Anorexia nervosa and autoimmune comorbidities: A bidirectional route?

Immunological dysfunctions in eating disorders have recently gained increasing sci-entific attention. Furthermore, the reciprocal association between anorexia and au-toimmune diseases is of particular interest and suggests a role of autoimmunity in the pathogenesis of eating disorders. Anorexia nervosa (AN) and autoimmune dis-eases are linked by a bidirectional relationship based on common immunopathological mechanisms. In this review, in addition to reporting the numerous cases described in which autoimmune disorders are associated with anorexia or vice versa, we summa-rize the many aspects of this relationship between the immune system (IS) and AN. We describe how the microbiota affects the IS, disrupts gut- brain communication, and possibly triggers eating disorders. We also describe the shared immunological pathways of autoimmune and eating disorders and in particular the occurrence of disrupted T cell tolerance and autoantibodies in AN. The described observations rep-resent the starting point for possible, future research directions.