The mirabilis period of autoimmunity




The development of autoimmunity and autoimmune diseases is believed to involve interactions between genes, hormones and the environment and was labelled in 1989 as ‘the mosaic of autoimmunity’. This complex interplay between the immune system and various stimuli that comprise the pebble of the mosaic is controlled by a wide array of mechanisms . In the last decade, there have been enormous strides in our understanding of autoimmune mechanisms which enabled us, to some extent, to predict and prevent diseases . The relationships between environmental factors such as infectious agents, vaccines, adjuvant and drugs as well as hormones such as vitamin D, ferritin and prolactin that can shift the immune perpendulum towards autoimmune inflammation have been extensively studied . Therefore, nowadays we aspire into an era where we can recommend preventive measurements that will ameliorate or postpone autoimmunity. Of which a proper diet, avoidance of exposure to certain hormones (i.e., oral contraceptive) or UV radiation, climatotherapy and the consumption of vitamin D have been reported . For instance, we have recently reported of an inverse association between vitamin D levels and thormoboses in patients with the anti-phospholipids syndrome . Moreover, in the same study the ability of vitamin D to prevent the production of tissue factor, an instrumental factor in the coagulation cascade, was documented, thus alluding to the notion that vitamin D may alter the main mechanism of thrombosis in this systemic autoimmune disease . Another aspect of this puzzle is the geo-epidemiology variability of autoimmune diseases. In other words, geo-epidemiology defines the crucial effects of different geographical areas, which represent diverse genetics susceptibilities and environmental factors, on determining which autoimmune disease will eventually develop. .


The diagnosis of autoimmune and auto-inflammatory diseases has always been a challenging task. The presence of autoantibodies, such as rheumatoid factor, anti-nuclear and anti-Cyclic Citrullinated Peptide (CCP) antibdoise, as well as newly recognised anti-pentraxin antibodies, in combination with diverse genetic markers have become central for early and accurate diagnosis of systemic diseases .


Last but not least the accumulated knowledge regarding systemic and organ-specific autoimmune diseases has opened a new horizon for target-oriented therapies. Intriguingly, it seems that once immune modulation is concerned, the resemblance between autoimmune diseases outweighs their differences. Thus, many of these novel targeted interventions were found to be beneficial in more than one autoimmune condition.


In the current issue of Best Practice and Research Clinical Rheumatology, we present 13 innovative papers that reveal the mosaic of autoimmune and auto-inflammatory diseases. The current issue starts with an elegant review by Muniz Caldas et al. on the above-mentioned pebbles of mosaic of autoimmunity. This is followed by Balbir A and Vincze M referral to specific pathogenic mechanisms in systemic sclerosis and inflammatory myopathies, respectively. The third arm of the mosaic, namely the sex hormone, is depicted by Perricone C et al. who analyse the impact of pregnancy on systemic autoimmunity. Classical diseases such as the anti-phospholipids syndrome , polymyalgia rheumatica , Sjogren’s syndrome , spondyloarthropthies , psoriatric arthritis , mixed connective tissue disease , familial Mediterranean fever and the undifferentiated connective tissue diseases are broadly reviewed, emphasising new diagnostic and therapeutically aspects.


This issue ends with a focus on one specific targeted therapy that represents the new era of biologic drugs . This new agent, Tocilizumab (anti-IL6), represents the huge change in our approach to therapy of autoimmune and rheumatic diseases. Tocilizumab was originally developed for the treatment of rheumatoid arthritis (RA) and systemic onset juvenile idiopathic arthritis (sJIA). The consideration of its mode of action has raised hope for its beneficial effect on a broad range of autoimmune and auto-inflammatory conditions.


We do hope that this issue will supplement the hottest issues in the field of autoimmunity, which will be further unravelled in the upcoming 8th International congress on autoimmunity in Granada (May 2012).




