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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 22. Testicular Involvement in Systemic Diseases. Pediatr Dev Pathol 2017; 19:431-451. [PMID: 25333836 DOI: 10.2350/14-09-1556-pb.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Normal testicular physiology requires appropriate function of endocrine glands and other tissues. Testicular lesions have been described in disorders involving the hypothalamus-hypophysis, thyroid glands, adrenal glands, pancreas, liver, kidney, and gastrointestinal tract. Testicular abnormalities can also associate with chronic anemia, obesity, and neoplasia. Although many of the disorders that affect the above-mentioned glands and tissues are congenital, acquired lesions may result in hypogonadism in children and adolescents.
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
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Soumya V, Padmanabhan RA, Titus S, Laloraya M. Murine uterine decidualization is a novel function of autoimmune regulator-beyond immune tolerance. Am J Reprod Immunol 2016; 76:224-34. [PMID: 27432359 DOI: 10.1111/aji.12538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/14/2016] [Indexed: 12/16/2023] Open
Abstract
PROBLEM Autoimmune polyendocrinopathy, candidiasis, and ectodermal dystrophy (APECED, APS-1) patients characterized by Aire (autoimmune regulator) mutations and Aire homozygous knockouts (Aire(-/-) ) exhibit infertility. It is not clear as to what contributes to infertility in the above. METHOD OF STUDY This study investigates the expression of "AIRE in the uterus" and its contribution to early pregnancy of mice by using quantitative real-time PCR analysis, immunohistochemistry, Western blotting, and in vivo Aire silencing experiments. RESULTS Aire (Isoform 1a) is expressed in the uterus during the "window of implantation" and decidualization. In vivo Aire silencing interfered with formation of implantation sites and stromal cell transformation by regulating bone morphogenetic protein-2,4 (Bmp2, Bmp4), homeobox A10 (Hoxa10), and insulin-like growth factor-binding protein 1(Igfbp1) leading to pregnancy failure. CONCLUSION Our consolidated results on extrathymic uterine expression of AIRE during early pregnancy and decidualization and impaired fertility on in vivo silencing are suggestive of its importance in pregnancy via a role beyond immune tolerance.
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Affiliation(s)
- Vasanthi Soumya
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Renjini A Padmanabhan
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Shiny Titus
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - Malini Laloraya
- Female Reproduction and Metabolic Syndromes Laboratory, Division of Molecular Reproduction, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
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Landegren N, Sharon D, Shum AK, Khan IS, Fasano KJ, Hallgren Å, Kampf C, Freyhult E, Ardesjö-Lundgren B, Alimohammadi M, Rathsman S, Ludvigsson JF, Lundh D, Motrich R, Rivero V, Fong L, Giwercman A, Gustafsson J, Perheentupa J, Husebye ES, Anderson MS, Snyder M, Kämpe O. Transglutaminase 4 as a prostate autoantigen in male subfertility. Sci Transl Med 2015; 7:292ra101. [PMID: 26084804 DOI: 10.1126/scitranslmed.aaa9186] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Autoimmune polyendocrine syndrome type 1 (APS1), a monogenic disorder caused by AIRE gene mutations, features multiple autoimmune disease components. Infertility is common in both males and females with APS1. Although female infertility can be explained by autoimmune ovarian failure, the mechanisms underlying male infertility have remained poorly understood. We performed a proteome-wide autoantibody screen in APS1 patient sera to assess the autoimmune response against the male reproductive organs. By screening human protein arrays with male and female patient sera and by selecting for gender-imbalanced autoantibody signals, we identified transglutaminase 4 (TGM4) as a male-specific autoantigen. Notably, TGM4 is a prostatic secretory molecule with critical role in male reproduction. TGM4 autoantibodies were detected in most of the adult male APS1 patients but were absent in all the young males. Consecutive serum samples further revealed that TGM4 autoantibodies first presented during pubertal age and subsequent to prostate maturation. We assessed the animal model for APS1, the Aire-deficient mouse, and found spontaneous development of TGM4 autoantibodies specifically in males. Aire-deficient mice failed to present TGM4 in the thymus, consistent with a defect in central tolerance for TGM4. In the mouse, we further link TGM4 immunity with a destructive prostatitis and compromised secretion of TGM4. Collectively, our findings in APS1 patients and Aire-deficient mice reveal prostate autoimmunity as a major manifestation of APS1 with potential role in male subfertility.
