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The microbiome in systemic autoimmune disease

mechanistic insights from recent studies

Dehner, Carina; Fine, Rebecca; Kriegel, Martin A.

Current Opinion in Rheumatology: March 2019 - Volume 31 - Issue 2 - p 201–207
doi: 10.1097/BOR.0000000000000574

Purpose of review The resident bacterial communities and the host immune system have coevolved for millennia. However, recent changes in modern societies have disrupted this coevolutionary homeostasis and contributed to a rise in immune-mediated conditions. The purpose of this review is to provide an overview of recently elucidated mechanisms of how certain taxa within the bacterial microbiome propagate autoimmunity.

Recent findings Interactions between the bacterial microbiome with innate and adaptive immune cells propagate autoreactivity, chronic inflammation, and tissue damage in susceptible hosts. These interactions contribute to autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus, which are the focus of this review. Recent findings suggest that autoimmune manifestations in genetically susceptible individuals can arise through cross-reactivity with commensal orthologs of autoantigens or commensal-mediated posttranslational modification of autoantigens. Physiologic responses to gut, oral, or skin commensal bacteria can thus be misdirected toward such autoantigens in susceptible hosts. In addition, recent studies highlight that a breach of the gut barrier and translocation of commensal bacteria to non-gut organs can trigger several autoimmune pathways that can be prevented by commensal vaccination or dietary interventions.

Summary Complex host–microbiota interactions contribute to systemic autoimmunity outside the gut. On a molecular level, posttranslational modification of, and cross-reactivity with, autoantigens represent mechanisms of how the microbiota mediates autoimmunity. On a cellular level, translocation of live gut bacteria across a dysfunctional gut barrier allows for direct interactions with immune and tissue cells, instigating autoimmunity systemically.

Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to Martin A. Kriegel, Department of Immunobiology, Yale School of Medicine, 10 Amistad Street, New Haven, CT 06519, USA. Tel: +1 203 737 2294; e-mail:

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