“…It is possible that activation through an endogenous TLR ligand, such as heat-shock proteins (HSPs) (17,47), may predispose the macrophages to heightened activation by subsequent exposure to microbial TLR ligands (48,49). Alternatively, it is also feasible that prior in vivo exposure to potential endogenous TLR-2 or TLR-4 ligands may have induced tolerance to repeat stimulation (50,51), partially reducing the response expected for the level of TLR-2 or TLR-4 expression in some RA patients, and possibly accounting for the lack of association between TLR expression and response to TLR ligand in RA patients.…”