Chapter 6 part 1 (Dr. Guervin) TEST 2 Flashcards

1
Q

Protect from Infectious Pathogens

A

INNATE IMMUNITY:
- Natural, or native, immunity: Ready to react to infections even before they occur

  • Specifically recognizes and combats microbes and damaged cells

ADAPTIVE IMMUNITY:
- Acquired, or Specific, immunity: consists of mechanisms that are stimulated by (“adapt to”) microbes and non-microbial substances

  • Capable of recognizing microbial and non-microbial substances
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2
Q

Components of Innate Immunity

A

1) EPITHELIAL BARRIERS:
– Skin, gastrointestinal tract, and respiratory tract

– Provides mechanical barriers to the entry of microbes

– Produce antimicrobial molecules such as defensins

– Lymphocytes located in the epithelia combat microbes

2) PHAGOCYTIC CELLS:
– Monocytes and neutrophils circulate in blood and can
rapidly be recruited to any site of infection

– Macrophages (mature monocytes) are present in all tissues
a) Sense the presence of microbes and other offending agents

b) Ingest (phagocytose) invaders and destroy them

3) DENDRITIC CELLS:
- In epithelia, lymphoid organs, and most tissues

– Capture protein antigens and display peptides for recognition by T lymphocytes

– Stimulate the secretion of Cytokines
a) Mediators that play critical roles in inflammation and anti-viral
defense

4) NATURAL KILLER CELLS (NK):
– Early protection against many viruses and intracellular bacteria

5) OTHER CELLS:
– MAST Cells: produce many mediators of inflammation

– INNATE LYMPHOID Cells: look like lymphocytes but have features of innate immunity

6) PLASMA PROTEINS:
– COMPLEMENT System: Proteins that are activated by microbes using the Alternative and Lectin pathways
a) In Adaptive immunity it is activated by antibodies using the Classical pathway

– Mannose-Binding Lectin and C-reactive protein: Coat microbes and promote phagocytosis

– Lung Surfactant: Provides protection against inhaled microbes

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3
Q

Pattern Recognition Receptors

A

• Recognize microbial components that are shared among related microbes
a) Often essential for infectivity (thus cannot be mutated)

• Damage-Associated Molecular Patterns: recognize
molecules released by injured and necrotic cells

• Located in all the cellular compartments where microbes may be present
a) Plasma membrane receptors detect extracellular microbes

b) Endosomal receptors detect ingested microbes
c) Cytosolic receptors detect microbes in the cytoplasm

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4
Q

Toll-Like Receptors (TLRs)

A
  • 10 TLRs in mammals - each recognizes a different set of microbial molecules
  • Signal a common pathway that leads to the ACTIVATION of Transcription Factors:

a) NF-κB: stimulates Synthesis and Secretion of CYTOKINES and the Expression of ADHESION molecules
i) Critical for the Recruitment and Activation of leukocytes

b) Interferon Regulatory Factors (IRFs): stimulates production ANTIVIRAL Cytokines (type I interferons)

• Germline loss-of-function mutations affecting TLRs and their signaling pathways
a) Rare but serious immunodeficiency syndromes

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5
Q

NOD-like Receptors (NLRs)

A
  • CYTOSOLIC Receptors
  • Recognize a wide variety of substances

a) Products of necrotic cells (e.g., uric acid and released ATP)
b) Ion disturbances (e.g., loss of K+)
c) Some microbial products

• Several NLRs signal via the INFLAMMASOME (a cytosolic multiprotein complex)

a) Gain-of-function mutations in one of the NLRs result in a periodic fever syndrome, called AUTOINFLAMMATORY SYNDROME
i) Can treat with IL-1 Antagonists

• The NLR-Inflammasome pathway may also play a role in:

a) Gout
b) Obesity-associated type 2 diabetes
c) Atherosclerosis
d) Other

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6
Q

Other Receptors for Microbial Products

A

• C-type LECTIN Receptors:

  • Plasma membrane of macrophages and dendritic cells
  • Detect fungal Glycans and elicit inflammatory reactions

• RIG-like Receptors:

  • Cytosol of most cell types
  • Detect nucleic acids of viruses and stimulate production of antiviral cytokines

• G PROTEIN–COUPLED Receptors:

