Primary immunodeficiency and autoimmunity: A comprehensive review

Laura Amaya-Uribe, Manuel Rojas, Gholamreza Azizi, Juan Manuel Anaya, M. Eric Gershwin

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

The primary immunodeficiency diseases (PIDs) include many genetic disorders that affect different components of the innate and adaptive responses. The number of distinct genetic PIDs has increased exponentially with improved methods of detection and advanced laboratory methodology. Patients with PIDs have an increased susceptibility to infectious diseases and non-infectious complications including allergies, malignancies and autoimmune diseases (ADs), the latter being the first manifestation of PIDs in several cases. There are two types of PIDS. Monogenic immunodeficiencies due to mutations in genes involved in immunological tolerance that increase the predisposition to develop autoimmunity including polyautoimmunity, and polygenic immunodeficiencies characterized by a heterogeneous clinical presentation that can be explained by a complex pathophysiology and which may have a multifactorial etiology. The high prevalence of ADs in PIDs demonstrates the intricate relationships between the mechanisms of these two conditions. Defects in central and peripheral tolerance, including mutations in AIRE and T regulatory cells respectively, are thought to be crucial in the development of ADs in these patients. In fact, pathology that leads to PID often also impacts the Treg/Th17 balance that may ease the appearance of a proinflammatory environment, increasing the odds for the development of autoimmunity. Furthermore, the influence of chronic and recurrent infections through molecular mimicry, bystander activation and super antigens activation are supposed to be pivotal for the development of autoimmunity. These multiple mechanisms are associated with diverse clinical subphenotypes that hinders an accurate diagnosis in clinical settings, and in some cases, may delay the selection of suitable pharmacological therapies. Herein, a comprehensively appraisal of the common mechanisms among these conditions, together with clinical pearls for treatment and diagnosis is presented.

Original languageEnglish (US)
Pages (from-to)52-72
Number of pages21
JournalJournal of autoimmunity
Volume99
DOIs
StatePublished - May 1 2019

Fingerprint

Autoimmunity
Autoimmune Diseases
Central Tolerance
Peripheral Tolerance
Molecular Mimicry
Mutation
Inborn Genetic Diseases
Regulatory T-Lymphocytes
Communicable Diseases
Hypersensitivity
Pharmacology
Pathology
Antigens
Therapeutics
Infection
Genes
Neoplasms

Keywords

  • Autoimmune diseases
  • Autoimmunity
  • Immunodeficiencies
  • Immunologic deficiency syndromes
  • Primary immunodeficiency

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Primary immunodeficiency and autoimmunity : A comprehensive review. / Amaya-Uribe, Laura; Rojas, Manuel; Azizi, Gholamreza; Anaya, Juan Manuel; Gershwin, M. Eric.

In: Journal of autoimmunity, Vol. 99, 01.05.2019, p. 52-72.

Research output: Contribution to journalReview article

Amaya-Uribe, Laura ; Rojas, Manuel ; Azizi, Gholamreza ; Anaya, Juan Manuel ; Gershwin, M. Eric. / Primary immunodeficiency and autoimmunity : A comprehensive review. In: Journal of autoimmunity. 2019 ; Vol. 99. pp. 52-72.
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