Thromboangiitis Obliterans: A Multifactorial Disease With an Immunological Basis

The aim of this review was to assess several factors associated with Buerger’s disease or thromboangiitis obliterans (TAO), especially the immunological basis of this disease. We found that an established etiology for TAO has not been agreed on so far, but no one denies the strong association between TAO and tobacco consumption. Another possible etiology for this disease is bacterial infections such as Porphyromonas gingivalis and Rickettsia and their possible role via inflammatory processes. TAO was more common in low socioeconomic societies with poor hygiene. It may be attributable to the prevalence of Rickettsia infection because of the tick bite in these societies. In case of autoimmunity, it should be noted that T 17 cells keep the body away from autoimmune processes. The number of infiltrated CD4+ T cells in the arterial wall is higher than B cells. In fact, this may propose the significant role of T cells in the immunopathology of patients with TAO. The disease is also associated with tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-4, IL-17 and IL-23, as inflammatory cytokines. Antiphospholipid antibodies, anti-CL, anti-TLRVYK, anti-TLRIYT, anti-TLALYK, and anticardiolipin may also play a role in this disease. Further evidence is needed to shed light on the condition, especially in case of T cell lymphocytes’ role.