Rawlings David J, Metzler Genita, Wray-Dutra Michelle, Jackson Shaun W
Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington 98101, USA.
Department of Immunology, University of Washington School of Medicine.
Nat Rev Immunol. 2017 Jul;17(7):421-436. doi: 10.1038/nri.2017.24. Epub 2017 Apr 10.
Recent work has provided new insights into how altered B cell-intrinsic signals - through the B cell receptor (BCR) and key co-receptors - function together to promote the pathogenesis of autoimmunity. These combined signals affect B cells at two distinct stages: first, in the selection of the naive repertoire; and second, during extrafollicular or germinal centre activation responses. Thus, dysregulated signalling can lead to both an altered naive BCR repertoire and the generation of autoantibody-producing B cells. Strikingly, high-affinity autoantibodies predate and predict disease in several autoimmune disorders, including type 1 diabetes and systemic lupus erythematosus. This Review summarizes how, rather than being a downstream consequence of autoreactive T cell activation, dysregulated B cell signalling can function as a primary driver of many human autoimmune diseases.
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