Graft-versus-host-like disease complicating thymoma: lack of AIRE expression as a cause of non-hereditary autoimmunity?
Three patients with graft-versus-host-like enterocolonopathy are reported. Their history was remarkable for thymoma and other autoimmune manifestations such as thrombocytopenia, red cell aplasia, interface dermatitis, Sjogren sialadenits, vanishing bile ducts and rheumatoid arthritis. In all patients, microsatellite analysis showed the autologous nature of the lymphocytes in the affected organs ruling out GVHD. In search for mechanisms that could mediate loss of tolerance to self-antigens we found in a panel of thymomas, including those of the three patients, a complete lack of autoimmune regulator (AIRE) and minimal expression of the transcription factor FOXP3 in the intra-tumoral T cells. AIRE is a recently discovered transcription factor which plays a key role in the maintenance of central tolerance and is mutated in the autosomal recessive autoimmune polyendocrinopathy syndrome APS-1. Our observations indicate that thymoma-related autoimmunity can potentially be elicited by an incomplete deletion of 'self'-specific T cells in concert with an insufficient formation of natural Tregs.
Offerhaus
G Johan
GJ
Department of Pathology, University Medical Center Utrecht, The Netherlands.
Schipper
Marguerite E I
ME
Lazenby
Audrey J
AJ
Montgomery
Elizabeth
E
Morsink
Folkert H M
FH
Bende
Richard J
RJ
Musler
Alex R
AR
van Lier
Rene A W
RA
van Noesel
Carel J M
CJ
D000328:Adult; D015551:Autoimmunity; D003092:Colitis / Q000276:immunology*; D005260:Female; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006086:Graft vs Host Disease / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000166:cytology / Q000276:immunology / Q000378:metabolism; D050378:T-Lymphocytes, Regulatory / Q000276:immunology / Q000378:metabolism; D013945:Thymoma / Q000276:immunology* / Q000378:metabolism; D013950:Thymus Gland / Q000276:immunology / Q000378:metabolism; D013953:Thymus Neoplasms / Q000276:immunology* / Q000378:metabolism; D014157:Transcription Factors / Q000378:metabolism*; D000096927:AIRE Protein
D051858:Forkhead Transcription Factors; D014157:Transcription Factors; D000096927:AIRE Protein; C418974:FOXP3 protein, human