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AUTOIMMUNITY
and
related Disorders
Dr Abhirup Chatterjee
MBBS MD(Medicine)
R G Kar MCH
• Basic Immunology in context of autoimmunity
• Spectrum of autoimmune disorders
• Recent advances in management of AIDs
Basic Immunology in context of
Autoimmunity
IMMUNE SYSTEM
• WHAT
• WHEN
• WHY
• WHERE
• HOW
IMMUNE SYSTEM
• WHAT is the immune system?
• WHEN
• WHY
• WHERE
• HOW
IMMUNE SYSTEM
• WHAT
• WHEN does it act?
• WHY
• WHERE
• HOW
IMMUNE SYSTEM
• WHAT
• WHEN
• WHY does it act at all?
• WHERE
• HOW
• Threats-External and Internal
• Healing and wound repair
• Clearance
IMMUNE SYSTEM
• WHAT
• WHEN
• WHY
• WHERE does it reside at?
• HOW
LYMPHOID ORGANS
• Primary – Marrow and Thymus
• Secondary – LN, Spleen, GALT, MALT
• Tertiary – site of infection and constant Ag
exposure
• WHAT
• WHEN
• WHY
• WHERE
• HOW does it do this?
HSC
CMP
Erythroid Myeloid
Granulo Myeloid
APCs
(Mono/
Mɸ/
Dendritic)
CLP
NK B T
Th
Th1 Th2 Treg Th17
Tc
INNATE IMMUNITY ACQUIRED IMMUNITY
INNATE IMMUNITY
IMMATURE
DC
Antigen capturing
phenotype
Encounter with Ag
MATURE DC
Antigen
presenting
phenotype
•LOSS OF PHAGOCYTOSIS AND LARGE SCALE
PINOCYTOSIS
•GAIN OF ANTIGEN PRESENTING FUNCTION
•GAIN OF EXPRESSION OF COSTIMULATORY
MOLECULE
ACQUIRED IMMUNITY
B-Lymphocyte
• BCR – soluble or particulate Ag
• Clonal selection hypothesis
• Surface Ab - unique specificity
• Antigenic diversity - V(D)J recombination
• Antibody diversity - Somatic Hypermutation
-Affinity maturation
• Class Switching
• ‘ACTIVATED’ B-Cell
-Effector B-cell = Plasma cells
-Memory B-cell
-APCs
T-Lymphocyte
• TCR- only processed Ag, typically peptides
• MHC- The processed Ag have to be bound to
this cell membrane Glycoprotein complex:
CD4+ with MHC class II, CD8+ with MHC class I
• Activation of T-cell
Three signals are required for activation of a naïve T cell.
1. The TCR/MHC-peptide interaction, along with CD4 and CD8 co-receptors and
adhesion molecules, provide Signal 1.
2. Co-stimulation by a separate set of molecules, including CD28 provide Signal 2.
3. Together, Signal 1 and Signal 2 initiate a signal transduction cascade that results
in activation of transcription factors and cytokines (Signal 3) that direct T-cell
proliferation (IL-2) and differentiation (polarizing cytokines).
(Cytokines can act in an autocrine manner, by stimulating the same cells that produce them,
or in a paracrine manner, by stimulating neighbouring cells.)
Regulation of Immune system
TOLERANCE
CENTRAL
PERIPHERAL
ANTIGEN
SEQUESTRATION
IMMUNE
PRIVILEGED
IMMUNOSUPPRESSIVE
MICRO-ENVIRONMENT
SELF-TOLERANCE/TOLERANCE
CENTRAL
NEGATIVE
SELECTION
RECEPTOR
EDITING
PERIPHERAL
COSTIMULATORY
SIGNAL
LACK OF T-
CELL HELP
REGULATORY
T-CELL/ TReg
nTreg
iTreg
May be induced to have increased
FOXP3 expression l/t development
of iTREG cells
-Cytokines eg TGFβ in
GALT
-Chr Ag exposure eg gut
flora or food
-Lack of co-stimulation
-Presence of immature
dendritic cells
REGULATORY T-CELL
CD4+ Treg cells
• Express high levels of IL-2Rα
aka CD25 which is a low
affinity receptor for IL-2
• It prevents binding of IL-2 with
other high affinity IL-2
receptors
• It also discourages expansion
of local immunostimulatory
effector T-cells
• Acts against both self and
non-self anigen
CD8+ Treg cells
• Some T-cells, from
Thymocytes, when come to
peripheral blood, they
increase expression of
FOXP3 being stimulated by
cytokines eg. TGF-β
• Minority of CD8+ cells
directly become nTreg cell
COSTIMULATORY SIGNAL
• T-cell activation signaling is manifold.
• Two-signal hypothesis (Quill and Schwartz,
1987)- TCR-MHC interaction of a naïve T-cell in
absence of functional APC renders T-cell non-
responsive – ANERGY
• Clonal Anergy results if a Costimulatory
Signal Is Absent
• CD28 acts as co-stimulatory receptor and
CD80/86 its ligand;
• Negative co-stimulator receptor: CTLA-4, PD-1,
BTLA
• Effector T-cells up-regulate negative co-
stimulatory receptors at the end of an immune
response, when proliferation is no longer
advantageous, whereas naïve Ts don’t.
TO BE CONTINUED…
In next class we will find answer of
• How this complex immune system fails, and
auto-immune response ensues?
