Organ-specific or endocrine autoimmune diseases are complex, polygenic afflictions the penetrance of which is heavily dependent
on various environmental influences. Important target tissues are the thyroid, the islets of Langerhans, gastric parietal
cells and steroid-producing cells in the adrenal and ovary. The etiology of these diseases remains to be clarified. The pathogenesis
is strongly associated with autoimmune phenomena. None of the current treatment approaches provides a cure; rather they represent
replacement therapy. An important objective in the treatment of endocrine/organ-specific autoimmune diseases is the detection
of individuals at risk for the development of such diseases and the development of interventions to prevent an outbreak of
the diseases. This requires an exquisite knowledge of the early etio-pathogenic stages of these diseases. This review concentrates
on the usefulness of animal models for a precise understanding of these very early stages. It must be emphasized that studying
animal models cannot answer all the problems presented by endocrine/organ-specific autoimmune diseases as seen in the clinic.
It must be expected – considering the different etiologies in the different animal models (see below) – that the causes of
the diseases in the human and the involvement of various genes and environmental factors may also vary. Yet, particularly
in the study of the pre-autoimmune phases of the diseases, there is hardly any alternative to the study of animal models.
Only limited series of experiments can be carried out in human subjects at risk to develop such diseases. Moreover, a general
semblance (blueprint) of the etio-pathogenesis found in the animal models can lead the way for human studies. Efforts to understand
the patho-physiology of the early stages of endocrine/organ-specific autoimmune diseases have mainly involved animal models
that ”spontaneously” develop such diseases. Of these the bio-breeding diabetes-prone (BB-DP) rat and the non-obese diabetes
(NOD) mouse are the most well studied, yet many studies have also been carried out in the obese strain (OS) chicken. Apart
from these spontaneous models there are animal models that are induced by environmental perturbations (viruses, toxic substances),
by thymectomy procedures or by genetic manipulations, e.g., the RIP-LCMV model and the BDC 2.5 TCR mouse model. A general
blueprint has emerged from the studies into the early stages of the pathogenesis of endocrine/organ-specific autoimmune diseases
in these animal models: animals at risk to develop endocrine/organ-specific autoimmune diseases show various pre-autoimmune
aberrancies in their target glands, T cells, macrophages (Mφ) and dendritic cells (DC). The presumably aberrant target cells,
T cells, DC and Mφ need to interact abnormally before autoimmune disease can fully develop. In this abnormal interaction additional
aberrancies in other regulatory systems may play a role in a further exacerbation of the self-directed immune response, such
as defects in the hypothalamus pituitary adrenal (HPA) axis system. The various aberrancies are partly genetically determined
by a variety of separate genes, particularly MHC-related genes, but they may also be environmentally induced (e.g., via viruses,
high iodine diet, and other experimental manipulations). Recently evidence has been gathered for pre-autoimmune aberrancies
similar to the animal models in the DC/ Mφ compartment and the HPA axis in humans at risk to develop endocrine/organ-specific
autoimmune diseases. However, analogous pre-autoimmune abnormalities in human target glands or in T cell function have not
yet been found with certainty. We believe that animal models of endocrine/organ-specific autoimmune disease still hold immense
promise for the discovery of pathways, genes and environmental factors that determine the development of endocrine/organ-specific
autoimmune diseases. Animals affected by such diseases provide a unique opportunity to uncover disease-associated pathways,
which are complicated to define in man.
Acknowledgments. Work in our departments is supported by grants from the Dutch Diabetic Foundation, the Dutch Organization for Scientific Research
Now – Health Sciences, the European Community and the American Diabetic Association.
Correspondence to: H.A. Drexhage