In many autoimmune diseases, the antigens that stimulate the disease or are the target of autoimmune attack are not clearly defined. There are some notable exceptions (Table 5.7).
One group of antigens, which have been implicated in the pathogenesis of a number of autoimmune diseases are the highly conserved heat shock proteins (hsp). When cells are stressed, heat shock proteins are produced preferentially and confer some protective effect on the stressed cells. They are so highly conserved that even bacteria produce these proteins and they show a high degree of homology to those produced by animals of various species. These proteins are grouped into families according to their molecular weight. Cell surface expression of hsp 90 is increased in about one-fifth of patients with systemic lupus erythematosus (particularly on B cells and CD4+ T cells). By contrast, hsp 65 levels are increased in patients with rheumatoid arthritis.
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