Role of Autoantibodies in the Pathogenesis and Association of Endocrine Autoimmune Disorders*

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Abstract
I. Introduction THE ROLE of autoantibodies (aAB) in the pathogenesis of autoimmune disorders (AID) is still unclear despite more than 30 yr of study. While certain aAB have been proven to cause tissue damage, and others suspected to, many appear to have no harmful effect even though they are classically detected often in very high concentrations in the serum of patients with AID, and thus are of diagnostic importance. Most harmful aAB are of the destructive type, which lead to target cell death by causing lysis, while others, particularly those directed against endocrine cell surface hormone receptors, may have either a hormonal-like stimulating action or may block access of a trophic hormone, thereby causing major functional abnormalities. This review concerns the role of aAB in the pathogenesis of endocrine autoimmune disorders (EAD). We will focus on 1) the nature, pathophysiological actions, and role of autoantibodies in the development and expression of EAD; 2) the nature of the equivalent monoclonal antibodies and the role that they play as probes in studies of endocrine autoimmunity; and 3) the characteristics of the corresponding autoantigens. We will discuss the aAB associated with type I insulin dependent diabetes mellitus (IDDM), autoimmune thyroid disorders and associated ophthalmopathy, the polyglandular syndromes, hypoparathyroidism, hypopituitarism, Addison's disease, and hypothalamic autoimmunity, and we will differentiate those with a possible pathogenic role from those which are markers of the autoimmune process but not (as far as is known) tissue damaging. Since immunological cross-reactivity against shared antigens appear to provide a possible mechanism for the association of such diseases as Graves' disease, ophthalmopathy, and type I IDDM, recent evidence for the existence of antigens shared between many endocrine (and other) tissues, and of aAB reactive with them will be discussed in detail.

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