Immunological Mechanisms Implicated in the Pathogenesis of Chronic Urticaria and Hashimoto Thyroiditis
Abstract
Autoimmunity represents the attack of the immune system of an organism against its own cells and tissues. Autoimmune diseases may affect one organ (Hashimoto thyroiditis) or can be systemic (chronic urticaria). Many factors are implicated in the pathogenesis of autoimmunity (white cells, cytokines, chemokines). Hashimoto thyroiditis has been associated with chronic urticaria in the last 3 decades in a number of clinical studies. Anti-thyroid antibodies have been documented in a proportion ranging from 10% to 30% in chronic urticaria patients in different countries from 3 continents. Two of the factors involved in the mechanism of autoimmunity are present both in the pathophysiology of Hashimoto thyroiditis and chronic urticaria. According to recent studies, IL6 is implicated in the pathogenesis of both diseases. TregsCD4+CD25+Foxp3+ cells have also been implicated in the pathological mechanisms of these 2 entities. This review offers an explanation of the clinical and statistical association between these two diseases from the pathophysiological point of view.
1. Poletaev AB, Churilov LP, Stroev YI, Agapov MM. Immunophysiology versus immunopathology: Natural autoimmunity in human health and disease. Pathophysiology 2012; 19(3):221-31.
2. Edwards JC, Cambridge G. B-cell targeting in rheumatoid arthritis and other autoimmune diseases.Nat Rev Immunol 2006; 6(5):394-403.
3. Kubach J, Becker C, Schmitt E, Steinbrink K, Huter E, Tuettenberg A, et al. Dendritic cells: sentinels of immunity and tolerance. Int J Hematol 2005; 81(3):197-203.
4. Srinivasan R, Houghton AN, Wolchok JD. Induction of autoantibodies against tyrosinase-related proteins following DNA vaccination: unexpected reactivity to a protein paralogue. Cancer Immun 2002; 2:8.
5. GreenRS, Stone EL, Tenno M, Lehtonen E, Farquhar MG, Marth JD. Mammalian N-glycan branching protects against innate immune self-recognition and inflammation in autoimmune disease pathogenesis. Immunity 2007; 27(2):308-20.
6. McGonagleD, McDermottMF. A proposed classification of the immunological diseases. PLoS Med 2006; 3(8):e297.
7. Doble ND, Banga JP, Pope R, Lalor E, Kilduff P, McGregor AM. Autoantibodies to the thyroid microsomal/thyroid peroxidase antigen are polyclonal and directed to several distinct antigenic sites. Immunology1988; 64(1):23-9.
8. Hiromatsu Y, Satoh H, Amino N. Hashimoto's thyroiditis: history and future outlook. Hormones 2013; 12(1):12-8.
9. McLachlan SM, Rapoport B. Breaking tolerance to thyroid antigens: changing concepts in thyroid autoimmunity.Endocr Rev2014; 35(1):59-105.
10. Swain M, Swain T, Mohanty BK. Autoimmune thyroid disorders-An update. Indian J ClinBiochem 2005; 20(1):9-17.
11. Pyzik A, Grywalska E, Matyjaszek-Matuszek B, Roliński J. Immune disorders in Hashimoto's thyroiditis: what do we know so far? J Immunol Res 2015; 2015:979167.
12. Popko K, GórskaE. The role of natural killer cells in pathogenesis of autoimmune diseases. Cent Eur J Immunol 2015; 40(4):470-6.
13. Dong YH, Fu DG. Autoimmune thyroid disease: mechanism, genetics and current knowledge. Eur Rev Med Pharmacol Sci 2014; 18(23):3611-8.
14. Dubska M, Banga JP, Plochocka D, Hoser G, Kemp EH, Sutton BJ, Gardas A, Gora M.Structural insights into autoreactive determinants in thyroid peroxidase composed of discontinuous and multiple key contact amino acid residues contributing to epitopes recognized by patients' autoantibodies. Endocrinology 2006; 147(12):5995-6003. Epub 2006 Sep 7.
15. Rho MH, Kim DW, Hong HP, Park YM, Kwon MJ, Jung SJ, et al. Diagnostic value of antithyroid peroxidase antibody for incidental autoimmune thyroiditis based on histopathologic results. Endocrine 2012; 42(3):647-52.
16. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev 2014; 13(4-5):391-7.
