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Review
. 2019 Jan;31(1):53-61.
doi: 10.1097/BOR.0000000000000564.

Sex bias in autoimmunity

Allison C Billi  1 , J Michelle Kahlenberg  2 , Johann E Gudjonsson  1
Affiliations
Review

Sex bias in autoimmunity

Allison C Billi et al. Curr Opin Rheumatol. 2019 Jan.

Abstract

Purpose of review: To give an overview of recently published articles addressing the mechanisms underlying sex bias in autoimmune disease.

Recent findings: Recent studies investigating the origins of sex bias in autoimmune disease have revealed an extensive and interconnected network of genetic, hormonal, microbial, and environmental influences. Investigation of sex hormones has moved beyond profiling the effects of hormones on activity and prevalence of immune cell types to defining the specific immunity-related genes driving these changes. Deeper examination of the genetic content of the X and Y chromosomes and genetic escapees of X chromosome inactivation has revealed some key drivers of female-biased autoimmunity. Animal studies are offering further insights into the connections among microbiota, particularly that of the gut, and the immune system.

Summary: Sex bias in autoimmune disease is the manifestation of a complex interplay of the sex chromosomes, sex hormones, the microbiota, and additional environmental and sociological factors.

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Conflict of interest statement

Conflicts of interest

The authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.. The sex distribution of the major autoimmune diseases.
The numbers above the bars refer to the total number of disease cases (×1,000,000) in the USA (3). SLE: systemic lupus erythematosus.
Figure 2.
Figure 2.. Female sex alone carries a risk of autoimmunity four times greater than any other known genetic risk variant for SLE.
Odds ratio (OR) for female sex was calculated based on prevalence data from the Georgia Lupus Registry from 2002 (6). ORs are shown for allelic associations at SLE susceptibility loci from a genome-wide association replication study (7).
See this image and copyright information in PMC

References

    1. El-Gabalawy H, Guenther LC, Bernstein CN. Epidemiology of immune-mediated inflammatory diseases: incidence, prevalence, natural history, and comorbidities. J Rheumatol Suppl. 2010;85:2–10. - PubMed
    1. Nalbandian G, Kovats S. Understanding sex biases in immunity: effects of estrogen on the differentiation and function of antigen-presenting cells. Immunol Res. 2005;31(2):91–106. - PubMed
    1. Whitacre CC. Sex differences in autoimmune disease. Nat Immunol. 2001;2(9):777–80. - PubMed
    1. Fish EN. The X-files in immunity: sex-based differences predispose immune responses. Nat Rev Immunol. 2008;8(9):737–44. - PMC - PubMed
    1. Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol. 1997;84(3):223–43. - PubMed

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