[Atherogenesis: a dysimmune disease]

The immuno-inflammatory response is central to the development of atherosclerosis. The important players of the adaptive immune system are all involved in this pathologic process. Several antigens have been identified these last years and they are mostly self-molecules that have been modified due to the complex microenvironment that is generated within the diseased artery. Pro-atherogenic autoreactive T cells have been characterized. The presence of auto-reactive natural antibodies has also been confirmed in the lesions. All these, together with the data showing that adoptive transfer of lymphocytes is able to modulate the disease, fulfill the criteria put forth by Witebsky and Rose to define a disease as being autoimmune. However, the complexity of the disease process extends to the immune system. Although T cells are known to be pro-atherogenic, B cells have been clearly shown to be athero-protective. The fine balance between the two extensions of the adaptive immune response is the key to a successful therapeutic approach towards atherosclerosis.