Opportunistic autoimmune disorders: from immunotherapy to immune dysregulation.
Rapid advances in our understanding of the immune network have led to treatment modalities for malignancies and autoimmune diseases based on modulation of the immune response. Yet therapeutic modulation has resulted in immune dysregulation and opportunistic autoimmune sequelae, despite prescreening efforts in clinical trials. This review focuses on recent clinical data on opportunistic autoimmune disorders arising from three immunotherapeutic modalities: (1) systemic immunomodulators, including interferon-alpha (also used to treat hepatitis C patients) and interferon-beta; (2) monoclonal antibodies to CTLA-4 and CD52, and (3) hematopoietic stem cell transplantation. Uncategorized predisposing factors in these patients include major histocompatibility complex and gender genetics, prevalence of different autoimmune diseases, prior chemotherapy, underlying disorder (e.g., hepatitis C), and preconditioning regimens as part of organ and stem cell transplants. Not unexpectedly, the prevalent autoimmune thyroid disease surfaced frequently. Our combination models to study the balance between thyroid autoimmunity and tumor immunity upon regulatory T-cell perturbation are briefly described.
Kong
Yi-chi M
YC
Department of Immunology and Microbiology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. ykong@med.wayne.edu
Wei
Wei-Zen
WZ
Tomer
Yaron
Y
D000818:Animals; D000911:Antibodies, Monoclonal / Q000276:immunology; D001327:Autoimmune Diseases / Q000209:etiology* / Q000276:immunology*; D004198:Disease Susceptibility; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D055633:Immune System Phenomena / Q000502:physiology*; D007155:Immunologic Factors / Q000009:adverse effects / Q000502:physiology; D007167:Immunotherapy / Q000009:adverse effects*; D012307:Risk Factors
D000911:Antibodies, Monoclonal; D007155:Immunologic Factors