  • Neutrophils, macrophages, and most leukocytes
  • Recognize bacterial peptides containing N-formylmethionyl

• MANNOSE Receptors:
- Recognize microbial sugars (mannose) → phagocytosis of the microbes

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7
Q

Reactions of Innate Immunity

A

• INFLAMMATION
– Via cytokines, products of complement activation, and other mediators

• ANTIVIRAL defense
– Via Type I interferons

• Also provides STIMULUS for the Adaptive Immune response

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8
Q

Adaptive Immunity

A
  • Develops later and is more powerful than innate immunity
  • Consists of lymphocytes and their products (antibodies) – Highly diverse receptors recognize a vast array of foreign substances (antigens)
  • 2 TYPES:

1) HUMORAL Immunity:
a) Protects against EXTRACELLULAR microbes and their toxins
b) Mediated by B Lymphocytes and Antibodies

2) CELL-MEDIATED (or cellular) immunity
a) Defense against INTRACELLULAR Microbes
b) Mediated by T lymphocytes

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9
Q

Cells of the Immune System: B and T Lymphocytes

A

• IMMUNE SURVEILLANCE:
– Constantly circulate via blood and lymphatics to lymphoid and other tissues

• LYMPHOCYTES:
– Naïve: not encountered the antigen for which they are specific

– Once they are activated by recognition of Antigens:
a) EFFECTOR Cells: eliminate microbes

b) MEMORY Cells: “remember” the antigen and can react rapidly and strongly to it in future encounters

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10
Q

Lymphocyte Diversity

A

• ~ 10^12 Lymphocytes (1 trillion) in a healthy adult
a) Recognize 107 to 109 (10 million to 1 billion) different antigens

• Lymphocytes can respond to Multiple Antigens, but once exposed to one
a) Undergoes CLONAL SELECTION (all lymph with same specificity are CLONES)

b) Number lymphs specific for any one antigen is:
i)

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11
Q

T Lymphocytes

A

• 3 types:
1) HELPER T lymphocytes stimulate B lymphocytes to make Antibodies and activate other leukocytes (e.g., phagocytes) to destroy microbes

2) CYTOTOXIC (CTLs) kill Infected Cells
3) REGULATORY T lymphocytes limit immune responses and prevent reactions against self antigens

• Majority of lymphocytes in blood and tissue are T lymphocytes

• Recognize specific cell-bound antigen via a specific TCR
a) 95% of these are Heterodimers made up of an α and a β Polypeptide chain

• αβ TCR recognizes antigens presented by Major Histocompatibility Complex (MHC) molecules on the surfaces of APC’s
a) This MHC restriction ensures that T cells see only cells-associated antigens

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12
Q

T Lymphocytes Cont

A

• Small population of mature T cells γδ TCR
a) Recognizes peptides, lipids, and small molecules, without assistance from MHC proteins

b) Aggregate at epithelial surfaces (e.g.skin,GIandurogenitaltracts)

• Small subset of NK-T cells express a very limited diversity of TCRs
a) Recognize Glycolipids that are displayed by the MHC-like Molecule CD1

• Other proteins that assist the TCR complex:

a) CD4 and CD8 (Mutually Exclusive)
i) ~60% of mature T cells are CD4+ and about 30% are CD8+

b) CD4+ T cells-CYTOKINE-Secreting helper cells that assist Macrophages and B lymphocytes
i) Bind to class II MHC molecules (coreceptor)

c) CD8+ T cells-CYTOTOXIC (killer) T lymphocytes (CTLs) that destroy host cells harboring microbes
i) Bind to class I MHC molecules (coreceptor)

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13
Q

B Lymphocytes

A

• ~10-20% of circulating lymphocytes

• Also present in:
– Lymphnodes,spleen,andmucosa-associatedlymphoidtissues

• B cells recognize antigen via the B-cell antigen receptor complex
a) Membrane-bound Antibodies of the IgM and IgD isotopes!!!!!!!!!!!!!!

b) Present on the surface of all Mature Naïve B Cells

c) After stimulation by Antigen, they develop into Plasma Cells
i) Can secrete 100s-1000s of antibody molecules per second

