Why Do Women Get Autoimmune Diseases Far More Often Than Men? Transgenic Mouse Study Suggests a Root Cause and Target for New Treatments

It’s one of the great mysteries of medicine, and one that affects the lives of millions of people: Why do women’s immune systems gang up on them far more than men’s do, causing far more women to develop autoimmune diseases such as lupus?

Part of the answer, it turns out, may lie in the skin.

New evidence points to a key role for a molecular switch called VGLL₃. Three years ago, a team of University of Michigan researchers showed that women have more VGLL₃ in their skin cells than men do.

Now, working in mice, they’ve discovered that having too much VGLL₃ in skin cells pushes the immune system into overdrive, leading to a “self-attacking” autoimmune response. Surprisingly, this response extends beyond the skin, attacking internal organs, too.

Writing in JCI Insight, the team describes how VGLL₃ appears to set off a series of events in skin that trigger the immune system to come running — even when there’s nothing to defend against.

“VGLL₃ appears to regulate immune response genes that have been implicated as important to autoimmune diseases that are more common in women but that don’t appear to be regulated by sex hormones,” says Johann Gudjonsson, M.D., Ph.D., who led the research team and is an associate professor of dermatology at the U-M Medical School.

“Now, we have shown that overexpression of VGLL₃ in the skin of transgenic mice is by itself sufficient to drive a phenotype that has striking similarities to systemic lupus erythematosus, including skin rash and kidney injury,” he says.

Gudjonsson worked with co-first authors Allison Billi, M.D., Ph.D., and Mehrnaz Gharaee-Kermani, Ph.D., and colleagues from several U-M departments to trace VGLL₃’s effects.

They found that extra VGLL₃ in skin cells changed expression levels of a number of genes important to the immune system. Expression of many of the same genes is altered in autoimmune diseases like lupus.

Wreaking havoc

The gene expression changes caused by excess VGLL₃ wreaked havoc in the mice. Their skin became scaly and raw. Immune cells thrived, filling the skin and lymph nodes. The mice also produced antibodies against their own tissues, including the same antibodies that can destroy the kidneys of lupus patients.

The researchers don’t yet know what causes female skin cells to have more VGLL₃ to begin with. It may be that over evolutionary time, females have developed stronger immune systems to fight off infections — but at the cost of increased risk for autoimmune disease if the body mistakes itself for an invader.

The researchers also don’t know what triggers might set off extra VGLL₃ activity. But they do know that in men with lupus, the same VGLL₃ pathway seen in women with lupus is activated.

Many of the current therapies for lupus, which affects 1.5 million Americans, come with unwanted side effects from steroids, including increased infection risk and cancer.

Potentially safer therapies

Finding the key factors downstream of VGLL₃ may identify targets for new, and potentially safer, therapies that could benefit patients of both sexes.

J. Michelle Kahlenberg, M.D., Ph.D., an associate professor in U-M’s Division of Rheumatology and a senior co-author on the VGLL₃ work, is recruiting patients with lupus for a study sponsored by U-M’s A. Alfred Taubman Medical Research Institute that could provide answers to these questions and more.

Billi, a resident in dermatology, notes that when she speaks with patients who come to Michigan Medicine’s dermatology clinics for treatment of the skin problems lupus can cause, she has to acknowledge the limits of current treatment. Even so, she says, patients are eager to take part in studies by contributing skin and DNA samples that could lead to new discoveries about their condition.

“Many patients are frustrated that they’ve had to try multiple therapies and still nothing is working well,” Billi says. “To be able to tell them that we’re working on a mouse that has the same disease as them, and that we need their help, brings out their motivation and interest in research.

“They know that it’s a long game, and they’re in for it.”

The research was funded by the National Institutes of Health and the University of Michigan, with additional support from the Rheumatology Research Foundation, the Dermatology Foundation, the Arthritis National Research Foundation, and the National Psoriasis Foundation.

Gudjonsson and Kahlenberg are supported by and are Emerging Scholars of the Taubman Institute. U-M has applied for a patent on the VGLL₃ mouse model.

Reference: JCI Insight, 2019;4(8):e127291. https://doi.org/10.1172/jci.insight.127291

This story was originally published by the Michigan Health Lab Blog on April 25, 2019.