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Affiliation(s)
- Nils Landegren
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm SE 171 76, Sweden. Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala SE 751 85, Sweden.
| | - Donald Sharon
- Department of Genetics, Stanford University, Stanford 94305, CA, USA. Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Anthony K Shum
- Division of Pulmonary and Critical Care, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Imran S Khan
- Diabetes Center, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kayla J Fasano
- Diabetes Center, University of California San Francisco, San Francisco, CA 94143, USA
| | - Åsa Hallgren
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm SE 171 76, Sweden. Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala SE 751 85, Sweden
| | - Caroline Kampf
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala SE 751 85, Sweden
| | - Eva Freyhult
- Cancer Pharmacology and Computational Medicine, Department of Medical Sciences, Bioinformatics Infrastructure for Life Sciences, Science for Life Laboratory, Uppsala University, Uppsala SE 751 85, Sweden
| | - Brita Ardesjö-Lundgren
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala SE 750 07, Sweden
| | - Mohammad Alimohammadi
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm SE 171 76, Sweden. Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala SE 751 85, Sweden. Department of Medical Sciences, Uppsala University, Uppsala SE 751 85, Sweden
| | - Sandra Rathsman
- Department of Laboratory Medicine/Microbiology, Örebro University Hospital, Örebro SE 701 85, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm SE 171 76, Sweden
| | - Dan Lundh
- School of Bioscience, University of Skövde, Skövde SE 541 28, Sweden
| | - Ruben Motrich
- Centro de Investigaciones en Bioquímica Clínica e Inmunología, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | - Virginia Rivero
- Centro de Investigaciones en Bioquímica Clínica e Inmunología, Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba 5000, Argentina
| | - Lawrence Fong
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94115, USA
| | - Aleksander Giwercman
- Molecular Reproduction Research, Department of Clinical Sciences Malmö, Lund University, Malmö SE 205 02, Sweden
| | - Jan Gustafsson
- Department of Women's and Children's Health, Uppsala University, Uppsala SE 751 85, Sweden
| | - Jaakko Perheentupa
- The Hospital for Children and Adolescents, University of Helsinki, Helsinki 00029, Finland
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, and Department of Medicine, Haukeland University Hospital, Bergen 5020, Norway
| | - Mark S Anderson
- Diabetes Center, University of California San Francisco, San Francisco, CA 94143, USA
| | - Michael Snyder
- Department of Genetics, Stanford University, Stanford 94305, CA, USA
| | - Olle Kämpe
- Department of Medicine (Solna), Karolinska University Hospital, Karolinska Institutet, Stockholm SE 171 76, Sweden. Department of Medical Sciences, Science for Life Laboratory, Uppsala University, Uppsala SE 751 85, Sweden
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Kekäläinen E, Pöntynen N, Meri S, Arstila TP, Jarva H. Autoimmunity, Not a Developmental Defect, is the Cause for Subfertility of Autoimmune Regulator (Aire) Deficient Mice. Scand J Immunol 2015; 81:298-304. [PMID: 25689230 DOI: 10.1111/sji.12280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/24/2015] [Indexed: 01/26/2023]
Abstract
Autoimmune regulator's (AIRE) best characterized role is in the generation immunological tolerance, but it is also involved in many other processes such as spermatogenesis. Loss-of-function mutations in AIRE cause a disease called autoimmune polyendocrinopathy, candidiasis and ectodermal dystrophy (APECED; also called autoimmune polyendocrinopathy syndrome type 1, APS-1) that is dominated by various autoimmune manifestations, mainly endocrinopathies. Both patients with APECED and Aire(-/-) mice suffer from varying levels of infertility, but it is not clear if it is a result of an autoimmune tissue damage or more of a developmental defect. In this study, we wanted to resolve whether or not the reduced fertility of Aire(-/-) mice is dependent on the adaptive immune system and therefore a manifestation of autoimmunity in these mice. We generated lymphopenic mice without Aire expression that were devoid of the autoimmune manifestations previously reported in immunocompetent Aire(-/-) mice. These Aire(-/-) Rag1(-/-) mice regained full fertility. This confirms that the development of infertility in Aire(-/-) mice requires a functional adaptive immune system. We also show that only the male Aire(-/-) mice are subfertile, whereas Aire(-/-) females produce litters normally. Moreover, the male subfertility can be adoptively transferred with lymphocytes from Aire(-/-) donor mice to previously fertile lymphopenic Aire(-/-) recipients. Our data show that subfertility in Aire(-/-) mice is dependent on a functional adaptive immune system thus confirming its autoimmune aetiology.