• Also part of the B-cell Antigen Receptor Complex:
a) Igα and Igβ proteins

• Other molecules that are essential for signaling:

a) Type 2 Complement Receptor (CR2,or CD21)
i) Also used by EPSTEIN-BARR VIRUS (EBV) to enter and infect B cells

b) CD40-receives signals from helper T Cells

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14
Q

Dendritic Cells

A
  • Most Important APC for INITIATING T-cell responses
  • Have numerous fine Cytoplasmic Processes
  • Keys for ANTIGEN PRESENTATION:

a) Located at the right place to capture antigens
i) Under epithelia (Langerhans cells in the skin)
ii) Interstitia of all tissues where antigens may be produced

b) Express many receptors for capturing and responding to microbes
i) TLRs and lectins

c) Recruited to the T-cell zones of lymphoid organs in response to microbes
d) Express high levels of MHC and other molecules needed for presenting antigens to and activating T cells

• FOLLICULAR Dendritic Cells: GERMINAL Centers of lymphoid follicles in the Spleen and Lymph nodes

a) Trap antigens bound to antibodies or complement proteins
b) Present antigens to B cells and select the HIGHEST AFFINITY B cells

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15
Q

Macrophages

A

• MONONUCLEAR Phagocytes

• Process antigens from phagocytosed microbes and proteins
a) Present peptide fragments to T cells

• T cells can activate Macrophages and enhance
their ability to KILL ingested microbes

• PHAGOCYTOSE and DESTROY microbes that are Opsonized (coated) by IgG or C3b

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16
Q

Natural Killer (NK) Cells

A

• Function is to DESTROY Irreversibly stressed and abnormal cells:
a) E.g. VIRUS-Infected cells and TUMOR CELLS

b) Do so without prior exposure to or activation by these microbes or tumors
c) Early line of defense

  • ~5-10% of peripheral blood lymphocytes
  • Do not express TCRs or IG
  • Surface molecules:

a) CD16 – an Fc Receptor for IgG
i) Lyse IgG- coated target cells–called Antibody-Dependent Cell- Mediated Cytotoxicity!!!!!!

b) CD56 – function not known

• Regulated by a balance between activating and inhibitory receptors

• Also secrete cytokines (IFN-γ)
a) Activates Macrophages to destroy Ingested Microbes

• NK cells are regulated by many cytokines:
a) IL-2 and IL-15 stimulate PROLIFERATION cells

b) IL-12 activates KILLING and SECRETION of IFN-γ

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17
Q

Innate Lymphoid Cells (ILCs)

A

• Recently identified (and still much to learn about them)

• Populations of Lymphocytes that LACK TCRs but PRODUCE Cytokines similar to T cells
a) NK cells are first defined ILC!!!!

b) Different subsets of ILCs produce IFN-γ, IL-5, IL-17, and IL-
22

• Functions of ILCs:

a) Early defense against infections
b) Recognize and eliminate stressed cells
c) Provide cytokines that influence the Differentiation of T lymphocytes

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18
Q

MHC Molecules

A
  • Key role in Adaptive Immune system
  • FUNCTION: Display Peptide Fragments of Protein Antigens
  • Linked to many autoimmune diseases

• Involved in REJECTION of Transplanted Organs
a) Major Histocompatibility Complex

  • MHC molecules are called HUMAN LEUKOCYTE ANTIGENS (HLA)
  • Genes that encode HLA molecules are clustered on Chromosome 6

a) Highly POLYMORPHIC
b) Thousands of alleles of MHC genes
c) Individual’s HLA alleles are pretty unique

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19
Q

MHC Class I Molecules

A
  • Expressed on ALL NUCLEATED CELLA and PLATELETS
  • HLA-A, HLA-B and HLA-C

• Display peptides derived from proteins located in the cytoplasm
a) E.g. viral and tumor antigens

• Recognized by CD8+ T lymphocytes
b) “Class I MHC-restricted”

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20
Q

MHC Class II Molecules

A

• Mainly expressed on Macrophages, B cells, and Dendritic Cells!!!!!!!!

• Encoded by HLA-D region
– 3 subregions: HLA-DP, HLA-DQ, and HLA-DR!!!!!!

