title: Rare phenotypes in the understanding of autoimmunity.
abstract: The study of rare phenotypes has a long history in the description of autoimmune disorders. First Mendelian syndromes of idiopathic tissue destruction were defined more than 100 years ago and were later revealed to result from immune-mediated reactivity against self. In the past two decades, continuous advances in sequencing technology and particularly the advent of next-generation sequencing have allowed to define the genetic basis of an ever-growing number of Mendelian forms of autoimmunity. This has provided unique insight into the molecular pathways that govern immunological homeostasis and that are indispensable for the prevention of self-reactive immune-mediated tissue damage and 'horror autotoxicus'. Here we will discuss selected examples of past and recent investigations into rare phenotypes of autoimmunity that have delineated pathways critical for central and peripheral control of the adaptive immune system. We will outline the implications of these findings for rare and common forms of autoimmunity and will discuss the benefits and potential pitfalls of the integration of next-generation sequencing into algorithms for clinical diagnostics. Because of the concise nature of this review, we will focus on syndromes caused by defects in the control of adaptive immunity as innate immune-mediated autoinflammatory disorders have been covered in excellent recent reviews on Mendelian and polygenic forms of autoimmunity.
authors: Department of General Pediatrics, University Medical Center Dresden, Technical University Dresden, Dresden, Germany.
authors: Yvonne
authors: Y
authors: Zeissig
authors: Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors: Britt-Sabina
authors: 0000-0001-9022-9017
authors: BS
authors: Petersen
authors: Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany.
authors: Andre
authors: A
authors: Franke
authors: Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Richard S
authors: RS
authors: Blumberg
authors: Department of Medicine I, University Medical Center Dresden, Technical University Dresden, Dresden, Germany.|Center for Regenerative Therapies, Technical University Dresden, Dresden, Germany.
authors: Sebastian
authors: S
authors: Zeissig
mesh_terms: D000818:Animals; D001327:Autoimmune Diseases / Q000235:genetics / Q000276:immunology; D015551:Autoimmunity / Q000235:genetics; D014644:Genetic Variation; D006801:Humans; D007108:Immune Tolerance / Q000235:genetics; D010641:Phenotype