Coeliac disease, an inflammatory disease of the small intestine, shares key features with autoimmune disorders, such as susceptibility genes, presence of autoantibodies and T cell-mediated destruction of specific cells. Strikingly, however, continuous exposure to the exogenous dietary antigen gluten and gluten-specific adaptive immunity are required to maintain immunopathology. These observations challenge the notion that autoimmunity requires adaptive immune activation towards self antigens. Using coeliac disease as an example, we propose that other exogenous factors might be identified as drivers of autoimmune processes, in particular when evidence for T cells with specificity for self antigens driving the disease is lacking.
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The work was supported by grants from the Research Council of Norway, the European Research Council and the South-East Norway Regional Health Authority to L.M.S. and by grants from the US National Institutes of Health (grants RO1DK063158, RO1DK58727and P30DK42086) to B.J.
The authors declare no competing financial interests.
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Sollid, L., Jabri, B. Triggers and drivers of autoimmunity: lessons from coeliac disease. Nat Rev Immunol 13, 294–302 (2013). https://doi.org/10.1038/nri3407
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