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Microbes & Immunity

REVIEW ARTICLE
A conceptual model of the role of infectious

agents in autoimmune diseases

Konstantinos L. Katsifarakis*
Department of Civil Engineering, Hydraulics and Environmental Engineering Division, Faculty of
Engineering, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece

Abstract
The correlation between microbes and autoimmunity is well established, but many
underlying mechanisms remain obscure. Thus, this paper attempts to elucidate
the role of infectious agents (bacteria, viruses, etc.) in autoimmune diseases.
To offer a concise framework for many relevant research findings, the following
general conceptual model is proposed and discussed: autoimmune diseases arise
from alterations in cells, tissues, or organs, caused by infectious agents. These
alterations evolve with time, beginning as subtle, often undetectable changes. As
the alterations become more severe, they can be identified by the immune system,
which may subsequently attack the infected cells. This process allows for new
explanations of relationships between triggers of autoimmunity and infectious
agents, the time lag between infection and autoimmune response, the progressive
nature of autoimmune diseases, and the role of virus persistence. It can also offer a
new point of view on molecular mimicry and epitope spreading. The roles of genetic
predisposition, sex, stress, dietary habits, the “hygiene hypothesis,” and the healing
*Corresponding author:
Konstantinos L. Katsifarakis effects of β-interferon also fit into this framework. In addition, the side effects of
(klkats@civil.auth.gr) malignancy treatments using immune checkpoint inhibitors can also be explained.
Citation: Katsifarakis KL. A Adhering to the framework, it is concluded that treatments should aim to eliminate
conceptual model of the role of the cause of these evolving alterations, namely, the infectious agents. Presumably,
infectious agents in autoimmune they could be based on antibiotics and antiviral drugs. Future research directions are
diseases. Microbes & Immunity.
2025;2(4):17-26. suggested for evaluating the proposed conceptual model.
doi: 10.36922/MI025100017
Received: March 3, 2025 Keywords: Autoimmune diseases; Infectious agents; Molecular mimicry; Epitope
Revised: March 25, 2025 spreading; Hygiene hypothesis; Virus persistence; Immune checkpoint inhibitors;
Resilience
Accepted: April 1, 2025
Published online: May 5, 2025
Copyright: © 2025 Author(s).
This is an Open-Access article 1. Introduction
distributed under the terms of the
Creative Commons Attribution Autoimmune diseases tend to evolve into a scourge, particularly in developed countries.
License, permitting distribution, At present, 80 – 120 diseases have been identified as autoimmune, depending on
1
and reproduction in any medium, the classification criteria. A common feature of autoimmune diseases is the immune
2
provided the original work is
properly cited. system’s aberrant attack on the body’s own cells, tissues, or organs, treating them as
foreign. Despite this shared characteristic, different triggers and evolution courses have
Publisher’s Note: AccScience
Publishing remains neutral with been identified, as described by Theofilopoulos et al. 3
regard to jurisdictional claims in
published maps and institutional At a fundamental level, autoimmune diseases have been linked to various dysfunctions
4-6
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affiliations. of the immune system, such as impaired tolerance, hormonal dysregulation, or
Volume 2 Issue 4 (2025) 17 doi: 10.36922/MI025100017