Journal
AUTOIMMUNITY
Volume 50, Issue 1, Pages 19-24Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/08916934.2017.1280029
Keywords
IgG4-RD; CD4(+) CTL; fibrosis; lymphoplasmacytic infiltrate
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Funding
- Autoimmune Center of Excellence Award from the National Institutes of Health [U19 AI 110495]
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IgG4-related disease (IgG4-RD) is a systemic condition of unknown cause characterized by highly fibrotic lesions, with dense lymphoplasmacytic infiltrates containing a preponderance of IgG4-expressing plasma cells. CD4(+) T cells and B cells constitute the major inflammatory cell populations in IgG4-RD lesions. IgG4-RD patients with active, untreated disease show a marked expansion of plasmablasts in the circulation. Although the therapeutic depletion of B cells suggests a role for these cells in the disease, a direct role for B cells or IgG4 in the pathogenesis of IgG4-RD is yet to be demonstrated. Among the CD4(+) T-cell subsets, Th2 cells were initially thought to contribute to IgG4-RD pathogenesis, but many previous studies were confounded by the concomitant history of allergic diseases in the patients studied and the failure to use multi-color staining to definitively identify T-cell subsets in tissue samples. More recently, using an unbiased approach to characterize CD4(+) T-cell subsets in patients with IgG4-RD - based on their clonal expansion and ability to infiltrate affected tissue sites - CD4(+) CTLs have been identified as the major CD4(+) T-cell subset in disease lesions as well as in the circulation. CD4(+) CTLs in affected tissues secrete pro-fibrotic cytokines including IL-1, TGF-1, and IFN- as well as cytolytic molecules such as perforin and granzymes A and B. In this review, we examine possible mechanisms by which activated B cells and plasmablasts may collaborate with the expanded CD4(+) CTLs in driving the fibrotic pathology of the disease and describe the lacunae in the field and in our understanding of IgG4-RD pathogenesis.
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