The autoimmune tautology

Although autoimmune diseases exhibit contrasting epidemiological features, pathology, and clinical manifestations, three lines of evidence demonstrate that these diseases share similar immunogenetic mechanisms (that is, autoimmune tautology). First, clinical evidence highlights the co-occurrence of distinct autoimmune diseases within an individual (that is, polyautoimmunity) and within members of a nuclear family (that is, familial autoimmunity). Second, physiopathologic evidence indicates that the pathologic mechanisms may be similar among autoimmune diseases. Lastly, genetic evidence shows that autoimmune phenotypes might represent pleiotropic outcomes of the interaction of non-specific disease genes.

Th e impact of genetic predisposition on susceptibility to autoimmune diseases was fi rst identifi ed by the analysis of disease concordance rates in monozygotic twins (concordance rates ranged from about 15% to 57%) [2]. Th e decrease in the concordance rates of siblings compared with the rate among monozygotic twins supports the presence of multiple genes contributing to the autoimmune phenotype onset.
A primary characteristic of complex diseases is that aff ected individuals tend to cluster in families (that is, familial aggregation, also referred to as recurrence risk). Recurrent associations of autoimmune diseases in family members of patients have been reported. Although nongenetic factors may have an eff ect on familial aggregation, shared genetic factors, in fact, may be the most likely cause for this aggregation [3]. However, segregation of autoimmunity is fairly well understood.
Becker and colleagues [4], on the basis of previous autoimmune disease linkage studies, reported 18 common non-major histocompatibility complex loci clusters and hypothesized a shared genetic basis for the autoimmune trait. Since then, several reports, including that of Eyre and colleagues, have confi rmed that autoimmune phenotypes might represent pleiotropic outcomes of nonspecifi c disease genes [1,[5][6][7][8]. However, the fi nding of a polymorphism associated with a trait is not complete until the functional relevance is examined and its biological eff ect on such a trait is understood.
It is noteworthy that not all autoimmune diseases share the same genetic susceptibility. Th us, the genetic risk factors for autoimmune diseases might well consist of two forms: those common to many autoimmune diseases and those specifi c to a given disorder. Combinations of common and disease-specifi c alleles at HLA and non-HLA genes, in interaction with epigenetic and environmental factors over time (that is, gluten, tobacco,

Abstract
Although autoimmune diseases exhibit contrasting epidemiological features, pathology, and clinical manifestations, three lines of evidence demonstrate that these diseases share similar immunogenetic mechanisms (that is, autoimmune tautology). First, clinical evidence highlights the co-occurrence of distinct autoimmune diseases within an individual (that is, polyautoimmunity) and within members of a nuclear family (that is, familial autoimmunity). Second, physiopathologic evidence indicates that the pathologic mechanisms may be similar among autoimmune diseases. Lastly, genetic evidence shows that autoimmune phenotypes might represent pleiotropic outcomes of the interaction of non-specifi c disease genes.
Epstein-Barr virus, cytomegalovirus, and so on), will determine the fi nal clinical autoimmune phenotype [9]. Yet only around 10% to 15% of the inherited risk for autoimmune diseases can be explained at present [7,8].
Most of the common variants individually or in combination confer relatively small increments in risk (1.1-to 1.5-fold) and explain only a small proportion of heritability (that is, the proportion of phenotypic variation in a population that is attributable to genetic variation among individuals). Th e amount of heritability depends on the investigated population because variations in both additive and non-additive genetic factors and the environmental variance are specifi c to the population [10]. As a corollary, genetic results should be confi rmed in diff erent populations [11]. Th ere are several examples in which polymorphisms infl uencing the risk for developing autoimmune diseases in a particular population are not replicated in another one. Besides the inner characteristic of the studied popu lation and gradients of allelic frequencies among popula tions, other explanations for the missing heritability have been suggested: much larger numbers of variants of smaller eff ect yet to be found; rarer variants (possibly with larger eff ects) that are poorly detected by available genotyping arrays that focus on variants present in 5% or more of the population; structural variants poorly captured by existing arrays; low power to detect gene-gene interactions; and failure to account adequately for a shared environment among relatives [12]. Potential sources of missing heritability and research strategies to elucidate the genetics of complex diseases have been proposed [12]. It is evident, however, that the rapid development of DNA sequencing technologies and the continuously improving depth of coverage of polymorphisms by DNA chips for genome-wide association studies will contribute to an extremely expansive phase of genetic research.
Identifi cation of genetic causes of autoimmune diseases will enhance our understanding of the mechanisms common to multiple autoimmune diseases and to specifi c ones and will assist in providing increasing predictive capacity to identify subjects at risk for these devastating diseases and to identify new therapeutic interventions. Th us, in the near future, we should be able to predict which families or individuals within families may have a higher predisposition to develop an autoimmune phenotype by inspecting his or her family medical history, ancestry, and genetic and autoantibody profi le [3]. Although much progress has been made in identifying genetic factors that infl uence susceptibility to auto immune diseases, progress is lacking in identifying those factors that infl uence disease progression or complica tions. It is conceivable that only a subset of the genetic factors that infl uence susceptibility to disease also infl u ence disease progression and complications.