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IMMUNE SYSTEM
Dr. Saket Kumar
NORMAL
IMMUNE
RESPONSE
Normal immune response
INNATEIMMUNITY
Innate
immunity
Introductio
n
Components
ā€¢ Epithelia
ā€¢ Neutrophils and
monocytes
ā€¢ Dendritic cells
ā€¢ NK cells
ā€¢ Mast cells
ā€¢ Complement system
Receptors of innate immunity (Pattern recognition
receptors)
ā€¢ Toll like receptors
ā€¢ NOD like receptors
ā€¢ C lectin type receptors
ā€¢ RIG like receptors
ā€¢ G protein coupled receptors
ā€¢ Mannose receptors
Reactions of innate
immunity
ā€¢ Inflammation
ā€¢ Anti viral defense
ā€¢ Stimulate adaptive immunity
INNATEIMMUNITY
INTRODUCTI
ON
Introduction
ā€¢ Innate immunity is always
present, ready to provide
defence against microbes and
to eliminate damaged cells
ā€¢ Does not have memory or
fine antigen specificity
ā€¢ Innate immunity uses about
100 different receptors to
recognize 1,000 molecular
patterns
ā€¢ In contrast, adaptive immunity
uses two types of receptors
(antibodies and T-cell receptors,
described later), each with
millions of variations, to
recognize millions of antigens.
INNATEIMMUNITY
COMPONEN
TS
Components
ā€¢ Epithelia
ā€¢ Neutrophils and
monocytes
ā€¢ Dendritic cells
ā€¢ NK cells
ā€¢ Mast cells
ā€¢ Complement system
Epithelia
ā€¢ Provide mechanical barriers to the
entry of microbes
ā€¢ Also produce antimicrobial molecules
such as defensins
Neutrophils
and
monocytes
ā€¢ Monocytes and neutrophils are
phagocytes in the blood
ā€¢ All tissues contain resident macrophages,
the professional phagocytes of the body
Dendritic
cells
ā€¢ Dendritic cells are
involved in the
initiation of innate
immune responses,
but, unlike
macrophages, they
are not key
participants in the
destruction of
microbes
ā€¢ Present in
epithelia,
lymphoid organs
ā€¢ They capture protein
antigens and display
peptides for
recognition by T
lymphocytes
Natural Killer
cells
ā€¢ Early protection against many viruses
and intracellular bacteria
Mast cells ā€¢ Capable of producing many
mediators of inflammation
INNATEIMMUNITY
RECEPTOR
S OF
Receptors of
innate immunity
Tolllike
receptors ā€¢ All these receptors signal by a common
pathway that culminates in the activation of
two sets of transcription factors:
ā€¢ NF-ĪŗB ā€“ critical for the recruitment
and activation of leukocytes
through
ā€¢ synthesis and secretion of cytokines
ā€¢ expression of adhesion molecules
ā€¢ Interferon regulatory factors (IRFs) -
antiviral cytokines
INNATEIMMUNITY
REACTIONS
OF
Reactionsof innate immunity
The innate immune system provides host defence by
ā€¢ Inflammation
ā€¢ Vascular and cellular components of inflammation
ā€¢ Stimulate adaptive immunity
ADAPTIVEIMMUNITY
Adaptive
immunity
ā€¢ Introductio
n ā€¢ Type
s ā€¢ Humoral
ā€¢ Cell
mediated
ā€¢ Cells of adaptive
immunity
ā€¢ Lymphocytes
ā€¢ T
lymphocytes
ā€¢ B
lymphocytes
ā€¢ Dendritic
cells
ā€¢ Macrophage
s
ā€¢ NK cells
ā€¢ Tissues of adaptive
immunity
ā€¢ Generative lymphoid organs
ā€¢ Thymus
ā€¢ Bone
marrow
ā€¢ Peripheral lymphoid
organs
ā€¢ Lymphnode
s
ā€¢ Spleen
ā€¢ MALT
ADAPTIVEIMMUNITY
INTRODUCTI
ON
INTRODUCTION ā€“ TYPESOFADAPTIVE IMMUNITY
Humoral immunity
Mediated by Blymphocytes by secreting
antibodies
Protect against extracellular microbes and their
toxins
Cell mediated immunity
Mediated by Tlymphocytes
Protect against intracellular pathogens
ADAPTIVEIMMUNITY
CELLS
OF
T
Lymphocytes Type
s
Helper T cells
(CD4)
-stimulate B
lymphocytes
to make antibodies
and activate other
leukocytes (e.g.,
phagocytes) to
destroy microbes
-60% of all T cells
Cytotoxic T cells
(CD8)
- kill infected
cells
- 30% of all T
cells
Regulator T
cells
- limit immune
responses and
prevent reactions
against self antigens
Mature T cells are found in the
blood, where they constitute 60%
to 70% of lymphocytes, and in T-
cell zones of peripheral lymphoid
organs
Major Histocompatibility
Complex (MHC)
Introductio
n
Introduction
ā€¢ Also called Human leukocyte antigens
(HLA) because they were initially
detected on leukocytes
ā€¢ Clustered on a small
segment of chromosome 6
ā€¢ MHC molecules are
ā€¢ Fundamental to the recognition
of antigens by T cells; display
peptide fragments of protein
antigens
T
ypes
ā€¢ Class I MHC
ā€¢ Display peptides
from viral and
tumour antigens;
that are located in
the cytoplasm;
recognized by CD8+
T lymphocytes
ā€¢ Class II MHC
ā€¢ Present antigens
that are internalized
into vesicles,
typically derived
from extracellular
microbes and
soluble proteins;
recognized by
CD4+ T cells
Roleof MHC
antigens
ā€¢ Organ transplantation
ā€¢ MHC system is highly polymorphic, meaning that there
are many alleles of MHC genes (in the thousands) in
humans and each individualā€™s alleles differ from those
inherited by most other individuals in the population.
