Fig. 1.
Hypothesized therapeutic role of blocking IL6 pathway in Sarcoidosis. Innate response to microbial infection induces IL6 by macrophages and dendritic cells leading to 1. Activation of the acute phase response with induction of serum amyloid A (SAA) that aggregates within granulomas and stimulates local T cell immunity; 2. induction of mTOR with metabolic changes and promoting epithelioid cell differentiation; 3. promotion of Th17 cell differentiation; 4. inhibition of regulatory T cell differentiation enhancing local Th1/ Th17/Th17.1 immunity. Blocking IL6 receptor with tocilizumab would potentially inhibit these responses.