Lopens Steffi, Krawczyk Marcin, Papp Maria, Milkiewicz Piotr, Schierack Peter, Liu Yudong, Wunsch Ewa, Conrad Karsten, Roggenbuck Dirk
Medipan GmbH, Dahlewitz, Germany.
Department of Medicine II, Saarland University Hospital, Saarland University, Homburg/Saar, Germany.
Auto Immun Highlights. 2020 Mar 16;11(1):6. doi: 10.1186/s13317-020-00129-x.
Unlike in other autoimmune liver diseases such as autoimmune hepatitis and primary biliary cholangitis, the role and nature of autoantigenic targets in primary sclerosing cholangitis (PSC), a progressive, chronic, immune-mediated, life threatening, genetically predisposed, cholestatic liver illness, is poorly elucidated. Although anti-neutrophil cytoplasmic antibodies (ANCA) have been associated with the occurrence of PSC, their corresponding targets have not yet been identified entirely. Genome-wide association studies revealed a significant number of immune-related and even disease-modifying susceptibility loci for PSC. However, these loci did not allow discerning a clear autoimmune pattern nor do the therapy options and the male gender preponderance in PSC support a pathogenic role of autoimmune responses. Nevertheless, PSC is characterized by the co-occurrence of inflammatory bowel diseases (IBD) demonstrating autoimmune responses. The identification of novel autoantigenic targets in IBD such as the major zymogen granule membrane glycoprotein 2 (GP2) or the appearance of proteinase 3 (PR3) autoantibodies (autoAbs) have refocused the interest on a putative association of loss of tolerance with the IBD phenotype and consequently with the PSC phenotype. Not surprisingly, the report of an association between GP2 IgA autoAbs and disease severity in patients with PSC gave a new impetus to autoAb research for autoimmune liver diseases. It might usher in a new era of serological research in this field. The mucosal loss of tolerance against the microbiota-sensing GP2 modulating innate and adaptive intestinal immunity and its putative role in the pathogenesis of PSC will be elaborated in this review. Furthermore, other potential PSC-related autoantigenic targets such as the neutrophil PR3 will be discussed. GP2 IgA may represent a group of new pathogenic antibodies, which share characteristics of both type 2 and 3 of antibody-mediated hypersensitive reactions according to Coombs and Gell.
与自身免疫性肝炎和原发性胆汁性胆管炎等其他自身免疫性肝病不同,原发性硬化性胆管炎(PSC)是一种进行性、慢性、免疫介导、危及生命、具有遗传易感性的胆汁淤积性肝病,其自身抗原靶点的作用和性质尚未得到充分阐明。虽然抗中性粒细胞胞浆抗体(ANCA)与PSC的发生有关,但其相应靶点尚未完全确定。全基因组关联研究揭示了大量与PSC相关的免疫相关甚至疾病修饰易感基因座。然而,这些基因座无法识别出明确的自身免疫模式,PSC的治疗选择和男性患病率也不支持自身免疫反应的致病作用。尽管如此,PSC的特征是炎症性肠病(IBD)的同时出现,而IBD表现出自身免疫反应。IBD中新型自身抗原靶点的鉴定,如主要的酶原颗粒膜糖蛋白2(GP2)或蛋白酶3(PR3)自身抗体(autoAbs)的出现,重新引发了人们对耐受性丧失与IBD表型以及因此与PSC表型之间假定关联的兴趣。不出所料,GP2 IgA自身抗体与PSC患者疾病严重程度之间关联的报告为自身免疫性肝病的自身抗体研究提供了新的动力。这可能会开创该领域血清学研究的新时代。本综述将阐述针对调节先天性和适应性肠道免疫的微生物群感知GP2的黏膜耐受性丧失及其在PSC发病机制中的假定作用。此外,还将讨论其他潜在的与PSC相关的自身抗原靶点,如中性粒细胞PR3。根据库姆斯和盖尔的分类,GP2 IgA可能代表一组新的致病抗体,它们具有抗体介导的超敏反应2型和3型的共同特征。
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