• Display Antigens that are internalized into vesicles
a) Typically from EXTRACELLULAR Microbes and SOLUBLE
Proteins

• Recognized by CD4+ T cells
a) “Class II MHC-restricted”

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21
Q

MHC Molecules Cont

A

• HLA Haplotype - Individuals inherit one set of HLA genes from each parent:
a) Typically TWO Different molecules for every locus

b) POLYMORPHISM = almost innumerable combination
c) Everyone is UNIQUE (except identical twins) – makes organ transplantation difficult

• Key roles in regulating T cell–Mediated Immune Responses

a) Determine what antigens a person reacts to
i) E.g.Ragweed Pollen

• Many AUTOIMMUNE and other diseases are associated with particular HLA alleles

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22
Q

Cytokines: Messenger Molecules of the Immune System

A
  • Secreted proteins
  • Mediate many cellular interactions and functions of leukocytes

• Can Act on the cells that produce them
a) Autocrine actions

• Can act on Neighboring cells
a) Paracrine

• Can act at a Distance
a) Endocrine

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23
Q

Cytokines contribute to different types of Immune Responses

A

• Innate immune responses – produced by Macrophages, Dendritic cells, NK cells and others
a) Induce inflammation and inhibit virus replication

b) TNF, IL-1, IL-12, type I IFNs, IFN-γ, and chemokines

• Adaptive Immune Responses – produced mainly by CD4+ T cells
a) Promote lymphocyte proliferation and differentiation and to activate effector cells

b) IL-2, IL-4, IL-5, IL-17, and IFN-γ

• Some Cytokines stimulate HEMATOPOIESIS
a) Called COLONY-STIMULATING FACTORS

b) Role is to INCREASE Leukocyte numbers
c) GM-CSF and IL-7!!!!!!

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24
Q

Cytokine and Therapy

A

• ANTAGONISTS:
a) Block harmful effects of Cytokines, Inflammation, and Tissue-Damaging responses

b) E.g. - Rheumatoid Arthritis
i) Dramatic responses to TNF antagonists!!!

• Administer Cytokines to BOOST Reactions:
a) E.g. - Hematopoiesis and defense against some Viruses

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25
Q

Tissues of the Immune System

A

• GENERATIVE Lymphoid Organs (Primary/central)
a) THYMUS: T cells develop

b) BONE MARROW: Production of all blood cells and where B lymphocytes mature

• PERIPHERAL Lymphoid Organs (Secondary):
a) Lymph nodes

b) Spleen
c) Mucosal and cutaneous lymphoid tissues

d) Tissues CONCENTRATE Antigens, Antigen-Presenting Cells, and Lymphocytes
i) Optimizes interactions among these cells and the DEVELOPMENT of Adaptive Immune responses

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26
Q

Lymph Nodes

A

• Nodular Aggregates of Lymphoid tissues located along lymphatic channels throughout the body

• Lymph carrying Antigens slowly suffuses through lymph nodes
a) Antigen-Presenting Cells in the nodes are able to sample the antigens of microbes

• DENDRITIC Cells pick up and transport Antigens of microbes from epithelia and tissues via lymphatic vessels to the Lymph Nodes

27
Q

The Spleen

A

• Abdominal organ

• Serves the same role in immune responses to BLOODBORNE Antigen!!!!!!
a) Lymph Nodes do in responses to LYMPH-BORNE Antigens!!!!!!!!

  • Blood entering the spleen flows through a network of sinusoids
  • Antigens are trapped by Dendritic Cells and Macrophages in the Spleen
28
Q

Cutaneous and Mucosal Lymphoid Systems

A

• Located UNDER the Epithelia of the Skin and the Gastrointestinal and Respiratory tracts
– >1/2 the body’s lymphocytes are in the MUCOSAL TISSUES
i) Many of these are MEMORY Cells

• Respond to Antigens that enter through BREACHES in the Epithelium

29
Q

Display and Recognition of Antigens

A
  • Microbes and other foreign antigens can Enter ANYWHERE in the Body
  • Captured and concentrated in Lymphoid Organs INCREASING the likelihood of lymphocytes finding the antigen they recognize
  • Antigens are Processed and Displayed with MHC molecules so T cells can recognize them

• B cells have antigen receptors (Membrane-Bound Antibody Molecules)
a) Recognize proteins, polysaccharides, and lipids

