Research ArticleInterstitital lung disease

BPIFB1 Is a Lung-Specific Autoantigen Associated with Interstitial Lung Disease

Science Translational Medicine  09 Oct 2013:
Vol. 5, Issue 206, pp. 206ra139
DOI: 10.1126/scitranslmed.3006998

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Seeing the Forest by Examining the Trees

Sometimes looking at something too closely obscures the big picture. However, when the big picture is too big, a reductionist approach may be best. Interstitial lung disease (ILD) is a complex and heterogeneous disorder, frequently associated with autoimmune syndromes. However, due in part to this heterogeneity, it remains unclear whether autoimmunity directly contributes to ILD. Now, Shum et al. attack this question by example—connecting one form of autoimmune disease, autoimmune polyglandular syndrome type 1 (APS1), with clinical ILD.

The authors screened patients with APS1 and found autoantibodies to a lung-specific protein—BPIFB1—associated with the development of ILD in APS1 patients. They then extended these findings to non-APS1–associated ILD and found that 12 to 15% of patients also had these autoantibodies. The authors then examined a potential pathogenic mechanism of these autoantibodies in a mouse model of APS1, finding that similar autoantibodies and development of ILD resulted from a defect in thymic tolerance. Indeed, autoimmune targeting of BPIFB1 could cause ILD in mice without the autoimmune defect. These results suggest not only that ILD may be an autoimmune disorder in APS1 patients but also that autoimmunity may also contribute to pathology in a broader swath of ILD patients.