Chronic mucocutaneous candidiasis in APECED or thymoma patients correlates with autoimmunity to Th17-associated cytokines

作者：Kai E. Kisand, Anette S. B. Wolff, Katarina Trebušak Podkrajšek, Liina Tserel, Maire Link, Kalle Kisand, Elisabeth Ersvær, Jaakko Perheentupa, Martina Moter Erichsen, Nina Bratanič, Antonella Meloni, Filomena Cetani, Roberto Perniola, Berrin Ergun-Longmire, Noel Keith Maclaren, Kai J. E. Krohn, Mikulas Pura, Berthold C. G. Schalke, Philipp Ströbel, Maria Isabel Leite, Tadej Battelino, Eystein Sverre Husebye, Pärt Peterson, Nick Willcox, Anthony Meager · 发表于：The Journal of Experimental Medicine · 年份：2010 · DOI：10.1084/jem.20091669 · 被引用次数：676 · 研究领域：Adrenal Hormones and Disorders、T-cell and B-cell Immunology、Myasthenia Gravis and Thymoma

Chronic mucocutaneous candidiasis (CMC) is frequently associated with T cell immunodeficiencies. Specifically, the proinflammatory IL-17A-producing Th17 subset is implicated in protection against fungi at epithelial surfaces. In autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED, or autoimmune polyendocrine syndrome 1), CMC is often the first sign, but the underlying immunodeficiency is a long-standing puzzle. In contrast, the subsequent endocrine features are clearly autoimmune, resulting from defects in thymic self-tolerance induction caused by mutations in the autoimmune regulator (AIRE). We report severely reduced IL-17F and IL-22 responses to both Candida albicans antigens and polyclonal stimulation in APECED patients with CMC. Surprisingly, these reductions are strongly associated with neutralizing autoantibodies to IL-17F and IL-22, whereas responses were normal and autoantibodies infrequent in APECED patients without CMC. Our multicenter survey revealed neutralizing autoantibodies against IL-17A (41%), IL-17F (75%), and/ or IL-22 (91%) in >150 APECED patients, especially those with CMC. We independently found autoantibodies against these Th17-produced cytokines in rare thymoma patients with CMC. The autoantibodies preceded the CMC in all informative cases. We conclude that IL-22 and IL-17F are key natural defenders against CMC and that the immunodeficiency underlying CMC in both patient groups has an autoimmune basis.