30
Q

Hypersensitivity Reactions

A

• “SENSITIZED”
a) Person’s been previously exposed to an antigen

• “HYPERSENSITIVITY”
a) Excessive or harmful reaction to antigen

• Can be EXOGENOUS Environmental Antigens (allergies) or ENDOGENOUS Self Antigens (autoimmune)
a) E.g. Dust, pollens, foods, drugs, microbes, and various chemicals

  • Responses range from Itching of the skin to bronchial asthma and anaphylaxis
  • Due to: IMBALANCE between the effector mechanisms of immune responses and the control mechanisms that limit responses
  • Associated with variety of Susceptibility Genes
31
Q

Immediate (Type I) Hypersensitivity

A

• Allergies triggered by “Allergen” (antigen)
a) Ingested (e.g. peanut), Inhaled (e.g. ragweed) or Injected (e.g. bee sting)

  • RAPID Immunologic reaction
  • Person who was PREVIOUSLY SENSITIZED
  • Antigen binds to IgE antibody on the surface of MAST CELLS
  • May also occur as a Systemic disorder or as a Local Reaction
  • Reactions range from rash to fatal when severe

1) IMMEDIATE REACTION:
- Vasodilation, Vascular Leakage, and depending on the location, Smooth Muscle Spasm or glandular secretions (Due to Prostaglandins and Granule Contents)
a) MINUTES after exposure and subsides in a few hours

2) LATE PHASE REACTIONS:
- (e.g., allergic rhinitis and bronchial asthma)

  • 2-24 hours AFTER Exposure (without additional exposure) to antigen
  • Lasts for SEVERAL Days
  • Infiltration of Tissues with Eosinophils, Neutrophils, Basophils, Monocytes, and
    CD4+ T cells (Due to Chemokines and Cytokines)
32
Q

Mast Cells

A

• Throughout the body, especially NEAR Blood Vessels, Nerves and in Subepithelial Tissues
a) Explains local immediate hypersensitivity reactions often occur at these sites

  • Have cytoplasmic membrane-bound granules
  • Activated by the cross-linking of high-affinity IgE Fc receptors (basophils too)

a) IgE-coated mast cells are “SENSITIZED”
i) I.e. Sensitive to SUBSEQUENT ENCOUNTER with the Specific Antigen

• Also triggered by:
- COMPLEMENT Components C5a and C3a (elicit reactions that mimic anaphylaxis)

– CHEMOKINES (e.g., IL-8)

– DRUGS (e.g., codeine and morphin)

– ADENOSINE

– MELITTIN (present in bee venom)

– PHYSICAL STIMULI (e.g., heat, cold, sunlight)

33
Q

Th2 Cells

A

• TH2 cells produce CYTOKINES
a) IL-4 :stimulates CLASS SWITCHING of B cells to IgE and promotes the DEVELOPMENT of additional TH2 cells

b) IL-5: DEVELOPMENT and ACTIVATION of EOSINOPHILS
c) IL-13: ENHANCES IgE PRODUCTION and acts on epithelial cells to stimulate mucus secretion

• TH2 cells, mast cells and epithelial cells: produce Chemokines that ATTRACT more TH2 cells and other leukocytes

34
Q

Preformed Mast Cell Mediators

A

• Released FIRST

• Vasoactive Amine: HISTAMINE
a) Causes Intense smooth muscle CONTRACTION, Increased
Vascular Permeability, and Increased Mucus Secretion

• ENZYMES: Neutral Proteases (chymase, tryptase) and several acid Hydrolases

a) Cause tissue damage
b) Acts on precursor proteins to:
i) Generate KININS
ii) ACTIVATE Components of Complement (e.g.,C3a)

• PROTEOGLYCANS:

a) HEPARIN: Anticoagulant
b) CHONDROITIN SULFATE

35
Q

Lipid Mast Cell Mediators

A

• Reactions in the mast cell membranes lead to activation of PHOSPHOLIPASE A2
a) Converts membrane phospholipids to arachidonic acid b) Converted to Leukotrienes and Prostaglandins

• LEUKOTRIENES C4 and D4 are the MOST POTENT Vasoactive and Spasmogenic agents known
– 1000’s times more active than histamine

• PROSTAGLANDIN D2:
a) Causes INTENSE BRONCHOSPASM and INCREASED MUCUS Secretion

• PLATELET-ACTIVATING FACTOR (PAF):
a) Causes Platelet AGGREGATION, release of Histamine, Bronchospasm, Increased Vascular Permeability, and Vasodilation

