Gene, Environment, Microbiome and Mucosal Immune Tolerance in Rheumatoid Arthritis

Anca I. Catrina; Kevin D. Deane; Jose U. Scher


Rheumatology. 2016;55(3):391-402. 

In This Article

Summary and Future Directions

As discussed above, several aspects of the mucosal system biology, including its relationship to a variety of commensal as well as pathogenic organisms, make it an attractive frontier in rheumatological research. However, several challenges on how to explore this frontier are still elusive (Table 2). Perhaps the most important factor in advancing the understanding of the role of mucosal biology in the development of rheumatic disease will be the careful utilization of well-characterized human cohorts followed longitudinally in various phases of development of rheumatic disease. These should range from a healthy state to preclinical disease (i.e. where there is evidence of autoimmunity but in the absence of clear target organ injury) and established disease (both before and after the initiation of immunomodulatory therapies that can alter mucosal inflammation and the microbiome). Given the great promise that the study of mucosal immunity holds for understanding the development of rheumatic and other autoimmune diseases, understanding this biological frontier should be in the vanguard of research in the field of human rheumatology, with the ultimate goal of elucidating pathways that can lead to preventive tools and strategies.