ABSTRACT
Autoantibodies have been described in most autoimmune diseases, yet the precise role played by antibody and the B-cell in most of these diseases is not clear. In a number of diseases these antibodies are known to be pathogenic but in others their significance is unknown. In addition, the role of the B-cell in autoimmunity may well extend beyond that of antibody secretion. The importance of delineating the contribution of different cell types to the development of disease lies in the targeting of
treatment. Anti-T-cell immunosuppression, e.g. cyclosporin, is not effective in many autoimmune diseases [such as systemic lupus erythematosus (SLE) or vasculitis] in which broad spectrum immunosuppression is currently required. Defining the pathogenic contribution of other cell types will encourage targeting of treatment to them, potentially increasing effectiveness whilst reducing toxicity. Here we will discuss the role of B-cells and of autoantibody in the pathogenesis of autoimmunity. We will first provide background information on the B-cell immune response, then on the maintenance and breakdown of B-cell tolerance. In the final section we will discuss evidence for the involvement of B-cells in individual autoimmune diseases.
