type 1 diabetes: Where are we now? Expert Rev Clin Immunol 2015;11(1):59-68
- Dubey D, Kieseier BC, Hartung HP, et al. Clinical management of multiple sclerosis and neuromyelitis optica with therapeutic monoclonal antibodies: Approved therapies and emerging candidates. Expert Rev Clin Immunol 2015;11(1):93-108
- Ebadi M, Aghamohammadi A, Rezaei N. Primary immunodeficiencies: a decade of shifting paradigms, the current status and the emergence of cutting-edge therapies and diagnostics. Expert Rev Clin Immunol 2015;11(1):117-39
- Jeffries MA, Sawalha AH. Autoimmune disease in the epigenetic era: how has epigenetics changed our understanding of disease and how can we expect the field to evolve? Expert Rev Clin Immunol 2015;11(1):45-58
- Lemos H, Huang L, McGaha T, Mellor AL. STING, nanoparticles, autoimmune disease and cancer: a novel paradigm for immunotherapy? Expert Rev Clin Immunol 2015;11(1):155-65
- Leone A, Sciascia S, Kamal A, Khamashta M. Biologicals for the treatment of systemic lupus erythematosus: current status and emerging therapies. Expert Rev Clin Immunol 2015;11(1):109-16
- Martinez FO, Gordon S. The evolution of our understanding of macrophages and translation of findings toward the clinic. Expert Rev Clin Immunol 2015;11(1):5-13
- Pajno GB, Nadeau KC, Passalacqua G, et al. The evolution of allergen and non-specific immunotherapy: past achievements, current applications and future outlook. Expert Rev Clin Immunol 2015;11(1):141-54
- Raphael I, Webb J, Stuve O, et al. Body fluid biomarkers in multiple sclerosis: how far we have come and how they could affect the clinic now and in the future. Expert Rev Clin Immunol 2015;11(1):69-91
- Spekhorst LM, Visschedijk MC, Weersma RK, Festen EA. Down the line from genome-wide association studies in inflammatory bowel disease: the resulting clinical benefits and the outlook for the future. Expert Rev Clin Immunol 2015;11(1):33-44
- Zignego AL, Gragnani L, Piluso A. Virus-driven autoimmunity and lymphoproliferation: the example of HCV infection. Expert Rev Clin Immunol 2015;11(1):15-31