4.5 Review

The gut-enthesis axis and the pathogenesis of Spondyloarthritis

Journal

SEMINARS IN IMMUNOLOGY
Volume 58, Issue -, Pages -

Publisher

ACADEMIC PRESS LTD- ELSEVIER SCIENCE LTD
DOI: 10.1016/j.smim.2022.101607

Keywords

Spondyloartrhitis; Enthesis; Gut; Innate immunity; Gut-joint axis; IL-17; Enthesitis

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Subclinical inflammation is linked to Spondylarthritis (SpA), with patients exhibiting dysbiosis, altered gut barrier function, and expansion of certain immune cells. Research suggests that activated intestinal immune cells may circulate in the blood and affect joints, supporting the gut-joint axis theory, and a potential gut-enthesis axis may also play a role in SpA development.
Subclinical inflammation is associated with Spondylarthritis (SpA). SpA patients show features of dysbiosis, altered gut barrier function, and local expansion of innate and innate-like cells involved in type 3 immune response. The recirculation of intestinal primed immune cells into the bloodstream and, in some cases, in the joints and the inflamed bone marrow of SpA patients gave the basis of the gut-joint axis theory.In the light of the critical role of enthesis in the pathogenesis of SpA and the identification of mucosal-derived immune cells residing into the normal human enthesis, a gut-enthesis axis is also likely to exist. This work re-views the current knowledge on enthesis-associated innate immune cells' primary involvement in enthesitis development, questions their origin, and critically discusses the clues supporting the existence of a gut-enthesis axis contributing to SpA development.

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