Autoantibody targets in autoimmune polyendocrine syndrome type 1 and lymphocytic hypophysitis

Research Doctorate - Doctor of Philosophy (PhD)Background: Autoimmune diseases arise from the breakdown of central tolerance resulting in the escape of self reactive T-lymphocytes from the thymus to the periphery. As a group of conditions, autoimmune diseases occur in approximately 5% of the general population and represent the third most common cause of morbidity, placing considerable expenses on the health care system and society. Understanding the underlying pathogenesis and pathophysiology of these diseases is therefore important for the correct diagnosis and treatment of these patients. While some autoimmune diseases have been paid particular attention, little is known about the pathogenesis of the pituitary autoantibodies. Aims: To identify target autoantigens in the pituitary autoimmune disease lymphocytic hypophysitis and autoantigen(s) relating to pituitary manifestations in APS1 patients. Methods: A pituitary cDNA expression library was immunocreened with lymphocytic hypophysitis and APS1 patient sera to identify target autoantigens. These were then tested in an ITT assay for autoantigen specificity to relating to the disorders. Immunofluorescence of pituitary tissue was performed to determine the cell types targeted in the disorders. Results: Two APS1 autoantigens were identified, a major autoantigen ECE-2 and a minor autoantigen TSGA10, although neither apparently correlated to pituitary manifestations in APS1. T-box 19 was also identified as a significant minor autoantigen in 10.5% of lymphocytic hypophysitis patients. Immunoreactivity in a single lymphocytic hypophysitis patient against cells of the intermediate lobe of the guinea pig pituitary is also reported. Discussion: Immunoscreening a target organ cDNA expression library is a valuable method for identifying novel autoantigens, with immunopreciptation assay a quick and reliable method for analysing a large cohort of patients for autoantibodies. We have identified another two APS1 autoantigens and the first significant autoantigen in lymphocytic hypophysitis. While further characterisation of these autoantigens are required, these novel findings broaden our current understanding of pituitary autoimmunity