17. Burek CL, Talor MV. Environmental triggers of autoimmune thyroiditis. J Autoimmun 2009; 33(3-4):183-9.
18. Saboori AM, Rose NR, Bresler HS, Vladut-Talor M, Burek CL. Iodination of human thyroglobulin(Tg) alters its immunoreactivity. I. Iodination alters multiple epitopes of human Tg. Clin ExpImmunol 1998; 113(2):297–302.
19. Saboori AM, Rose NR, Burek CL. Iodination of human thyroglobulin (Tg) alters its immunoreactivity.II. Fine specificity of a monoclonal antibody that recognizes iodinated Tg. Clin. Exp.Immunol 1998; 113:303–8.
20. Rasooly L, Rose NR, Saboori AM, Ladenson PW,
Burek CL. Iodine is essential for human T cell recognition of human thyroglobulin. Autoimmunity 1998; 27(4):213–9.
21. Carayanniotis G. Molecular parameters linking thyroglobulin iodination with autoimmune thyroiditis. Hormones (Athens) 2011; 10(1):27-35.
22. Li HS, Jiang HY, Carayanniotis G. Modifying effects of iodine on the immunogenicity of thyroglobulin peptides. J Autoimmun 2007; 28(4):171-6.
23.Czarnocka B. Thyroperoxidase, thyroglobulin, Na(+)/I(-) symporter, pendrin in thyroid autoimmunity. Front Biosci 2011; 16:783-802.
24. Yoshida A, Hisatome I, Taniguchi S, Shirayoshi Y, Yamamoto Y, Miake J, et al. Pendrin is a novel autoantigen recognized by patients with autoimmune thyroid diseases.J Clin Endocrinol Metab 2009; 94(2):442-8.
25.Yoneda M, Fujii A, Ito A, Yokoyama H, Nakagawa H, Kuriyama M. High prevalence of serum autoantibodies against the amino terminal of alpha-enolase in Hashimoto's encephalopathy. J Neuroimmunol 2007; 185(1-2):195-200.
26. Weetman AP. The immunopathogenesis of chronic autoimmune thyroiditis one century after hashimoto. Eur Thyroid J 2013; 1(4):243-50.
27. Antonelli A, Ferrari SM, Corrado A, Di Domenicantonio A, Fallahi P. Autoimmune thyroid disorders. Autoimmun Rev 2015; 14(2):174-80.
28. Yang X, Gao T, Shi R, Zhou X, Qu J, Xu J, et al. Effect of iodine excess on Th1, Th2, Th17, and Treg cell subpopulations in the thyroid of NOD.H-2h4 mice. BiolTrace Elem Res 2014;159(1-3):288-96.
29. Cui SL, Yu J, Shoujun L. Iodine Intake Increases IP-10 Expression in the Serum and Thyroids of Rats with Experimental Autoimmune Thyroiditis. Int J Endocrinol 2014; 2014:581069.
30. Zuberbier T, Aberer W, Asero R, Bindslev-Jensen C, Brzoza Z, Canonica GW, et al. The EAACI/GA(2) LEN/EDF/WAO Guideline for the definition, classification, diagnosis, and management of urticaria: the 2013 revision and update. Allergy2014; 69(7):868–87
31. Powell RJ, Leech SC, Till S, Huber PA, Nasser SM, Clark AT.BSACI guidelinefor the management of chronic urticaria and angioedema. Clin Exp Allergy 2015; 45(3):547-65.
32. Greaves MW. Chronic idiopatic urticaria. Cur Opin Allergy ClinImmunol 2003; 3(5):363-8.
33. Wardhana, Datau EA. Chronic autoimmune urticaria. Acta Med Indones 2012; 44(2):165-74.
34. Viegas LP, Ferreira MB, Kaplan AP. The maddening itch: an approach to chronic urticaria. J Investig Allergol Clin Immunol 2014; 24(1):1-5
35. Jain S. Pathogenesis of chronic urticaria: an overview. Dermatol Res Pract 2014; 2014:674709.
36. Konstantinou GN, Asero R, Ferrer M, Knol EF, Maurer M, Raap U, Schmid-Grendelmeier P, Skov PS, Grattan CE. EAACI task force position paper: evidence for autoimmune urticaria and proposal for defining diagnostic criteria. Allergy 2013; 68(1):27-36.
37. Ferrer M. Immunological events in chronic spontaneous urticaria. Clin Transl Allergy; 5:30.
38. Altman K, Chang C. Pathogenic intracellular and autoimmune mechanisms in urticaria and angioedema. Clin Rev Allergy Immunol 2013; 45(1):47-62.
