Pathogenic processes related to IgA deposition
Processos patogênicos relacionados ao depósito de IgA
Victoria Luisa Pereira Aguiar, Maria Helena Sampaio Favarato
Abstract
Immunoglobulin A (IgA) antibodies play an important role in immunity owing to their structure, glycosylation, location, receptor interactions, and multiple functions. Dysregulation of IgA-mediated immune responses can result in diseases associated with IgA deficiency or inflammation, including diseases characterized by tissue deposition of IgA, such as IgA nephropathy (IgAN), IgA vasculitis (IgAV), and linear IgA bullous dermatosis (LABD). A systematic literature review was conducted to describe the pathogenic mechanisms underlying IgA deposition in IgAN, IgAV, and LABD. Searches were performed in the PubMed, BVS, and LILACS databases, including articles published from 2018 to 2023 in English, Portuguese, Spanish, and French. Results were summarized to correlate key pathogenic mechanisms with relevant clinical findings. A total of 461 articles were identified, of which 46 were included for IgAV, 122 for IgAN, and 3 for LABD. In IgA-V, galactose-deficient IgA1 (Gd-IgA1) produced by activated B cells forms immune complexes that activate neutrophils and trigger vascular inflammation. In IgAN, pathogenesis involves the aberrant production of Gd-IgA1, formation of autoantibodies, glomerular and mesangial deposition, and complement activation. In LABD, genetic susceptibility appears to play an important role, particularly through associations with specific human leukocyte antigen (HLA) alleles. Several HLA alleles have also been associated with disease susceptibility. In addition, elevated levels of pro-inflammatory cytokines, including interleukin (IL)-17, IL-8, and IL-6, as well as dysregulation of immune cells, such as T helper 1 (Th1), Th2, Th17, and regulatory T cells, contribute to disease pathogenesis. This review integrates current knowledge of the pathogenic mechanisms of IgA deposition and dysfunction, correlating them with diverse clinical manifestations observed across IgA-mediated diseases.
Keywords
Resumo
Os anticorpos do isotipo imunoglobulina A (IgA) desempenham um papel importante na imunidade devido à sua estrutura, glico‑ silação, localização e interações com receptores, bem como às suas múltiplas funções. Disfunções nesse sistema podem levar a doenças associadas à deficiência de IgA ou à inflamação, como doenças relacionadas à deposição tecidual de IgA: nefropatia por IgA (NIgA), vasculite por IgA (VAIgA) e dermatose autoimune bolhosa mediada por IgA (DIgA). Foi realizada revisão sistemática nos bancos de dados PubMed, BVSalud e LILACS com o objetivo de descrever os processos patogênicos que explicam a deposição de IgA na NIgA, VAIgA e DAIgA. A busca por artigos incluiu artigos do período 2018 a 2023 nos idiomas português, inglês, francês e espanhol. Os resultados foram resumidos de forma a corre‑ lacionar os pontos-chave da patogênese e os achados clínicos relevantes. Foram encontrados 461 artigos, sendo incluídos 46 para VIgA, 122 para IgAN e 3 para DIgA. A NIgA envolve produ‑ ção aberrante de IgA1, formação de autoanticorpos, deposição glomerular e mesangial e ativação do complemento. Na DIgA, destaca-se a influência genética em doenças dermatológicas, como a associação com alguns alelos HLA. Na IgA-V, a Gd-IgA1 produzida por células B ativadas e imunocomplexos ativa neutró‑ filos, desencadeando inflamação vascular. Os alelos HLA estão associados à suscetibilidade. Citocinas pró-inflamatórias, como IL-17, IL-8, IL-6, estão elevadas, enquanto células imunes (Th1, Th2, Th17 e Treg), estão desreguladas. Esta revisão de literatura unifica o conhecimento atual sobre a fisiopatologia das doenças relacionadas à deposição e disfunção de IgA, correlacionando-a com as diferentes manifestações clínicas.
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Referências
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16/11/2024
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21/11/2025
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