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Affiliation(s)
- E Kekäläinen
- Department of Bacteriology and Immunology and Immunobiology Research Program, University of Helsinki, Helsinki, Finland
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Abstract
CONTEXT Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy is known as a rare hereditary disease with classic triad of mucocutaneous candidiasis, hypoparathyroidism, and adrenocortical failure, two of which, diagnostic dyad, are required for the diagnosis. Evidently many patients suffer unrecognized because the condition is more variable and complex. OBJECTIVE The objective of the study was to describe the variability of autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy for promoting recognition and adequate follow-up of patients. SETTING The Finnish series of patients is the largest internationally. PATIENTS The study population was all 91 known Finnish patients. RESULTS Besides the classical triad, a dozen autoimmune endocrine and other components occurred variably, several of them dangerous. The initial manifestation appeared within the age range of 0.2-18 yr, mucocutaneous candidiasis being part of it in 60% of the patients, hypoparathyroidism in 32%, and adrenocortical failure in 5%. But 23% of the patients had one to six other components before the diagnostic dyad: hepatitis, keratoconjunctivitis, chronic diarrhea, periodic rash with fever. The dyad appeared 0.2-20 yr later. Prevalence of most components increased with age, diabetes mellitus, hypothyroidism, and testicular failure becoming common toward middle age. Tubulointerstitial nephritis occurred in 9% of the patients, apparent mineralocorticoid excess in 9%, asplenia in 19% of adults, and oral or esophageal squamous cell carcinoma in 10% of patients older than 25 yr. CONCLUSIONS Any child or young adult with one of the many disease components should be examined for others and consideration of AIRE mutation assay.
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Affiliation(s)
- Jaakko Perheentupa
- The Hospital for Children and Adolescents, Helsinki University Hospital, FIN-00029 Helsinki, Finland.
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Skau PA, Folstad I. Does immunity regulate ejaculate quality and fertility in humans? Behav Ecol 2004. [DOI: 10.1093/beheco/ari004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The clinical picture and course of APS-I or APD-I/APECED is widely variable: the list of possible disease components includes some 30 disorders. The initial manifestation may not include any of the known characteristic components, namely, mucocutaneous candidiasis, hypoparathyroidism, or adrenocortical insufficiency. Although mutation detection is available, it does not help to exclude this disease. Diagnostic strategy needs to be based on knowledge of the clinical picture, including the features of ectodermal dystrophy.
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Affiliation(s)
- Jaakko Perheentupa
- Hospital for Children and Adolescents, University of Helsinki, PO Box 281, Fin-00029 HYKS, Helsinki, Finland.
