The association between smoke habit and autoimmunity has been hypothesized long time ago. Smoke has been called to play a pathogenic role since in certain autoimmune disease as it may trigger the development of autoantibodies, and act on pathogenic mechanism possibly related with an imbalance of the immune system. Indeed, it has been proven by epidemiologic studies as well as in animal models the potential burden caused by smoke. For instance, smoke, by provoking oxidative stress, may contribute to lupus disease by dysregulating DNA demethylation, upregulation of immune genes and leading to autoreactivity. Moreover, it can alter the lung microenvironment, facilitating infections, which, in turn, may trigger the development of an autoimmune condition. This, in turn, may result in a dysregulation of the autoimmune system leading to autoimmune phenomena. Not only cigarette smoke, but also air pollution has been called responsible for the development of autoimmunity. These evidences suggest the need for large epidemiological studies in order to further explore the biological plausibility of smoke effect in the pathogenesis of autoimmune diseases.
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