39. Pan XF, Gu JQ, Shan ZY. The prevalence of thyroid autoimmunity in patients with urticaria: a systematic review and meta-analysis. Endocrine 2015; 48(3):804-10.
40. Leznoff A, Josse RG, Denburg J, Dolovich J. Association of chronic urticaria and angioedema with thyroid autoimmunity. Arch Dermatol 1983; 119(8):636-40.
41. Leznoff A, Sussman GL. Symdrome of idiophatic chronic urticaria and angioedema with thyroid autoimmunity: a study of 90 patents. J Allergy Clin Immunol 1989; 84(1):66-71.
42. Turktas I, Gokcora N, Demirsoy S, Cakir N, Onal E. The association of chronic urticariaand angioedema with autoimmune thyroiditis.Int J Dermatol 1997; 36(3):187-90.
43. Zauli D, Deleonardi G, Foderaro S, Grassi A, Bortolotti R, Ballardini G, et al. Thyroid autoimmunity in chronic urticaria. Allergy Asthma Proc 2001; 22(2):93-5.
44. Kullavanijaya P, Puavilai G, Puavilai S, Chanprasertyothin S. Prevalence of thyroid antibodies in Thai patients with chronic idiopathic urticaria. J Med Assoc Thai 2002; 85(8):901-6.
45. Jiménez Saab NG, Goméz Vera J, LópezTiro JJ, Salas Pérez G, López Islas I, Pliego Reyes CL. Prevalence of chronic urticaria of autoimmune origin at the Regional Hospital Adolfo Lopez Mateos. Rev Alerg Mex 2006; 53(2):58-63.
46. Cebeci F, Tanrikut A, Topcu E, Onsun N, Kurtulmus N, Uras AR. Association between chronic urticaria and thyroid autoimmunity. Eur J Dermatol 2006; 16(4):402-5.
47. Aamir IS, Tauheed S, Majeed F, Atif A. Serum antithyroid antibodies in female patients with chronic urticaria. J Coll Physicians Surg Pak 2008; 18(8):498-501.
48. Nuzzo V, Tauchmanova L, Colasanti P, Zuccoli A, Colao A. Idiopathic chronic urticaria and thyroid autoimmunity: Experience of a single center. Dermatoendocrinol 2011; 3(4):255-8.
49. Irani C, Jammal M, Asmar G, Hajj H, Halaby G. Chronic urticaria and autoimmune thyroiditis. J Med Liban 2012; 60(2):88-90.
50. Missaka RF, Penatti HC, Silvares MR, Nogueira CR, Mazeto GM. Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study. Sao Paulo Med J 2012; 130(5):294-8.
51. Sugiyama A, Nishie H, Takeuchi S, Yoshinari M, Furue M. Hashimoto's disease is a frequent comorbidity and an exacerbating factor of chronic spontaneous urticaria. Allergol Immunopathol (Madr) 2015; 43(3):249-53.
52. Bumbacea RS, Popa LG, Orzan OA, Voiculescu VM, Giurcaneanu C. Clinical and Therapeutic Implications of the Association between Chronic Urticaria and Autoimmune Thyroiditis. Acta Endo (Buc) 2014; 10:595-604.
53. Confino-Cohen R, Chodick G, Shalev V, Leshno M, Kimhi O, Goldberg A. Chronic urticaria and autoimmunity: associations found in a large population study. J Allergy Clin Immunol 2012; 129(5):1307-13.
54. Kasperska-Zajac A, Sztylc J, Machura E, Jop G. Plasma IL-6 concentration correlates with clinical disease activity and serum C-reactive protein concentration in chronic urticaria patients. Clin Exp Allergy 2011; 41(10):1386-91.
55. Kasperska-Zajac A. Acute-phase response in chronic urticaria. J Eur Acad Dermatol Venereol 2012; 26(6):665-72.
56. Kasperska-Zajac A, Jasinska T, Grzanka A, Kowalik-Sztylc A. Markers of systemic inflammation in delayed pressure urticaria. Int J Dermatol 2013; 52(3):309-10.