References



  1. *[1]. Shoenfeld Y., Blank M., Abu-Shakra M., Amital H., Barzilai O., Berkun Y., et al: The mosaic of autoimmunity: prediction, autoantibodies, and therapy in autoimmune diseases—2008. Israel Medical Association Journal 2008; 10: pp. 13-19

  2. [2]. Agmon-Levin N., Lian Z., and Shoenfeld Y.: Explosion of autoimmune diseases and the mosaic of old and novel factors. Cellular and Molecular Immunology 2011; 8: pp. 189-192

  3. [3]. Agmon-Levin N., and Shoenfeld Y.: Prediction and prevention of autoimmune skin disorders. Archives of Dermatological Research 2008; 301: pp. 57-64

  4. *[4]. Rubtsov A.V., Rubtsova K., Kappler J.W., and Marrack P.: Genetic and hormonal factors in female-biased autoimmunity. Autoimmunity Reviews 2010; 9: pp. 494-498

  5. *[5]. Kivity S., Agmon-Levin N., Blank M., and Shoenfeld Y.: Infections and autoimmunity–friends or foes? Trends in Immunology 2009; 30: pp. 409-414

  6. *[6]. Agmon-Levin N., Paz Z., Israeli E., and Shoenfeld Y.: Vaccines and autoimmunity. Nature Reviews Rheumatology 2009; 5: pp. 648-652

  7. [7]. Shoenfeld Y., and Agmon-Levin N.: ’ASIA’ – autoimmune/inflammatory syndrome induced by adjuvants. Journal of Autoimmunity 2011; 36: pp. 4-8

  8. [8]. Da Costa R., Szyper-Kravitz M., Szekanecz Z., Csépány T., Dankó K., Shapira Y., et al: Ferritin and prolactin levels in multiple sclerosis. Israel Medical Association Journal 2011; 13: pp. 91-95

  9. [9]. Praprotnik S., Agmon-Levin N., Porat-Katz B.S., Blank M., Meroni P.L., Cervera R., et al: Prolactin’s role in the pathogenesis of the antiphospholipid syndrome. Lupus 2010; 19: pp. 1515-1519

  10. *[10]. Cutolo M., Pizzorni C., and Sulli A.: Vitamin D endocrine system involvement in autoimmune rheumatic diseases. Autoimmunity Reviews 2011; 11: pp. 84-87

  11. [11]. Arnson Y., Amital H., Agmon-Levin N., Alon D., Sánchez-Castañón M., López-Hoyos M., et al: Serum 25-OH vitamin D concentrations are linked with various clinical aspects in patients with systemic sclerosis: a retrospective cohort study and review of the literature. Autoimmunity Reviews 2011; 10: pp. 490-494

  12. [12]. Powell J.J., Faria N., Thomas-McKay E., and Pele L.C.: Origin and fate of dietary nanoparticles and microparticles in the gastrointestinal tract. Journal of Autoimmunity 2010; 34: pp. J226-J233

  13. [13]. Shen L., Matsunami Y., Quan N., Kobayashi K., Matsuura E., and Oguma K.: In vivo oxidation, platelet activation and simultaneous occurrence of natural immunity in atherosclerosis-prone mice. Israel Medical Association Journal 2011; 13: pp. 278-283

  14. [14]. Harari M., Dramsdahl E., Shany S., Baumfeld Y., Ingber A., Novack V., et al: Increased vitamin D serum levels correlate with clinical improvement of rheumatic diseases after Dead sea climatotherapy. Israel Medical Association Journal 2011; 13: pp. 212-215

  15. *[15]. Agmon-Levin N., Blank M., Zandman-Goddard G., Orbach H., Meroni P.L., Tincani A., et al: Vitamin D: an instrumental factor in the anti-phospholipid syndrome by inhibition of tissue factor expression. Annals of Rheumatic Diseases 2011; 70: pp. 145-150

  16. *[16]. Selmi C., and Tsuneyama K.: Nutrition, geoepidemiology, and autoimmunity. Autoimmunity Reviews 2010; 9: pp. A267-A270

  17. [17]. Berkun Y., and Padeh S.: Environmental factors and the geoepideiology of juvenile idiopathic arthritis. Autoimmunity Reviews 2010; 9: pp. A319-A324

  18. [18]. Biggioggero M., and Meroni P.L.: The geoepidemiology of the antiphospholipid antibody syndrome. Autoimmunity Reviews 2010; 9: pp. A299-A304

