title: ANCA-Associated Vasculitis Pathogenesis: A Commentary.
abstract: OBJECTIVE
  The ANCA-associated vasculitides are a group of small vessel vasculitides characterized by autoantibodies recognizing the neutrophil cytoplasmic antigens PR3 and MPO. We examine the current clinical and molecular immunology understanding of ANCA-associated vasculitides and discuss the current needs in our understanding of the pathogenic mechanisms of these rare diseases.
  
  
  RESULTS
  The majority of efforts to understand the pathogenesis of these diseases have focused on dissecting neutrophil biology because the neutrophil is the primary expressor of ANCA autoantigens. However, a number of important genetic, clinical, and cellular biology observations suggest that attempts to understand the pathogenesis of ANCA vasculitides should move away from emphasis on the role of the neutrophil and instead re-focus on the potential role of other immune cell mediators. Whether or not neutrophils are the key determinant of ANCA-associated vasculitis pathogenesis should be revisited in detail. A neutrophil-centric view of the pathogenesis of these diseases cannot fully account for important genetic, clinical, and cellular biology observations that implicate important and under-appreciated roles for monocytes and T cells. Refocusing on these findings will likely lead to new discovery of novel therapeutic targets and the identification of clinically useful biomarkers for disease activity.
authors.affiliation: Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Center Tower, Ste. 5300, Baltimore, MD, 21224, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Gapud
authors.affiliation: Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Center Tower, Ste. 5300, Baltimore, MD, 21224, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Seo
authors.affiliation: Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Center Tower, Ste. 5300, Baltimore, MD, 21224, USA. bantioc1@jhmi.edu.
authors.forename: Brendan
authors.initials: B
authors.lastname: Antiochos
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000276:immunology*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000096:biosynthesis / Q000276:immunology; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D009504:Neutrophils / Q000276:immunology
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic
keywords: AAV pathogenesis; ANCA-associated vasculitis; Eosinophilic granulomatosis with polyangiitis; Granulomatosis with polyangiitis; Microscopic polyangiitis