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Environmental factors influencing the risk of ANCA-associated vasculitis
Wen-Man Zhao1, Zhi-Juan Wang1, Rui Shi1
1Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China.
Abstract:
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of diseases characterized by inflammation and destruction of small and medium-sized blood vessels. Clinical disease phenotypes include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The incidence of AAV has been on the rise in recent years with advances in ANCA testing. The etiology and pathogenesis of AAV are multifactorial and influenced by both genetic and environmental factors, as well as innate and adaptive immune system responses. Multiple case reports have shown that sustained exposure to silica in an occupational environment resulted in a significantly increased risk of ANCA positivity. A meta-analysis involving six case-control studies showed that silica exposure was positively associated with AAV incidence. Additionally, exposure to air pollutants, such as carbon monoxide (CO), is a risk factor for AAV. AAV has seasonal trends. Studies have shown that various environmental factors stimulate the body to activate neutrophils and expose their own antigens, resulting in the release of proteases and neutrophil extracellular traps, which damage vascular endothelial cells. Additionally, the activation of complement replacement pathways may exacerbate vascular inflammation. However, the role of environmental factors in the etiology of AAV remains unclear and has received little attention. In this review, we summarized the recent literature on the study of environmental factors, such as seasons, air pollution, latitude, silica, and microbial infection, in AAV with the aim of exploring the relationship between environmental factors and AAV and possible mechanisms of action to provide a scientific basis for the prevention and treatment of AAV.
Insights
Environmental factors like silica exposure and air pollution are increasingly linked to antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Understanding these triggers may help prevent and treat AAV.
Area of Science:
- Immunology
- Environmental Medicine
- Rheumatology
Background:
- Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) encompasses diseases like MPA, GPA, and EGPA, characterized by small and medium blood vessel inflammation.
- AAV incidence is rising, partly due to improved ANCA testing, with multifactorial causes involving genetics and environmental exposures.
- While genetic factors are recognized, the role of environmental influences in AAV etiology remains under-explored.
Purpose of the Study:
- To review and synthesize current literature on environmental factors implicated in AAV.
- To explore the relationship between various environmental elements and AAV development.
- To elucidate potential mechanisms linking environmental factors to AAV pathogenesis for improved prevention and treatment strategies.
Main Methods:
- Literature review of recent studies on environmental factors and AAV.
- Analysis of data concerning seasons, air pollution (e.g., CO), latitude, silica exposure, and microbial infections.
- Examination of proposed mechanisms involving neutrophil activation, extracellular traps, and complement pathways.
Main Results:
- Silica exposure is significantly associated with increased ANCA positivity and AAV incidence, supported by case reports and meta-analyses.
- Air pollutants, including carbon monoxide, are identified as risk factors for AAV.
- AAV exhibits seasonal trends, suggesting environmental stimuli trigger neutrophil activation and vascular damage.
Conclusions:
- Environmental factors play a crucial, yet often overlooked, role in the etiology and pathogenesis of AAV.
- Further research into environmental triggers like silica, air pollution, and infections is essential for AAV prevention and treatment.
- Understanding these environmental links can provide a scientific basis for targeted interventions against AAV.
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