  19. [19]. Borchers A.T., Naguwa S.M., Shoenfeld Y., and Gershwin M.E.: The geoepidemiology of systemic lupus erythematosus. Autoimmunity Reviews 2010; 9: pp. A277-A287

  20. [20]. Chen M., and Kallenberg C.G.: The environment, geoepidemiology and ANCA-associated vasculitides. Autoimmunity Reviews 2010; 9: pp. A293-A298

  21. [21]. Mavragani C.P., and Moutsopoulos H.M.: The geoepidemiology of Sjogren’s syndrome. Autoimmunity Reviews 2010; 9: pp. A305-A310

  22. *[22]. Selmi C.: The worldwide gradient of autoimmune conditions. Autoimmunity Reviews 2010; 9: pp. A247-A250

  23. *[23]. Lleo A., Invernizzi P., Gao B., Podda M., and Gershwin M.E.: Definition of human autoimmunity–autoantibodies versus autoimmune disease. Autoimmunity Reviews 2010; 9: pp. A259-A266

  24. [24]. Bassi N., Ghirardello A., Blank M., Zampieri S., Sarzi-Puttini P., Mantovani A., et al: IgG anti-pentraxin 3 antibodies in systemic lupus erythematosus. Annals of Rheumatic Diseases 2010; 69: pp. 1704-1710

  25. [25]. Iobagiu C., Magyar A., Nogueira L., Cornillet M., Sebbag M., Arnaud J., et al: The antigen specificity of the rheumatoid arthritis-associated ACPA directed to citrullinated fibrin is very closely restricted. Journal of Autoimmunity 2011; 37: pp. 263-272

  26. *[26]. Leung P.S., Shu S.A., Kenny T.P., Wu P.Y., and Tao M.H.: Development and validation of gene therapies in autoimmune diseases: epidemiology to animal models. Autoimmunity Reviews 2010; 9: pp. A400-A405

  27. [27]. Muniz Caldas C.A., and de Carvalho J.: The role of environmental factors in the pathogenesis of non-organ-specific autoimmune diseases. Best Pract Res Clin Rheumatol 2012; 26: pp. 5-11

  28. [28]. Balbir-Gurman A., and Braun-Moscovici Y.: Scleroderma – new aspects in pathogenesis and treatments. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 13-24

  29. [29]. Vincze M., and Danko K.: Idiopathic inflammatory myopathies. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 25-45

  30. [30]. Perricone C., de Carolis C., and Perricone R.: Pregnancy and autoimmunity: a common problem. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 47-60

  31. [31]. Taraborelli M., Andreoli L., and Tincani A.: Much more than thrombosis and pregnancy loss: the antiphospholipid syndrome as a “systemic disease”. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 79-90

  32. [32]. Soriano A., Landolfi R., and Manna R.: Polymyalgia rheumatica in 2011. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 91-104

  33. [33]. Peri Y., Agmon-Levin N., Theodor E., and Shoenfeld Y.: Sjögren’s syndrome the old and the new. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 105-117

  34. [34]. Ehrenfeld Michael: Spondyloarthropathies. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 135-145

  35. [35]. Vieira Duarte G., Faillace C., and de Carvalho J.: Psoriatic arthritis. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 147-156

  36. [36]. Ortega-Hernandez Oscar-Danilo, and Shoenfeld Yehuda: Mixed connective tissue disease: an overview of clinical manifestations, diagnosis and treatment. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 61-72

  37. [37]. Feld O., Yahalom G., and Livneh A.: Neurologic and other systemic manifestations in FMF: published and own experience. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 119-133

  38. [38]. Mosca Marta, Tani Chiara, Carli Linda, and Bombardieri Stefano: Undifferentiated CTD: a wide spectrum of autoimmune diseases. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 73-77

  39. [39]. Kaly L., and Rosner I.: Tocilizumab – a novel therapy for non organ specific autoimmune diseases. Best Practice and Research Clinical Rheumatology 2012; 26: pp. 157-165

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Nov 11, 2017 | Posted by in RHEUMATOLOGY | Comments Off on The mirabilis period of autoimmunity

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