Imperial College London
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DrVictoriaMale

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Senior Lecturer in Reproductive Immunology
 
 
 
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v.male

 
 
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Location

 

Chelsea and Westminster HospitalChelsea and Westminster Campus

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Summary

 

Publications

Citation

BibTex format

@article{Keestra:2021:10.1016/j.mehy.2021.110558,
author = {Keestra, SM and Male, V and Salali, GD},
doi = {10.1016/j.mehy.2021.110558},
journal = {Medical Hypotheses},
pages = {1--15},
title = {Out of balance: the role of evolutionary mismatches in the sex disparity in autoimmune disease},
url = {http://dx.doi.org/10.1016/j.mehy.2021.110558},
volume = {151},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Over the past century autoimmune disease incidence has increased rapidly in (post-) industrialised, affluent societies, suggesting that changes in ecology and lifestyle are driving this development. Epidemiological studies show that (i) 80% of autoimmune disease patients are female, (ii) autoimmune diseases co-occur more often in women, and (iii) the incidence of some autoimmune diseases is increasing faster in women than in men. The female preponderance in autoimmunity is most pronounced between puberty and menopause, suggesting that diverging sex hormone levels during the reproductive years are implicated in autoimmune disease development. Using an evolutionary perspective, we build on the hypotheses that female immunity is cyclical in menstruating species and that natural selection shaped the female immune system to optimise the implantation and gestation of a semi-allogeneic foetus. We propose that cyclical immunomodulation and female immune tolerance mechanisms are currently out of balance because of a mismatch between the conditions under which they evolved and (post-)industrialised, affluent lifestyles. We suggest that current changes in autoimmune disease prevalence may be caused by increases in lifetime exposure to cyclical immunomodulation and ovarian hormone exposure, reduced immune challenges, increased reproductive lifespan, changed reproductive patterns, and enhanced positive energy balance associated with (post-)industrialised, affluent lifestyles. We discuss proximate mechanisms by which oestrogen and progesterone influence tolerance induction and immunomodulation, and review the effect of the menstrual cycle, pregnancy, and contraceptive use on autoimmune disease incidence and symptoms.
AU  - Keestra,SM
AU  - Male,V
AU  - Salali,GD
DO  - 10.1016/j.mehy.2021.110558
EP  - 15
PY  - 2021///
SN  - 0306-9877
SP  - 1
TI  - Out of balance: the role of evolutionary mismatches in the sex disparity in autoimmune disease
T2  - Medical Hypotheses
UR  - http://dx.doi.org/10.1016/j.mehy.2021.110558
UR  - https://www.sciencedirect.com/science/article/pii/S0306987721000761?via%3Dihub
UR  - http://hdl.handle.net/10044/1/90865
VL  - 151
ER  -
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