• Where lies the problem?
• What are various of auto-immune disorders?
• Why women are more susceptible than men?
and ………………………………….. many newer aspects

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Autoimmunity basics

  • 1. AUTOIMMUNITY and related Disorders Dr Abhirup Chatterjee MBBS MD(Medicine) R G Kar MCH
  • 2. • Basic Immunology in context of autoimmunity • Spectrum of autoimmune disorders • Recent advances in management of AIDs
  • 3. Basic Immunology in context of Autoimmunity
  • 4. IMMUNE SYSTEM • WHAT • WHEN • WHY • WHERE • HOW
  • 5. IMMUNE SYSTEM • WHAT is the immune system? • WHEN • WHY • WHERE • HOW
  • 6. IMMUNE SYSTEM • WHAT • WHEN does it act? • WHY • WHERE • HOW
  • 7. IMMUNE SYSTEM • WHAT • WHEN • WHY does it act at all? • WHERE • HOW
  • 8. • Threats-External and Internal • Healing and wound repair • Clearance
  • 9.
  • 10. IMMUNE SYSTEM • WHAT • WHEN • WHY • WHERE does it reside at? • HOW
  • 11. LYMPHOID ORGANS • Primary – Marrow and Thymus • Secondary – LN, Spleen, GALT, MALT • Tertiary – site of infection and constant Ag exposure
  • 12.
  • 13. • WHAT • WHEN • WHY • WHERE • HOW does it do this?
  • 14. HSC CMP Erythroid Myeloid Granulo Myeloid APCs (Mono/ Mɸ/ Dendritic) CLP NK B T Th Th1 Th2 Treg Th17 Tc INNATE IMMUNITY ACQUIRED IMMUNITY
  • 16.
  • 17.
  • 18. IMMATURE DC Antigen capturing phenotype Encounter with Ag MATURE DC Antigen presenting phenotype •LOSS OF PHAGOCYTOSIS AND LARGE SCALE PINOCYTOSIS •GAIN OF ANTIGEN PRESENTING FUNCTION •GAIN OF EXPRESSION OF COSTIMULATORY MOLECULE
  • 20. B-Lymphocyte • BCR – soluble or particulate Ag • Clonal selection hypothesis • Surface Ab - unique specificity • Antigenic diversity - V(D)J recombination • Antibody diversity - Somatic Hypermutation -Affinity maturation • Class Switching • ‘ACTIVATED’ B-Cell -Effector B-cell = Plasma cells -Memory B-cell -APCs
  • 21.
  • 22. T-Lymphocyte • TCR- only processed Ag, typically peptides • MHC- The processed Ag have to be bound to this cell membrane Glycoprotein complex: CD4+ with MHC class II, CD8+ with MHC class I • Activation of T-cell
  • 23.
  • 24. Three signals are required for activation of a naïve T cell. 1. The TCR/MHC-peptide interaction, along with CD4 and CD8 co-receptors and adhesion molecules, provide Signal 1. 2. Co-stimulation by a separate set of molecules, including CD28 provide Signal 2. 3. Together, Signal 1 and Signal 2 initiate a signal transduction cascade that results in activation of transcription factors and cytokines (Signal 3) that direct T-cell proliferation (IL-2) and differentiation (polarizing cytokines). (Cytokines can act in an autocrine manner, by stimulating the same cells that produce them, or in a paracrine manner, by stimulating neighbouring cells.)
  • 25.
  • 26. Regulation of Immune system TOLERANCE CENTRAL PERIPHERAL ANTIGEN SEQUESTRATION IMMUNE PRIVILEGED IMMUNOSUPPRESSIVE MICRO-ENVIRONMENT
  • 28. May be induced to have increased FOXP3 expression l/t development of iTREG cells -Cytokines eg TGFβ in GALT -Chr Ag exposure eg gut flora or food -Lack of co-stimulation -Presence of immature dendritic cells
  • 29. REGULATORY T-CELL CD4+ Treg cells • Express high levels of IL-2Rα aka CD25 which is a low affinity receptor for IL-2 • It prevents binding of IL-2 with other high affinity IL-2 receptors • It also discourages expansion of local immunostimulatory effector T-cells • Acts against both self and non-self anigen CD8+ Treg cells • Some T-cells, from Thymocytes, when come to peripheral blood, they increase expression of FOXP3 being stimulated by cytokines eg. TGF-β • Minority of CD8+ cells directly become nTreg cell
  • 30. COSTIMULATORY SIGNAL • T-cell activation signaling is manifold. • Two-signal hypothesis (Quill and Schwartz, 1987)- TCR-MHC interaction of a naïve T-cell in absence of functional APC renders T-cell non- responsive – ANERGY • Clonal Anergy results if a Costimulatory Signal Is Absent
  • 31.
  • 32. • CD28 acts as co-stimulatory receptor and CD80/86 its ligand; • Negative co-stimulator receptor: CTLA-4, PD-1, BTLA • Effector T-cells up-regulate negative co- stimulatory receptors at the end of an immune response, when proliferation is no longer advantageous, whereas naïve Ts don’t.
  • 33.
  • 35. In next class we will find answer of • How this complex immune system fails, and auto-immune response ensues? • Where lies the problem? • What are various of auto-immune disorders? • Why women are more susceptible than men? and ………………………………….. many newer aspects