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Rheumatology Advance Access originally published online on February 28, 2003
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Rheumatology 2003; 42: 404-412
© 2003 British Society for Rheumatology

Review

Breaking the rules: the unconventional recognition of HLA-B27 by CD4+ T lymphocytes as an insight into the pathogenesis of the spondyloarthropathies

L. H. Boyle and J. S. Hill Gaston

University of Cambridge School of Clinical Medicine, Department of Medicine, Cambridge, UK

Despite extensive research, it remains unclear why a small proportion of HLA- B27+ individuals develop spondyloarthropathies (SpA). Because the function of HLA-B27, as a major histocompatibility complex (MHC) class I molecule, is peptide presentation to CD8+ T cells, research has concentrated on the role of HLA-B27 as a restriction element for CD8+ cytotoxic T lymphocytes in pathogenesis. However, findings in the B27-transgenic animal models, together with the identification of unusual processing and presentation features of HLA-B27, have raised alternative hypotheses for the pathogenic role of HLA-B27. One such hypothesis is that HLA-B27 can be recognized by CD4+ T lymphocytes. Here we report the identification of such unusual cells, which break the conventional rules of MHC restriction, and propose a model for the role of such CD4+ T cells in SpA.

KEY WORDS: Major histocompatibility complex, Spondyloarthropathy, HLA-B27, T lymphocytes.

Correspondence to: L. H. Boyle, Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK. E-mail: lhb22{at}medschl.cam.ac.uk


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