journal article Jul 25, 2015

Human autoimmune diseases: a comprehensive update

Journal of Internal Medicine Vol. 278 No. 4 pp. 369-395 · Wiley
View at Publisher Save 10.1111/joim.12395
Abstract
Abstract
There have been significant advances in our understanding of human autoimmunity that have led to improvements in classification and diagnosis and, most importantly, research advances in new therapies. The importance of autoimmunity and the mechanisms that lead to clinical disease were first recognized about 50 years ago following the pioneering studies of Macfarlane Burnett and his Nobel Prize‐winning hypothesis of the ‘forbidden clone’. Such pioneering efforts led to a better understanding not only of autoimmunity, but also of lymphoid cell development, thymic education, apoptosis and deletion of autoreactive cells. Contemporary theories suggest that the development of an autoimmune disease requires a genetic predisposition and environmental factors that trigger the immune pathways that lead, ultimately, to tissue destruction. Despite extensive research, there are no genetic tools that can be used clinically to predict the risk of autoimmune disease. Indeed, the concordance of autoimmune disease in identical twins is 12–67%, highlighting not only a role for environmental factors, but also the potential importance of stochastic or epigenetic phenomena. On the other hand, the identification of cytokines and chemokines, and their cognate receptors, has led to novel therapies that block pathological inflammatory responses within the target organ and have greatly improved the therapeutic effect in patients with autoimmune disease, particularly rheumatoid arthritis. Further advances involving the use of multiplex platforms for diagnosis and identification of new therapeutic agents should lead to major breakthroughs within the next decade.
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Metrics
994
Citations
259
References
Details
Published
Jul 25, 2015
Vol/Issue
278(4)
Pages
369-395
License
View
Funding
National Institutes of Health Award: DK39588
National Natural Science Foundation of China Award: 81470837
Cite This Article
Lifeng Wang, Fu‐Sheng Wang, M. Eric Gershwin (2015). Human autoimmune diseases: a comprehensive update. Journal of Internal Medicine, 278(4), 369-395. https://doi.org/10.1111/joim.12395
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