Ch 4 - Immunopathology Flashcards
seasonal conjunctivitis is typically caused by
allergies to pollens that are released during a particular time of the year.
What is the most common type I hypersensitivity disease in adults?
Allergic rhinitis (hay fever)
Allergic rhinitis (hay fever) may be caused by;
pollen, house dust, animal dandruff, and many other allergens.
Antigens inhaled react with what?
IgE
IgE is attached to
basophils in the nasal mucosa
Antigen + IgE attached to basophils in the nasal mucosa triggers
the release of vasoactive substances stored in cytoplasmic granules.
the main mediator released from mast cells?
Histamine,
Histamine released from mast cells does what?
increases the permeability of mucosal vessels, causing edema and sneezing.
What are Type III hypersensitivity reactions are characterized by?
1) immune complex deposition, 2) complement fixation, 3) localized inflammation.
What can give rise to a type III response?
Antibody directed against either a circulating antigen or an antigen that is deposited in a tissue
What are some diseases that seem to be most clearly attributable to the deposition of immune complexes?
1) systemic lupus erythematosus 2) rheumatoid arthritis 3) varieties of glomerulonephritis.
How can Streptoccocal infection lead to nephritic syndrome?
deposition of antigens and antibodies in glomerular basement membranes
clinical features of nephritic syndrome
hematuria, oliguria, and hypertension
Systemic lupus erythematosus
(SLE) is an autoimmune, inflammatory disease that may involve almost any organ
What does SLE characteristically affect?
the kidneys, joints, serous membranes, and skin.
In SLE what are autoantibodies formed against?
a variety of self-antigens.
What are the most important diagnostic autoantibodies in SLE?
those against nuclear antigens
What are the autoantibodies in SLE against nuclear antigens that are most important diagnostically?
antibody to; 1) double-stranded DNA 2) Sm (Smith) antigen - a soluble nuclear antigen complex that is part of the spliceosome
High titers for what two autoantibodies (termed antinuclear antibodies) are nearly pathognomonic for SLE?
Those against nuclear antigens - antibody to; 1) double-stranded DNA 2) Sm (Smith) antigen
Antibodies to rheumatoid factor are seen in patients with
rheumatoid arthritis.
Antineutrophil cytoplasmic antibodies are seen in patients with;
small vessel vasculitis (e.g., Wegener granulomatosis).
Acquired deficiencies of early complement components occur in patients with
autoimmune diseases - especially those associated with circulating immune complexes (e.g., systemic lupus erythematosus [SLE]).
hypocomplementemia and autoimmune diseases such as SLE
Antigen-antibody complexes formed in the circulation during the active stage of these diseases lead to a marked reduction in circulating levels of complement proteins (hypocomplementemia).
Scleroderma is
an autoimmune disease of connective tissue
How is scleroderma similar to graft versus host disease?
Circulating male fetal cells have been demonstrated in blood and blood vessel walls of many women with scleroderma who bore male children many years before the disease began. Accordingly, it has been suggested that scleroderma in these patients is similar
Antinuclear antibodies for SLE versus scleroderma.
They are common but are usually present in a lower titer than in patients with SLE.
Antibodies virtually specific for scleroderma include:
(1) nucleolar autoantibodies (primarily against RNA polymerase); (2) antibodies to Scl-70, a nonhistone nuclear protein topoisomerase; and (3) anticentromere antibodies, which are associated with the “CREST” variant of the disease.
The Scl-70 autoantibody
is most common and specific for the diffuse form of scleroderma and is seen in 70% of patients.
Autoantibodies to double-stranded DNA are seen in patients with
SLE.
Autoantibodies to SS-A/SS-B are seen in patients with
Sjögren syndrome.
Scleroderma is characterized by
1) vasculopathy 2) excessive collagen deposition in the skin and internal organs, such as the lung, gastrointestinal tract, heart, and kidney.
Scleroderma disease population.
The disease occurs four times as often in women as in men and mostly in persons aged 25 to 50 years.
Progressive systemic sclerosis is characterized by
widespread excessive collagen deposition.
In progressive systemic sclerosis there is emerging evidence for what?
the expansion of fibrogenic clones of fibroblasts.
In Progressive systemic sclerosis what do the fibrogenic clones display?
augmented procollagen synthesis, including increased circulating levels of type III collagen aminopropeptide. Tissue levels of the other proteins are not significantly altered in patients with scleroderma.
Delayed-type hypersensitivity is defined as
a tissue reaction involving lymphocytes and mononuclear phagocytes,
What does delayed-type hypersensitivity occur in response to?
a soluble protein antigen and reaches greatest intensity 24 to 48 hours after initiation.
