[Frontiers in Bioscience E1, 501-509, June 1, 2009]

The mosaic of autoimmunity: the role of environmental factors

Jozelio Freire de Carvalho1,2, Rosa Maria Rodrigues Pereira1, Yehuda Shoenfeld2,3

1Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo e Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil, 2Center for Autoimmune Diseases and Department of Medicine B, Chaim Sheba Medical Center Tel- Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel, 3Incumbent of the Laura Schwartz-Kipp Chair for Autoimmunity, Tel Aviv University


1. Abstract
2. Introduction
3. Infections and autoimmunity
3.1. Epstein-Barr virus and cytomegalovirus infections in autoimmune diseases
4. Vaccination and autoimmunity
5. Smoking and autoimmunity
5.1. Autoimmune disease associated with cigarette smoking 5.1.1. Rheumatoid arthritis
5.1.2. Systemic lupus erythematosus
5.1.3. Multiple sclerosis
5.1.4. Graves' hyperthyroidism
5.1.5. Ulcerative colitis and Crohn´s Disease 6. Stress and autoimmunity
7. The multifactorial balance of autoimmunity
8. References


The "mosaic of autoimmunity" describes the multifactorial origin and diversity of expression of autoimmune diseases in humans. The term implies that different combinations of the many factors that are involved in auto-immunity produce varying and unique clinical pictures in a wide spectrum of autoimmune diseases. Most of the factors involved in autoimmunity can be categorized into four groups: genetic, immune defects, hormonal and environmental factors. In this communication, only the environmental factors are reviewed such as: infectious agents (represented by Epstein-Barr virus and cytomegalovirus), vaccines as triggers of autoimmunity, smoking and its relationship with rheumatoid arthritis, systemic lupus erythematosus, thyroid disease, multiple sclerosis and inflammatory bowel diseases. Some aspects of stress as implicated in causing autoimmunity and the processes leading to autoimmunity are reviewed as well.