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Obermayer-Straub P, Strassburg CP, Manns MP. Autoimmune polyglandular syndrome type 1. Clin Rev Allergy Immunol 2000; 18:167-83. [PMID: 10944704 DOI: 10.1385/criai:18:2:167] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- P Obermayer-Straub
- Department of Gastroenterology and Hepatology, Hannover Medical School, Germany
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Obermayer-Straub P, Manns MP. Autoimmune polyglandular syndromes. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1998; 12:293-315. [PMID: 9890074 DOI: 10.1016/s0950-3528(98)90136-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Autoimmune polyglandular syndrome type 1 (APS1) is characterized by a variable combination of disease components: (1) mucocutaneous candidiasis; (2) autoimmune tissue destruction; (3) ectodermal dystrophy. The disease is caused by mutations in a single gene called APECED (autoimmune polyendocrinopathy-candidiasis-ectodermal-dystrophy) or AIRE (autoimmune regulator) coding for a putative transcription factor featuring two zinc-finger (PHD-finger) motifs. APS1 shows a penetrance of 100%, lack of female preponderance and lack of association with HLA-DR. Typically, onset of APS1 occurs in childhood and multiple autoimmune manifestations evolve throughout lifetime. Organ-specific autoantibodies associated with hypoparathyroidism, adrenal and gonadal failures, IDDM, hepatitis and vitiligo are discussed, and autoantibody patterns in APS1 patients are compared with autoantibodies in APS type 2 (APS2). APS2 is characterized by adult onset adrenal failure associated with IDDM and/or hyperthyroidism. APS2 is believed to be polygenic, characterized by dominant inheritance and association with HLA DR3.
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Affiliation(s)
- P Obermayer-Straub
- Department of Gastroenterology and Hepatology, Hannover Medical School, Germany
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Omu AE, Makhseed M, Mohammed AT, Munim RA. Characteristics of men and women with circulating antisperm antibodies in a combined infertility clinic in Kuwait. ARCHIVES OF ANDROLOGY 1997; 39:55-64. [PMID: 9202834 DOI: 10.3109/01485019708987902] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Antisperm antibodies were determined in the sera of 250 infertile couples and 100 puerperal women as controls using the immunofluorescence technique. Couples with significant circulating antisperm antibodies were placed on low-dose prednisolone 5 mg daily for 3-6 months. Initial routine semen analysis and hypoosmotic swelling test were done and repeated after 3 months of therapy. The incidence of antisperm antibodies (ASA) was 18.8 and 17.6% in the men and women, respectively, compared to 4% in the women controls (p < .02). In the men, the main determinants (with incidence) of ASA included smoking (33.9%), past history of sexually transmitted disease (33.3%), surgery to genital tract (28.6%), trauma (27.3%), and unexplained infertility (18.5%). In women whose husbands had antisperm antibodies the incidence of circulating antisperm antibodies was 38.3%, while endometriosis and thyroid dysfunction had incidence of antisperm antibodies of 21.4 and 16.7%, respectively. In the 27 (10.8%) case of unexplained infertility, the incidence of antisperm antibodies was 22.2%. High follicle-stimulating hormone (FSH) in the men and low midluteal-phase progesterone in the women were associated with increased expression of antisperm antibodies. Antisperm antibodies adversely affected quality of sperm. Low-dose prednisolone significantly reduced the titer of antisperm antibodies and improved the sperm parameters and conception rate.
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Affiliation(s)
- A E Omu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Omu AE, al-Qattan F, Abdul Hamada B. Effect of low dose continuous corticosteroid therapy in men with antisperm antibodies on spermatozoal quality and conception rate. Eur J Obstet Gynecol Reprod Biol 1996; 69:129-34. [PMID: 8902446 DOI: 10.1016/0301-2115(95)02539-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of steroids for treating male immunological infertility is controversial. The effect of low dose prednisolone on sperm quality in men with antisperm antibodies and the conception rate, was evaluated in 40 men and their wives. Significant circulating antisperm antibodies were detected by immunofluorescence technique. Prednisolone (5 mg) was administered orally, daily for 3-6 months in men with significant antisperm antibodies. Another group of 37 men with significant antisperm antibodies, formed the control group. Both groups had initial pre- and post therapy semen analysis and hypoosmotic swelling (HOS) test. They were followed up for 12-18 months and the pregnancy outcome documented. There were significant improvement in sperm motility and hypoosmatic swelling test with therapy (P < 0.01, P > 0.05) of 13 and 15%, respectively. The pregnancy rate of 20% was much greater than 5% in the control group (P < 0.01). There were no side effects of prednisolone. Low dose prednisolone is useful in Antisperm antibody associated infertility, by improving the sperm quality and giving rise to pregnancies.
