ArticleEvolutionary applications2021
Why women have more autoimmune diseases than men: An evolutionary perspective.
Article in Evolutionary applications, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 2 of them syntheses that pooled it.
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Who cites it
87 citing papers in PubMed, 2 syntheses or guidelines pooled it, 132 citations in OpenAlex.
- Effects of post-COVID-19 vaccination in oral cavity: a systematic review.Evidence-based dentistry · 2024Pooled it
- TFOS lifestyle: Impact of societal challenges on the ocular surface.The ocular surface · 2023Pooled it
- Multipeptide vaccines for melanoma in the adjuvant setting: long-term survival outcomes and post-hoc analysis of a randomized phase II trial.Nature communications · 2024Trial
- Comorbidity Associations with Ocular Pain after Cataract Surgery: Overall and Sex-Stratified Analysis.AJO international · 2026Article
- Sex-specific biological aging clocks across organs and omics.Nature medicine · 2026Article
- PLCγ2 deficiency compromises systemic immune tolerance and erodes myelin homeostasis while enhancing oxidative metabolism in the mouse brain.bioRxiv : the preprint server for biology · 2026Article
- Primary adrenal insufficiency induced by immune checkpoint inhibitors (ICIs): a case series and systematic literature review.Reviews in endocrine & metabolic disorders · 2026Review
- Serum Calprotectin Concentration in Patients with Oral Lichen Planus: A Cross-Sectional Study.Medicina (Kaunas, Lithuania) · 2026Article
- Changes in ANA Positivity Following SARS-CoV-2 Outbreak in Lombardy Region, Italy.Journal of medical virology · 2026Article
- Sex Differences in Metabolite-Immune Circuits of Neuroinflammation.Immunological reviews · 2026Review
- Age and sex differences in diabetic ketoacidosis outcomes in type 1 diabetes: a national cohort study.BMJ open diabetes research & care · 2026Article
- Association of alopecia areata with COVID-19 vaccination: A vaccine adverse events reporting system analysis.Dermatology online journal · 2026Article
- Sex matters in CSU: Women face greater burden and poorer urticaria control, especially in midlife-CURE insights.Journal of the European Academy of Dermatology and Venereology : JEADV · 2026Article
- Therapeutic potential of TAM receptors in autoimmune diseases: insights from original studies.Oxford open immunology · 2026Review
- Identification of a TCR signature in peripheral blood derived CD4+ T cells, associated with chronic chikungunya disease, suggests a conducive, female-biased, background immune profile.Frontiers in immunology · 2026Article
- Thyroid dysfunction in ageing populations.Endocrine connections · 2025Review
- Inflammatory Semaphorins in the Pathogenesis and Prognosis of Acute Ischemic Stroke.Medicina (Kaunas, Lithuania) · 2025Article
- Sex- and strain-differential plasma proteomic signatures in C57BL/6 and BALB/c mice.Scientific reports · 2025Article
- Patient-reported characteristics of pernicious anaemia: a first step to initiate James Lind Alliance Priority Setting Partnership driven research.BMC primary care · 2025Article
- Sex-related differences in treatment outcomes of chronic hepatitis C with direct-acting antivirals.World journal of hepatology · 2025Article
27 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Women have up to a fourfold increase in risk for autoimmune disease compared to men. Many explanations have been proposed, including sex hormones, the X chromosome, microchimerism, environmental factors, and the microbiome. However, the mechanism for this autoimmune sex bias remains obscure. In this manuscript, we evaluate the hypothesis that qualitative or quantitative differences in circulating antibodies may explain, at least in part, the pathogenesis of autoimmune disease and its sex bias-especially when considering an evolutionary perspective. Indeed, women have higher absolute levels of antibodies than men, and (auto)antibodies are also associated with most autoimmune diseases. Several facts suggest differences in antibodies may cause increased prevalence of autoimmune disease in women. First, the association between increased quantities of serum antibodies and increased prevalence of autoimmunity is found not only in women, but also in men with Klinefelter syndrome. Second, both serum antibody levels and autoimmunity spike in the postpartum period. Third, a dose-response effect exists between parity and both serum antibodies and prevalence of autoimmune disease. Fourth, many biologically plausible mechanisms explain the association, such as T cell-dependent activation of B cells and/or VGLL3. The evolutionary underpinning of increased antibodies in women is likely to be protection of offspring from infections. Overall, this evolutionary paradigm can help explain why the phenomenon of autoimmunity occurs preferentially in women and raises the possibility of new treatment options.
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