57. Lin P. Targeting interleukin-6 for noninfectious uveitis. Clin Ophthalmol 2015; 9:1697-702.
58. Tanaka T, Kishimoto T. The biology and medical implications of interleukin-6. Cancer Immunol Res 2014; 2(4):288-94.
59. Kasperska-Zajac A, Brzoza Z, Rogala B. Plasma concentration of interleukin 6 (IL-6), and its relationship with circulating concentration of dehydroepiandrosterone sulfate (DHEA-S) in patients with chronic idiopathic urticaria. Cytokine 2007; 39(2):142-6.
60. Rasool R, Ashiq I, Shera IA, Yousuf Q, Shah ZA. Study of serum interleukin (IL) 18 and IL-6 levels in relation with the clinical disease severity in chronic idiopathic urticaria patients of Kashmir (North India). Asia Pac Allergy 2014; 4(4):206-11.
61. Lawlor F, Bird C, Camp RD, Barlow R, Barr RM, Kobza-Black A, et al. Increased interleukin6, but reduced interleukin 1, in delayed pressure urticaria. Br J Dermatol 1993; 128(5):500–3.
62. Bai X, Sun J, Wang W, Shan Z, Zheng H, Li Y, et al. Increased differentiation of Th22 cells in Hashimoto,s thyroiditis. Endocr J 2014; 61(12):1181-90.
63.Khan FA, Al-Jameil N, Khan MF, Al-Rashid M, Tabassum H. Thyroid dysfunction: an autoimmune aspect. Int J Clin Exp Med 2015; 8(5):6677-81.
64. Boutzios G, Kaltsas G. Immune System Effects on the Endocrine System.In: De Groot LJ, Beck-Peccoz P, Chrousos G, Dungan K, Grossman A, Hershman JM, Koch C, McLachlan R, New M, Rebar R, Singer F, Vinik A, Weickert MO, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-2015.
65. Mellanby RJ, Thomas DC, Lamb J. Role of regulatory T-cells in autoimmunity. ClinSci (Lond) 2009; 116(8):639-49.
66. Eisenstein EM, Williams CB. The T (reg)/Th17 cell balance: a new paradigm for autoimmunity. Pediatr Res2009; 65(5 Pt2):26R-31R.
67. Valencia X, Lipsky PE. CD4+CD25+FoxP3+ regulatory T cells in autoimmune diseases. Nat Clin Pract Rheumatol 2007; 3(11):619-26.
68. Abdulahad WH, Boots AM, Kallenberg CG. FoxP3+ CD4+ T cells in systemic autoimmune diseases: the delicate balance between true regulatory T cells and effector Th-17 cells. Rheumatology (Oxford) 2011; 50(4):646-56. Epub 2010 Oct 28.
69. Arshi S, Babaie D, Nabavi M, Tebianian M, GhalehbaghiB, Jalali F,et al. Circulating level of CD4+CD25+FOXP3+Tcells in patients with chronic urticaria. Int J Dermatol 2014; 53(12):e561-6.
70. Sun RS, Sui JF, Chen XH, Ran XZ, Yang ZF, Guan WD, et al. Detection of CD4+ CD25+ FOXP3+regulatoryTcells in peripheral blood of patients with chronic autoimmune urticaria. Australas J Dermatol 2011; 52(3):e15-8.
71. Chen WC, Chiang BL, Liu HE, Leu SJ, Lee YL. Defective functions of circulating CD4+CD25+ and CD4+CD25-Tcells in patients with chronic ordinary urticaria. J Dermatol Sci 2008; 51(2):121-30.
72. Xue H, Wang W, Shan Z, Li Y, Li Y, Teng X, et al. Dynamic changes of CD4+CD25 +regulatory T cells in NOD. H-2h4 mice with iodine-induced autoimmune thyroiditis. Biol Trace Elem Res2011; 143(1):292-301.
73. Glick AB, Wodzinski A, Fu P, Levine AD, Wald DN. Impairment of regulatoryT-cell function in autoimmune thyroid disease. Thyroid 2013; 23(7):871-8.
74. Xue H, Yu X, Ma L, Song S, Li Y, Zhang L, et al. The possible role of CD4(+)CD25(high)Foxp3(+)/CD4(+)IL-17A(+) cell imbalance in the autoimmunity of patients with Hashimoto thyroiditis. Endocrine 2015; 50(3):665-73.
| Files | ||
| Issue | Vol 16, No 4 (2017) | |
| Section | Short Perspective | |
| Keywords | ||
| CD 4 CD25 Tcells Chronic urticaria Hashimoto thyroiditis Interleukin 6 | ||
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