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Affiliation(s)
- A E Omu
- Department of Obstetrics and Gynaecology, Faculty of Medicine Kuwait University, Maternity Hospital Kuwait, Kuwait
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Root-Bernstein RS, DeWitt SH. Semen alloantigens and lymphocytotoxic antibodies in AIDS and ICL. Genetica 1995; 95:133-56. [PMID: 7744257 DOI: 10.1007/bf01435006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
More than 90% of people with AIDS develop circulating immune complexes (CICs) and lymphocytotoxic antibodies (LCTAs). Animals infected with HIV, however, never display CICs or LCTAs, and remain healthy. Similarly, HIV-infected people who do not develop CICs or LCTAs also do not progress to AIDS. The appearance of CICs and LCTAs is, however, highly prognostic for AIDS and death. Since HIV infection does not, per se, lead to the development of CICs and LCTAs, other causes are likely. One such cause, for which both epidemiologic and experimental evidence exists, is semen. Semen components include sperm, seminal fluid, lymphocytes, and sometimes infectious agents, including HIV, mycoplasmas, and herpes and hepatitis viruses, all of which independently cause immune suppression. Extensive evidence demonstrates sperm (and various viruses) contains many proteins mimicking the CD4 protein of T-helper cells, while HIV, mycoplasmas, and seminal fluid mimic class II MHC proteins of other lymphocytes. We identify a large number of protein sequences that display such mimicry using computer homology searching, and demonstrate experimentally that sperm antibodies specifically precipitate antibodies against class II MHC mimics such as mycoplasmas, which in turn precipitate antibodies to lymphocyte antigens. These data prove that immunologic exposure to sperm and lymphocytes (as may occur in receptive anal intercourse, needle sharing, or blood transfusions) is theoretically capable of initiating lymphocytotoxic autoimmunity. Such autoimmunity may play a significant role in the pathogenesis of AIDS, and will need to be addressed clinically in high risk individuals regardless of HIV status and regardless of the success of anti-HIV prophylaxis and treatment.
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Affiliation(s)
- R S Root-Bernstein
- Department of Physiology, Michigan State University, East Lansing 48824, USA
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Weetman AP. Autoimmunity to steroid-producing cells and familial polyendocrine autoimmunity. BAILLIERE'S CLINICAL ENDOCRINOLOGY AND METABOLISM 1995; 9:157-74. [PMID: 7726795 DOI: 10.1016/s0950-351x(95)80899-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
New insights into the autoimmune basis for Addison's disease have come from identification of at least three P450 cytochrome enzymes as autoantigens, each having distinct associations with Addison's disease as part of the APS type 1 or 2 syndrome. Enzymes are tissue-restricted proteins which are the frequent targets of autoimmunity in other organ-specific diseases (Editorial, 1992), and it seems likely that further P450 enzymes could be involved in the pathogenesis of other components of these syndromes. How adrenal damage is initiated remains unclear. Adrenal autoantibodies may have a pathogenic role, as yet obscure, or could arise secondary to T cell-mediated tissue damage, although it seems highly likely that the same autoantigen provokes cell-mediated and humoral autoimmunity. Sharing of autoantigens between ovary and adrenal glands, particularly the side-chain cleavage enzyme, is one explanation for the close association of ovarian failure and Addison's disease, but other, more common forms of ovarian autoimmune disease exist. Their further definition will come from identification of the autoantigens involved. By analogy with animal models, T cell-mediated injury is likely to be central to pathogenesis. The evidence for antibodies blocking hormone receptors in premature ovarian failure is meagre at present, but the availability of recombinant LH and FSH receptors should clarify this issue. HLA-DR3 is associated with almost all autoimmune endocrinopathies, and this is particularly striking in APS type 2. However, there is no such association with APS type 1; the most likely genetic candidate in this condition is at a locus controlling T cell development. Although the adrenal and ovarian autoimmune processes in APS type 1 and 2 may be distinct, the characterization of the gene involved in APS type 1 will have major implications for our understanding of autoimmune endocrine disease.
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