Does the epithelial barrier hypothesis explain the increase in allergy, autoimmunity and other chronic conditions?

There has been a steep increase in allergic and autoimmune diseases, reaching epidemic proportions and now affecting more than one billion people worldwide. These diseases are more common in industrialized countries, and their prevalence continues to rise in developing countries in parallel to urban...

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Vydané v:	Nature reviews. Immunology Ročník 21; číslo 11; s. 739 - 751
Hlavný autor:	Akdis, Cezmi A
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	England Nature Publishing Group 01.11.2021
Predmet:	Allergens Allergic rhinitis Allergies Alzheimer's disease Animals Ankylosing spondylitis Asthma Atopic dermatitis Autism Autoimmune diseases Autoimmune Diseases - epidemiology Autoimmunity Celiac disease Chronic Disease - epidemiology Chronic illnesses Dermatitis Dermatitis, Atopic - epidemiology Developing countries Diabetes mellitus Disease Epithelium Esophagitis Hepatitis Humans Hypersensitivity - epidemiology Hypotheses Immune response Industrial development Industrialization Inflammatory bowel diseases LDCs Leukocytes (eosinophilic) Metabolism Movement disorders Mucosa Multiple sclerosis Neurodegenerative diseases Parkinson's disease Pollutants Rheumatoid arthritis Rhinitis Rhinitis, Allergic - epidemiology Toxins Urbanization
ISSN:	1474-1733, 1474-1741, 1474-1741
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Popis
Shrnutí:	There has been a steep increase in allergic and autoimmune diseases, reaching epidemic proportions and now affecting more than one billion people worldwide. These diseases are more common in industrialized countries, and their prevalence continues to rise in developing countries in parallel to urbanization and industrialization. Intact skin and mucosal barriers are crucial for the maintenance of tissue homeostasis as they protect host tissues from infections, environmental toxins, pollutants and allergens. A defective epithelial barrier has been demonstrated in allergic and autoimmune conditions such as asthma, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, coeliac disease and inflammatory bowel disease. In addition, leakiness of the gut epithelium is also implicated in systemic autoimmune and metabolic conditions such as diabetes, obesity, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and autoimmune hepatitis. Finally, distant inflammatory responses due to a 'leaky gut' and microbiome changes are suspected in Alzheimer disease, Parkinson disease, chronic depression and autism spectrum disorders. This article introduces an extended 'epithelial barrier hypothesis', which proposes that the increase in epithelial barrier-damaging agents linked to industrialization, urbanization and modern life underlies the rise in allergic, autoimmune and other chronic conditions. Furthermore, it discusses how the immune responses to dysbiotic microbiota that cross the damaged barrier may be involved in the development of these diseases.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23
ISSN:	1474-1733 1474-1741 1474-1741
DOI:	10.1038/s41577-021-00538-7