Anti-cytokine autoantibodies suggest pathogenetic links with autoimmune regulator deficiency in humans and mice

J Kärner, A Meager, M Laan… - Clinical & …, 2013 - academic.oup.com
J Kärner, A Meager, M Laan, J Maslovskaja, M Pihlap, A Remm, E Juronen, ASB Wolff…
Clinical & Experimental Immunology, 2013academic.oup.com
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is a
recessive disorder resulting from mutations in the autoimmune regulator (AIRE). The
patients' autoantibodies recognize not only multiple organ-specific targets, but also many
type I interferons (IFNs) and most T helper type 17 (Th17) cell-associated cytokines, whose
biological actions they neutralize in vitro. These anti-cytokine autoantibodies are highly
disease-specific: otherwise, they have been found only in patients with thymomas, tumours …
Summary
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is a recessive disorder resulting from mutations in the autoimmune regulator (AIRE). The patients' autoantibodies recognize not only multiple organ-specific targets, but also many type I interferons (IFNs) and most T helper type 17 (Th17) cell-associated cytokines, whose biological actions they neutralize in vitro. These anti-cytokine autoantibodies are highly disease-specific: otherwise, they have been found only in patients with thymomas, tumours of thymic epithelial cells that fail to express AIRE. Moreover, autoantibodies against Th17 cell-associated cytokines correlate with chronic mucocutaneous candidiasis in both syndromes. Here, we demonstrate that the immunoglobulin (Ig)Gs but not the IgAs in APECED sera are responsible for neutralizing IFN-ω, IFN-α2a, interleukin (IL)-17A and IL-22. Their dominant subclasses proved to be IgG1 and, surprisingly, IgG4 without IgE, possibly implicating regulatory T cell responses and/or epithelia in their initiation in these AIRE-deficiency states. The epitopes on IL-22 and IFN-α2a appeared mainly conformational. We also found mainly IgG1 neutralizing autoantibodies to IL-17A in aged AIRE-deficient BALB/c mice – the first report of any target shared by these human and murine AIRE-deficiency states. We conclude that autoimmunization against cytokines in AIRE deficiency is not simply a mere side effect of chronic mucosal Candida infection, but appears to be related more closely to disease initiation.
Oxford University Press