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Cited by 629Systemic Lupus Erythematosus ResearchT-cell and B-cell ImmunologySex and Gender in Healthcare

Sex Differences in Autoimmune Disease from a Pathological Perspective

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Fairweather, DeLisa, Frisancho-Kiss, Sylvia, Rose, Noel R.·2008·The American Journal of Pathology
DOI 10.2353/ajpath.2008.071008PMC PMC2527069
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Abstract

Autoimmune diseases affect approximately 8% of the population, 78% of whom are women. The reason for the high prevalence in women is unclear. Women are known to respond to infection, vaccination, and trauma with increased antibody production and a more T helper (Th)2-predominant immune response, whereas a Th1 response and inflammation are usually more severe in men. This review discusses the distribution of autoimmune diseases based on sex and age, showing that autoimmune diseases progress from an acute pathology associated with an inflammatory immune response to a chronic pathology associated with fibrosis in both sexes. Autoimmune diseases that are more prevalent in males usually manifest clinically before age 50 and are characterized by acute inflammation, the appearance of autoantibodies, and a proinflammatory Th1 immune response. In contrast, female-predominant autoimmune diseases that manifest during the acute phase, such as Graves' disease and systemic lupus erythematosus, are diseases with a known antibody-mediated pathology. Autoimmune diseases with an increased incidence in females that appear clinically past age 50 are associated with a chronic, fibrotic Th2-mediated pathology. Th17 responses increase neutrophil inflammation and chronic fibrosis. This distinction between acute and chronic pathology has primarily been overlooked, but greatly impacts our understanding of sex differences in autoimmune disease.

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Cited by

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Authors
Fairweather, D., Frisancho-Kiss, S., & Rose, N. R.
Affiliations
Johns Hopkins University (US)
Corresponding author
Fairweather, DeLisa
ORCID
Fairweather, DeLisa
Venue
The American Journal of Pathology
Publisher
Elsevier BV
Published
2008-09
Volume
173
Issue
3
Pages
600-609
ISSN
0002-9440 (ISSN-L)
DOI
10.2353/ajpath.2008.071008
PMC
PMC2527069
OpenAlex
W2129710299
Cited by
629
References
7
Citations by year
2026: 38 · 2025: 37 · 2024: 46 · 2023: 30 · 2022: 32 · 2021: 51 · 2020: 53 · 2019: 46 · 2018: 41 · 2017: 42 · 2016: 45 · 2015: 32 · 2014: 34 · 2013: 21 · 2012: 23
FWCI
2.71
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal Of Pathology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institutes of Health (P30 ES03819, R01 HL67290, R01 HL087033)
Topics
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Life Sciences › Immunology and Microbiology › Immunology › T-cell and B-cell Immunology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
Keywords
sex differences, autoimmune disease, Th1/Th2 immune response, Th17 cells, fibrosis, chronic inflammation, Graves' disease, systemic lupus erythematosus, autoantibodies, neutrophilic inflammation, age of onset, sex differences in disease prevalence
MeSH terms
Autoimmune Diseases, Female, Humans, Male, Sex Characteristics, Incidence

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