36
Q

Mast Cell Cytokines

A

• TNF, IL-1, and Chemokines:

a) Promote Leukocyte RECRUITMENT (typical of the late-phase reaction)
i) Inflammatory cells release additional waves of mediators (including cytokines)

ii) Cause epithelial cell damage
iii) Epithelial cells can also produce Chemokines

• IL-4
– Amplifies the TH2 response;

37
Q

Late-Phase Reaction

A

• Leukocytes (especially eosinophils) are recruited which amplify and sustain the inflammatory response
a) WITHOUT ANTIGEN

• EOSINOPHILS Damage Tissue via release of:
– Proteolytic enzymes
– Major basic protein
– Eosinophil Cationic Protein

• This Late-Phase reaction is a MAJOR CAUSE of SYMPTOMS in some TYPE I HYPERSENSITIVITY disorders:
– E.g., allergic asthma.
– TREATMENT requires broad-spectrum ANTI-INFLAMMATORY drugs
– Anti-histamine drugs are ONLY useful for the IMMEDIATE Reaction
i) E.g., Allergic Rhinitis(hayfever)

38
Q

Allergies- Genetics

A

• ATOPY: Increased propensity to develop immediate Hypersensitivity reactions
a) Have higher serum IgE levels and more IL-4 – producing TH2 cells!!!!!!

• Studies in patients with Asthma show linkage to Polymorphisms in several genes

a) Some genes are located on Chromosome 5
i) Genes encoding the Cytokines

b) Linkage also noted to Chromosome 6, close to the HLA Complex

39
Q

Allergies- Environment

A

• Exposure to Environmental Pollutants is a Predisposing Factor
a) Likely MORE IMPORTANT than genes

b) Incidence of many Allergic Diseases is INCREASING in
developed countries

  • Viral Infections of the airways are TRIGGERS for Bronchial Asthma
  • Bacterial Skin Infections are strongly associated with ATOPIC DERMATITIS

• HYGIENE HYPOTHESIS
a) Decrease in Infections during early life associated with higher incidence

b) Exposure to microbial agents “EDUCATES” the immune system in early childhood and even prenatally
c) This hypothesis is difficult to prove

• Microbiome

40
Q

Non-Atopic Allergy

A

• ~20-30% of IMMEDIATE Hypersensitivity Reactions

• Triggered by Non-Antigenic stimuli:
– TEMPERATURE Extremes and exercise

  • DOES NOT involve TH2 cells or IgE!!!!!!
  • Thought due to Mast Cells that are abnormally SENSITIVE to ACTIVATION
41
Q

Examples of Disorders Caused by Immediate Hypersensitivity

A
  • Anaphylaxis
  • Bronchial Asthma
  • Allergic Rhinitis, Sinusitis (Hay Fever)
  • Food Allergies
42
Q

Systemic Anaphylaxis

A

• VASCULAR SHOCK, widespread EDEMA, and difficulty in breathing:
– Within minutes after exposure: Itching, Hives, and Skin Erythema appear

– Followed by a striking CONTRACTION of Respiratory Bronchioles and respiratory distress

– LARYNGEAL EDEMA → hoarseness and further compromises breathing

– Vomiting, Abdominal Cramps, Diarrhea, and laryngeal obstruction follow – Patient may go into shock and even die within the hour

• Occurs in SENSITIZED Individuals (but they may not know it yet)

• HOSPITAL:
– Foreign Proteins (e.g., antisera), Hormones, Enzymes, Polysaccharides, and Drugs (e.g., the antibiotic penicillin)

• COMMUNITY:
– Food ALLERGENS (e.g., peanuts, shellfish)

– Insect TOXINS (e.g., those in bee venom)

• Extremely SMALL DOSES of Antigen may trigger Anaphylaxis
– Even tiny amounts used in skin testing for various forms of allergies

43
Q

Local Immediate Hypersensitivity Reactions

A
  • ~10-20% of the population
  • Common environmental allergens
  • Pollen, animal dander, house dust, foods

• DISEASES:
– Urticaria, Allergic Rhinitis (hay fever), Bronchial Asthma, and Food Allergies

