Role of autoimmunity in the pathogenesis of chronic obstructive pulmonary disease and pulmonary emphysema

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality. Cigarette smoke is the cause of COPD. However, only a fraction of current and/or former smokers develop an increased immune response in the lungs that has a role in COPD progression correlating with lungs infiltration by innate and adaptive immune cells. Both cellular and antibody-mediated autoimmunity can induce COPD in experimental models. In particular, carbonyl-modified proteins modulate autoimmunity in lungs resulting in airways abnormalities and pulmonary emphysema. Although a role for autoimmunity in COPD patients is known, a cause-and-effect relationship between autoimmunity and the mechanisms of COPD has to be proven. In addition, the role of autoimmune responses in the pathogenesis of COPD exacerbations is still unclear. Several drugs targeting autoimmune responses are available and the results of clinical trials are awaited. Finally, specific serum autoantibodies could be used as biomarkers to predict clinical phenotypes or progression of stable COPD.