Tolerance, autoimmunity, and autoimmune diseases Flashcards
What are the two broad groups of autoimmune diseases?
- Systemic diseases
- Organ-specific diseases
What are the causes of autoimmune diseases?
- Genetic predisposition (commonly involving HLA genes)
- Environmental influences
Which organs are affected by SLE?
- Joints: arthritis
- Skin: butterfly rash on the face
- Kidneys: inflammation
- Blood cells
- Heart: pericarditis
- Lungs: pleurisy
Which genes are particularly important in the pathogenesis of SLE?
- C1q, C2, and C4
- FCGRIIB (for the IgG receptor FCγRIIb)
How does SLE develop, from an immune perspective?
- B cells form autoantibodies nad present autoantigens for activation of autoreactive T cells
- T cells participate through co-stimulator-mediated signaling pathways and secretion of cytokines
- Innate immunity participates through a TLR on certain pDCs that can be activated by the autoimmune complex, inducing production of IFN-α and the formation of NETs
What are the phases in the pathogenesis of SLE?
- Loss of adaptive immune tolerance leads to an increase in autoreactive B cells
- Signals from self-antigens, TLR ligands, BAFF/APRIL, and T cell-derived cytokines promote the formation of germinal centers and production of autoantibodies
- Innate immune defects lead to increased availability of self-antigens, including increased NETosis, impaired clearance of apoptotic debris, and reduced phagocytosis
How is the immune system implicated in type 1 diabetes?
- Decreased efficiency of negative selection of T cells, either due to altered tissue-specific antigen expression or due to TCR signaling, allows for the increased escape of pancreatic β cell-specific T cells
- β cell-specific Foxp3+ Treg development may be suboptimal due to dysregulation of TCR signaling
- β cell-specific T cells are stimulated in the pancreatic lymph nodes by APCs, leading to effector T cell formation. These effector T cells drive inflammation in the pancreatic islets
- Ongoing islet inflammation also leads to generation of new autoantigens either directly in β cells or during antigen processing by APCs
What is Grave’s disease?
An autoimmune disease affecting the thyroid where autantibodies against the thyroid stimulating hormone (TSH) receptor act as agonists and induce hyperthyroidism and goiter
What are the symptoms of Grave’s disease?
- Sweating
- Exophthalmos
- Goiter
- Arrythmia and tachycardia
- Nausea and diarrhea
- Tremor
What are examples of autoantigens associated with SLE?
- Nucleolin
- Ku
- Lamins
What are the types of self-tolerance?
- Central tolerance: induced in immature self-reactive lymphocytes in the generative lymphoid organs, ensuring that the repertoire of mature lymphocytes is incapable of responding to self antigens
- Peripheral: induced in mature lymphocytes in peripheral sites, preventing activation of self-reactive lymphocytes that managed to evade central tolerance measures
What are the mechanisms of central T cell tolerance?
- Negative selection: deletion of T cells that react strongly to self-antigens by apoptosis
- Development of these T cells into reuglatory T cells that do not perform immune-stimulating effector functions and promote peripheral tolerance
How are T cells exposed to a wide repertoire of antigens while in the thymus?
The thymic epithelium expresses many protein antigens that are typically present only in certain peripheral tissues by the function of autimmune regulator (AIRE) protein
What disease is associated with mutations in the AIRE gene?
Autoimmune polyendocrine syndrome type 1 (APS1)
What are the features of autoimmune polyendocrine syndrome type 1?
Antibody- and lymphocyte-mediated injury to multiple endocrine organs, including the parathyroids, adrenals, and pancreatic islets