44
Q

Antibody-Mediated (Type II) Hypersensitivity

A
  • Can be AUTOANTIBODIES: antibodies specific for normal cell or tissue antigens
  • ANTIBODIES to EXOGENOUS ANTIGENS, such as chemical or microbial proteins
45
Q

Type II Hypersensitivity Examples

A
  • Autoimmune Hemolytic Anemia
  • Autoimmune Thrombocytopenia Purpura
  • Pemphigus Vulgaris
  • Vasculitis caused by ANCA
  • Goodpasture Syndrome
  • Acute Rheumatic Fever
  • Myasthenia Gravis
  • Graves Disease (Hyperthyroidism)
  • Insulin Resistant Diabetes
  • Pernicious Anemia
46
Q

Antibody-Mediated Cell Destruction and Phagocytosis in Disease

A

• TRANSFUSION REACTIONS
– Cells from an incompatible donor react with and are OPSONIZED by preformed antibody in the host

• HEMOLYTIC DISEASE of the Newborn (erythroblastosis fetalis)
– Maternal IgG Anti-Erythrocyte antibodies CROSS the Placenta and cause destruction of fetal red cells

• AUTOIMMUNE HEMOLYTIC ANEMIA, Agranulocytosis, and Thrombocytopenia
– Antibodies to their OWN Blood Cells, which are then destroyed

• CERTAIN DRUG REACTIONS
– Drug acts as a “HAPTEN” by attaching to plasma membrane proteins of Red Cells and Antibodies are produced against the drug-protein complex

47
Q

Antibody-Mediated Inflammation in Disease

A

• Responsible for tissue injury in some forms of
– GLOMERULONEPHRITIS
– Vascular rejection in Organ Grafts
– Others

48
Q

Antibody-Mediated Cellular Dysfunction in Disease

A

• MYASTHENIA GRAVIS:
– Antibodies reactive with ACETYLCHOLINE Receptors in the motor end plates of skeletal muscles BLOCK Neuromuscular Transmission → Muscle Weakness

• GRAVES DISEASE:
– Antibodies against the THYROID-STIMULATING HORMONE receptor on thyroid epithelial cells stimulate the cells → HYPERTHYROIDISM

49
Q

Immune Complex- Mediated (Type III) Hypersensitivity

A

• ANTIGEN-ANTIBODY COMPLEXES produce tissue damage mainly by eliciting inflammation at the sites of deposition
– Typically in vessel walls

• Antigens can be EXOGENOUS or ENDOGENOUS

• Immune COMPLEX–mediated diseases preferentially Involve:
– KIDNEY (glomerulonephritis)
– JOINTS (arthritis)
– Small Blood Vessels (Vasculitis)

Organs where blood is filtered at high pressure to form other fluids, like urine and synovial fluid, tend to concentrated immune complexes*

50
Q

Type III Hypersensitivity Examples

A
  • Systemic Lupus Erythematosus
  • Poststreptococcal Glomerulonephritis
  • Polyarteritis Nodosa
  • Reactive Arthritis
  • Serum Sickness
  • Arthus Reaction (Experimental)
51
Q

Immune Complex Disease Pathogenesis

A

• COMPLEMENT-FIXING ANTIBODIES (i.e., IgG and IgM)
– Induce the Pathologic lesions of immune complex disorders

• Complement Proteins can be detected at the site of injury

• Consumption in active disease → DECREASED serum levels of C3
– Can be used to MONITOR Disease Activity

52
Q

T Cell- mediated (Type IV) Hypersensitivity

A

• Caused by INFLAMMATION resulting from Cytokines produced by CD4+ T cells and CELL KILLING by CD8+ T cells

53
Q

Type IV Hypersensitivity Examples

A
  • Rheumatoid Arthritis
  • Multiple Sclerosis
  • Type 1 Diabetes Mellitus
  • Inflammatory Bowel Disease
  • Psoriasis
  • Contact Sensitivity
54
Q

CD4+ T Cell- Mediated Inflammation Stages: Activation of CD4+ T Cells

A
  • Naive CD4+ T cells recognize peptides displayed by Dendritic Cells and SECRETE IL-2 → stimulate PROLIFERATION of Antigen-Responsive T cells
  • Antigen-Stimulated T cells differentiate to TH1 or TH17 cells BASED ON the Cytokines Produced by APCs
55
Q

CD4+ T Cell-Mediated Inflammation Stages: Responses of Differentiated Effector T Cells

A

• Repeat exposure to antigen → TH1 cells secrete cytokines (IFN-γ)

• IFN-γ-Activated MACROPHAGES:
– Enhanced ability to PHAGOCYTOSE and KILL Microorganisms

– Express MORE class II MHC molecules on the surface

– Secrete TNF, IL-1, and chemokines → INFLAMMATION

– Produce more IL-12 → AMPLIFIED TH1 Response.

