Figure 2.
Hypothetical schematic representation of proposed interplay between cytokine biomarkers and immune cells in wAIHA. Activated macrophages in spleen and/or liver produce wAIHA biomarkers IL-6, IL-8/CXCL8, IL-10, MCP-1/CXCL2, IP-10/CXCL10, TNFα, and MDC/CCXL22. IL-6, TNFα, and IL-10 dysregulate the humoral immune response in GC. TNFα downregulates T regulatory (Treg) cells in the periphery and Tfr cells in the GC. IL-10 is essential for generation of GC B-cell response; IL-6, produced by activated macrophages and plasmablast B cells, enhances gene transcription and function of Tfh cells that pushes and maintains autoantibody production. IL-8/CXCL8 may play a pivotal role in inducing autoantigens on the RBC because of ROS-induced oxidative stress. MCP-1 and IP-10 may indicate severity of wAIHA as MCP-1 is produced from macrophages owing to antibody-sensitized RBCs binding to FcRs, and IP-10 is necessary for effector T-cell generation and may influence Tfh effector cells as well. Down regulation of MDC may help to shift the TH2 response to a more inflammatory TH1 response and help drive the wAIHA. Cytokine/chemokines in red are potential biomarkers of wAIHA.