What happens in the initial phase for delayed-type hypersensitivity?
foreign protein antigens or chemical ligands interact with accessory cells bearing class II HLA molecules.
What happens to protein antigens?
they are actively processed into short peptides within phagolysosomes and are presented on the cell surface in conjunction with the class II HLA molecules.
The protein antigens are recognized by?
CD4+ T cells
What happens to the CD4+ T cells upon binding to the class II HLA?
they become activated to synthesize an array of cytokines.
What do the cytokines released from CD4 activation do?
The cytokines recruit and activate lymphocytes, monocytes, fibroblasts, and other inflammatory cells.
Suppressor T cells are
CD8+
Class I HLA molecules provide targets for
cell-mediated cytotoxicity.
GlyCAM-1 is
a cell adhesion molecule involved in lymphocyte trafficking.
What are Type II hypersensitivity reactions mediated by?
Antibodies directed against fixed antigens. For example, preformed antibodies in the patient’s blood attach to foreign antigens (oligosaccharides) on the membranes of the transfused erythrocytes. At sufficient density, bound immunoglobulins fix complement
Once activated what does the complement cascade lead to?
destruction of the target cell through formation of a membrane attack complex.
Type II hypersensitivity leading to complement-mediated cell lysis occurs in what?
autoimmune hemolytic anemia.
Antibody-dependent cell mediated cytotoxicity (ADCC) involves
cytolytic leukocytes that attack antibody-coated target cells.
ADCC may be involved in the pathogenesis of
some autoimmune diseases (e.g., autoimmune thyroiditis).
Delayed-type hypersensitivity occurs over a period of
days and does not involve preformed antibodies.
Humoral immune responses to specific viral antigens involve?
the activation and differentiation of B lymphocytes into antibody-secreting plasma cells.
Analogous to T cells, B cells express what?
an antigen-binding receptor, namely mIg.
How does the immunoglobulin mIg on the B cell compare to the immunoglobulin that is secreted?
This immunoglobulin bears the same antigen specificity as the soluble immunoglobulin that is ultimately secreted.
Class I HLA molecules provide targets for
CD8+ T cells in cell-mediated cytotoxicity.
Class II HLA molecules are recognized by
CD4+ T cells, which become activated to synthesize an array of cytokines.
Class I molecules of the major histocompatibility complex present what?
foreign peptides and are recognized by cytotoxic T lymphocytes during graft rejection or during cell-mediated killing of virus-infected cells.
What expresses class I?
All tissues express class I molecules, whereas class II molecules are displayed primarily on macrophages and B lymphocytes.
CD4 and CD8
are cell surface markers of helper and killer T lymphocytes, respectively.
GlyCAM-1
facilitates lymphocyte recirculation by providing a receptor for leukocyte attachment to high endothelial venules.
Sjögren syndrome (SS) is
an autoimmune disorder
Sjögren syndrome (SS) is characterized by
keratoconjunctivitis sicca and xerostomia in the absence of other connective tissue disease.
In patients with Sjögren syndrome (SS) what are typically produced?
the production of autoantibodies, particularly antinuclear antibodies directed against DNA or nonhistone proteins, typically occurs in patients with SS.
What are found in half of patients with primary SS and what are they associated with?
1) Autoantibodies to soluble nuclear nonhistone proteins, especially the antigens SS-A and SS-B, and 2) are associated with more severe glandular and extraglandular manifestations.
In SS are autoantibodies to DNA or histones common?
They are rare.
What are autoantibodies to centromere proteins seen in?
the CREST variant of progressive systemic sclerosis.
In SS are organ specific antibodies common?
Organ-specific autoantibodies, such as those directed against salivary gland antigens, are distinctly uncommon.
Bruton X-linked agammaglobulinemia
congenital disorder that appears in male infants at 5 to 8 months of age,
In Bruton X-linked agammaglobulinemia, why does it appear at 5 to 8 months of age?
the period during which maternal antibody levels begin to decline
In Bruton X-linked agammaglobulinemia what does the infant suffer from?
1) recurrent pyogenic infections 2) severe hypogammaglobulinemia.
In Bruton X-linked agammaglobulinemia where are the mature B cells?
There is an absence of both mature B cells in peripheral blood and plasma cells in lymphoid tissues.
In Bruton X-linked agammaglobulinemia where and what is the genetic defect?
Its located on the long arm of the X chromosome, it is an inactivating mutation of the gene for B-cell tyrosine kinase, an enzyme critical to B-lymphocyte maturation.
DiGeorge syndrome
is a developmental disorder characterized by thymic and parathyroid aplasia.
Wiskott-Aldrich syndrome
an X-linked genetic disease but is characterized by defects in both B-cell and T-cell functions (i.e., humeral and cellular immunity).