• Activated Macrophages ELIMINATE the Offending Antigen, but if activation is Sustained, Continued Inflammation and tissue injury result

• Activated TH17 cells secrete IL-17, IL-22, Chemokines, and other Cytokines
– Recruit NEUTROPHILS and MONOCYTES to the reaction

– Produce IL-21 → AMPLIFIES the TH17 response!!!!!!!!!!!!!

56
Q

Clinical Examples of CD4+ T Cell-Mediated Inflammatory Reactions

A

• Classic example of DTH is the TUBERCULIN REACTION
– Intracutaneous injection of PURIFIED Protein Derivative (PPD, also called Tuberculin), a protein- containing antigen of the tubercle bacillus

– PREVIOUSLY SENSITIZED Individuals → Reddening and induration of the site appear in 8 to 12 hours and peaks at 24 to 72 hours

57
Q

Clinical Examples of CD4+ T Cell-Mediated Inflammatory Reactions

A

• TUBERCULOUS INFECTION:
– Persistent or Nondegradable ANTIGENS (Tubercle Bacilli)

– Colonizes LUNGS or Other tissues

– Infiltrate is DOMINATED by MACROPHAGES after 2-3 weeks

– SUSTAINED ACTIVATION → Macrophages undergo a morphologic transformation into EPITHELIOID CELLS, large epithelium-like cells with abundant cytoplasm
i) A microscopic aggregation of the Epithelioid cells, usually SURROUNDED by LYMPHOCYTES, is called a GRANULOMA

• GRANULOMATOUS INFLAMMATION:
– Associated with STRONG TH1-cell activation and high-level
PRODUCTION of Cytokines such as IFN-γ

– Also caused by INDIGESTIBLE FOREIGN BODIES, which Activate Macrophages, but DONT ELICIT an Adaptive immune response

58
Q

CD8+ T Cell- Mediated Cytotoxicity

A

• T Cell–Mediated Diseases
– E.g. Type 1 Diabetes
– GRAFT REJECTION after organ transplantation!!!

• Plays a role in reactions AGAINST VIRUSES
– Some cases it is responsible for Cell Damage that accompanies the Infection (e.g., in viral hepatitis)

• Involved in KILLING TUMOR CELLS
– Tumor-associated antigens are presented on the cell surface

59
Q

Microbiome

A
  • “Microorganisms (bacteria, viruses, protozoa, and fungi) and their collective genetic material present in or on the human body or in another environment”
60
Q

Gut Microbiome

A
  • 100 Trillion microbes in the gut
  • Human cells are OUTNUMBERED 10 to 1 – >150 times more genes than human genes
  • 1-2 kg (about the same as the brain)
  • 50% of fecal matter is bacteria
  • Interface between food and the human body
61
Q

Gut Microbiome

A
  • Organ
  • PLAY IMPORTANT ROLE IN LOCAL AND SYSTEMIC IMMUNE FUNCTIONS
  • Important for brain development: Gut-Brain Axis
  • Metabolic functions
  • Hormones and Neurochemical PRODUCTION
  • Provide a BIOFILM Protection
62
Q

Gut Microbiome Cont

A
  • Formation influenced by mode of delivery and infant/child diet
  • By 3-4 yrs, adult-like
  • Maintained by DIET
  • Altered by dietary changes (3-4 days), Prebiotics, Probiotics, and Antibiotics
  • Much MORE STABLE in healthy persons
63
Q

Dysbiosis

A
  • “An alteration of the body’s microbial community that DECREASES the Population of ‘GOOD’ bacteria and allows ‘BAD’ bacteria to flourish”
64
Q

The link for Understanding “Western Diseases”

A

Dysbiosis causes:

  • Inflammatory Bowel Disease
  • Allergy
  • Autoimmune Diseases