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Egress from the thymus through the perivascular space (PVS) to the blood is another possible checkpoint, as shown by some autoimmune\/immunodeficiency syndromes. In polygenic autoimmune diseases, subtle thymic dysfunctions may compound genetic, hormonal and environmental cues. Here, we cover (a) tolerance-inducing cell types, whether thymic epithelial or tuft cells, or dendritic, B- or thymic myoid cells; (b) tolerance-inducing mechanisms and their failure in relation to thymic anatomic compartments, and with special emphasis on human monogenic and polygenic autoimmune diseases and the related thymic pathologies, if known; (c) polymorphisms and mutations of tolerance-related genes with an impact on positive selection (e.g. the gene encoding the thymoproteasome-specific subunit,<jats:italic>PSMB11<\/jats:italic>), promiscuous gene expression (e.g.<jats:italic>AIRE<\/jats:italic>,<jats:italic>PRKDC<\/jats:italic>,<jats:italic>FEZF2<\/jats:italic>,<jats:italic>CHD4<\/jats:italic>), Treg development (e.g.<jats:italic>SATB1<\/jats:italic>,<jats:italic>FOXP3<\/jats:italic>), T-cell migration (e.g.<jats:italic>TAGAP<\/jats:italic>) and egress from the thymus (e.g.<jats:italic>MTS1<\/jats:italic>,<jats:italic>CORO1A<\/jats:italic>); (d) myasthenia gravis as the prototypic outcome of an inflamed or disordered neoplastic \u2018sick thymus\u2019.<\/jats:p>","DOI":"10.1007\/s00281-021-00842-3","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T17:03:12Z","timestamp":1612371792000},"page":"45-64","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":108,"title":["Thymus and autoimmunity"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9722-2483","authenticated-orcid":false,"given":"Alexander","family":"Marx","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Simon-Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berthold","family":"Schalke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Willcox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Str\u00f6bel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleo-Aron","family":"Weis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,2,3]]},"reference":[{"key":"842_CR1","doi-asserted-by":"publisher","unstructured":"Kappler JW, Roehm N, Marrack P (1987) T cell tolerance by clonal elimination in the thymus. 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