Immunology of endocrine disease Flashcards

1
Q

What is immunological tolerance?

A

Unresponsiveness to an antigen that is induced by previous exposure to that antigen

In healthy bodies, this is what prevents autoimmunity - as there is tolerance to self-antigens

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2
Q

When lymphocytes encounter antigens, they may be activated, leading to _________, or they may be _______ or ________, leading to tolerance

A

When lymphocytes encounter antigens, they may be activated, leading to immune responses, or inactivated or eliminated, leading to tolerance.

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3
Q

In terms of tolerance, what causes autoimmunity?

A

Failure of tolerance to self-antigens

Failure results in attack against these autologous antigens

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4
Q

How is it that our bodies ensure that there are no self-reactive immune cells?

A

Some of our T and B cells have self antigen receptors

These are usually identified and promptly dominated

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5
Q

What is meant by central tolerance?

A

This is the process of eliminating immature lymphocytes

Self-tolerance may be induced in immature self-reactive lymphocytes in the generative lymphoid organs

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6
Q

Where does central tolerance with T cells occur?

A

The thymus

plays an important role in eliminating T cells with high affinity to self-antigens

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7
Q

Where does central tolerance for B cells happen?

A

Bone marrow

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8
Q

What is meant by peripheral tolerance?

A

Process in which mature lymphocytes that have escaped central tolerance are inactivated or killed off

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9
Q

How are self-reactive lymphocytes dealt with, in peripheral tolerance?

A

Mature lymphocytes that recognize self antigens in peripheral tissues become incapable of activation by re-exposure to that antigen or die by apoptosis

also maintained by regulatory T cells (Tregs) that actively suppress the activation of lymphocytes specific for self and other antigens.

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10
Q

What are the 3 mechanisms of peripheral tolerance?

A

Anergy

Suppression

Deletion

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11
Q

What is anergy?

A

Functional unresponsiveness

Even when correctly bound to (activated) - there is no immune response made by the lymphocyte

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12
Q

What is meant by suppression?

A

Treg suppression

Regulatory T cells suppress lymphocyte activation

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13
Q

What is meant by deletion?

A

Binding to self-antigen causes the self-reactive lymphocyte to undergo apoptosis

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14
Q

What can happen to self-reactive lymphocytes in central tolerance?

A

If immature self-reactive lymphocytes encounter their antigen when in their generative tissue - 3 things can happen:

1) Apoptosis (deletion)
2) Changes to their specificity (B cells only)
3) Conversion to Treg cells (CD4+ T cells only)

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15
Q

What can cause peripheral tolerance to fail?

A

It can result from:

  • Inappropriate access of self-antigens
  • Inappropriate or increased expression of co-stimulatory molecules
  • Alterations of the ways in which self-antigens are presented to the immune system
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16
Q

What damage to tissue can cause peripheral tolerance to fail?

Why?

A

More likely to happen when inflammation or tissue damage is present due to the increased activity of proteolytic enzymes

17
Q

What features cause autoimmune disease to occur

A

Combination of:

Genes

Infections

Environmental factors

18
Q

What is the significance of Genetics as a cause of autoimmunity?

(incl gender)

A

Autoimmune diseases show clustering within families

Almost all types of autoimmune diseases are more common in women (Exception, ankylosing spondylitis).

19
Q

What are the peak years of onset for autoimmune disease?

A

15-65 years old

except for T1DM

So autoimmune questions will have patients that are likely to be middle-aged

20
Q

What is the pathological difference between non-organ specific autoimmune disease and organ specific autoimmune disease?

A

Non-specific (multi-organ):

  • Associated with autoimmune responses against self-molecules which are widely distributed throughout the body

Organ-specific:

  • affect a single (endocrine gland) organ
  • Autoimmune responses against cells found in that organ
21
Q

What autoimmune conditions arise from problems with hormone receptors?

A

TSH receptor - Hyper/hypothyroidism

Insulin receptor - Hyper/hypoglycaemia

22
Q

What autoimmune conditions arise from problems with neurotransmitter receptors?

A

Acetylcholine receptor - Myasthenia gravis

23
Q

What autoimmune conditions arise due to defects in cell adhesion molecules?

A

Epidermal cells adhesion molecules

Cause of blistering skin diseases

24
Q

What autoimmune condition arises due to defects in plasma proteins?

A

Factor VIII - Acquired haemophilia

Beta-2 glycoprotein (& others) - Antiphospholipid syndrome

25
Q

What Autoimmune condition involves red blood cell antigens?

A

Haemolytic anaemia

26
Q

What autoimmunity condition involves destruction of platelets?

A

Thrombocytopenic purpura

27
Q
A