Revisiting Crohn's disease as a primary immunodeficiency of macrophages

Jean-Laurent Casanova, Laurent Abel, Jean-Laurent Casanova, Laurent Abel

Abstract

Despite two decades of mouse immunology and human genetics studies, the pathogenesis of Crohn's disease (CD) remains elusive. New clinical investigations suggest that CD may be caused by inborn errors of macrophages. These errors may result in impaired attraction of granulocytes to the gut wall, causing impaired clearance of intruding bacteria, thereby precipitating the formation of granulomas. This theory paves the way for a macrophage-based Mendelian genetic dissection of CD.

Figures

Figure 1.
Figure 1.
A model of intestinal chronic inflammation caused by inborn errors of macrophages in patients with CD. Macrophages from the patients are intrinsically defective, with impaired secretion of cytokines that are normally translated but internally degraded. Because of insufficient production of cytokines and chemokines, there is impaired attraction of granulocytes to mucosal breaches. Impaired acute, granulocytic inflammation results in impaired clearance of bacteria and debris from the gut wall, itself resulting in chronic, granulomatous inflammation.

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