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Premature Ovarian Failure and Ovarian Autoimmunity¹

Department of Immunology (A.H.), Erasmus University, 3000 DR Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology (J.S.), Academic Hospital of the Vrije Universiteit, Amsterdam, The Netherlands; and Department of Immunology (H.A.D.), Erasmus University, 3000 DR Rotterdam, The Netherlands

I. Introduction

II. Definition and Clinical Presentation of Premature Ovarian Failure (POF)

III. Cells Involved in the Immune Response

A. Antigen presentation and antigen-presenting cells, in particular dendritic cells

B. T cells

C. B cells

D. Effector cells in immune responses

IV. Tolerance to Self

A. Clonal deletion

B. Clonal anergy

C. Active immunosuppression

D. Balance between Th1 and Th2 pathways

V. Autoimmune Endocrine Disease: Developmental Stages and Genetic Predisposition

VI. POF in Association with Adrenal Autoimmunity and/or Addison’s Disease

A. Antibodies in POF patients with adrenal autoimmunity and/or Addison’s disease

B. Histology of ovaries in patients with POF in combination with adrenal autoimmunity and/or Addison’s disease

C. Immunogenetic aspects of POF in association with adrenal autoimmunity and/or Addison’s disease

D. Conclusions

VII. Signs of Ovarian Autoimmunity in Patients with Idiopathic POF in the Absence of Adrenal Autoimmunity and/or Addison’s Disease

A. Histology of the ovaries in patients with idiopathic POF in the absence of adrenal autoimmunity and/or Addison’s disease

B. Autoantibodies in patients with idiopathic POF in the absence of adrenal autoimmunity and/or Addison’s disease

C. Cellular immune abnormalities in patients with idiopathic POF in the absence of adrenal autoimmunity and/or Addison’s disease

D. Conclusions

VIII. Animal Models of Autoimmune Oöphoritis

A. Immunization with crude ovarian antigens

B. Immunization with heterologous ZP antigens or purified ZP3 antigens

C. Neonatal thymectomy models

D. Transfer of normal T cells to athymic (nu/nu) mice

E. Conclusions

IX. Summary

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