ā€¢ This constitutes a formidable barrier in organ
transplantation
and graft rejection
ā€¢ Autoimmune diseases
ā€¢ Number of autoimmune diseases are associated
with the inheritance of particular HLA alleles
ā€¢ Immune response
ā€¢ Individual mounts an immune response against a
protein antigen only if he or she inherits the genes for
those MHC molecules that can bind peptides derived
from the antigen and present it to T cells
ā€¢ By segregating cytoplasmic and internalized antigens,
MHC molecules ensure that the correct immune
response is mounted against different microbes
ā€¢ Allergic reactions
ā€¢ If the antigen is a peptide from ragweed pollen, the
individual who expresses class II molecules capable
of binding the antigen would be genetically prone to
allergic reactions against pollen
Lymphocyte
Activation and
Immune Response
Introduction
ā€¢ All adaptive immune responses
develop in steps, consisting of:
ā€¢ Antigen recognition, activation of
specific lymphocytes
ā€¢ Differentiation into effector and
memory cells
ā€¢ Elimination of the antigen
ā€¢ Decline of the response, with memory
cells
being the long-lived survivors
Lymphocyte
Activation and
Immune
Response
Display
and
recognitio
n of
antigens
Cell
mediate
d
immunit
y
Humora
l
immunit
y
Immunologi
c
memory
Display and
recognition
of antigens
Cellmediated immunity
Humoral
immunity
ā€¢ Each plasma cell is derived from an
antigen- stimulated B cell and secretes
antibodies that recognize the same
antigen that was bound to the BCR and
initiated the response
ā€¢ T cell dependent response ā€“
ā€¢ B cells ingest protein antigens into
vesicles, degrade them, and display
peptides bound to class II MHC
molecules for recognition by helper T
cells
ā€¢ T-dependent responses show features
such as immunoglobulin isotype
switching and affinity maturation
ā€¢ T cell independent response ā€“
ā€¢ Many polysaccharide and lipid antigens
are able to engage receptor molecules
on B cell and initiate the process of B-
Wayshumoral response works
an important goal of vaccination
HYPERSENSITIVITY
Hypersensitivity
General features
And Classification
Type I
ā€¢ Localised reaction
ā€¢ Immediate reaction
ā€¢ Activation of TH2
Cells and
Production of IgE
Antibody
ā€¢ Sensitization
and Activation
of Mast Cells
ā€¢ Mediators of
Immediate
Hypersensitivit
y
ā€¢ Late-Phase Reaction
ā€¢ Allergy
ā€¢ Systemic Anaphylaxis
ā€¢ CLINICAL
MANIFESTATIO
NS
Type II
ā€¢ Introduction
ā€¢ Mechanisms
ā€¢ Opsonization
and
Phagocytosis
ā€¢ Inflammation
ā€¢ Cellular dysfunction
ā€¢ Examples
Type III
ā€¢ Introduction
ā€¢ Immune complex
diseases
ā€¢ Systemic
Immune
Complex
Disease
ā€¢ Acute
ā€¢ Chronic
ā€¢ Morphology
ā€¢ Local Immune
Complex
Disease
(Arthus
Reaction)
Type IV
ā€¢ Introduction
ā€¢ CD4+ T Cellā€“Mediated
Inflammation
ā€¢ Responses of
Differentiated
Effector T Cells
ā€¢ Clinical Examples of
CD4+ T Cellā€“
Mediated
Inflammatory
Reactions
ā€¢ CD8+ T Cellā€“Mediated
Cytotoxicity
HYPERSENSITIVITY
General features &
Classification
General
features
ā€¢ Hypersensitivity implies an excessive or
harmful
reaction to
antigen
ā€¢ Can be elicited by
ā€¢ Exogenous environmental antigens ā€“
Allergy
ā€¢ Dust, pollens, foods, drugs, microbes,
and various chemicals
ā€¢ Immune responses to such antigens
range from itching of the skin, to
potentially fatal diseases, such as
bronchial asthma and anaphylaxis
ā€¢ Endogenous self antigens ā€“ Autoimmune
diseases
ā€¢ Results from an imbalance between the
effector mechanisms of immune responses
and the control mechanisms that serve to
normally limit such responses
ā€¢ Often associated with the inheritance of
particular susceptibility genes
Hypersensitivit
y
Classification
ā€¢ TYPE I ā€“ Immediate hypersensitivity
ā€¢ Caused by TH2 cells, IgE
antibodies, and mast cells and
other leukocytes
ā€¢ TYPE II ā€“ Antibody mediated disorders
ā€¢ Secreted IgG and IgM antibodies injure
cells
by promoting their phagocytosis or lysis
ā€¢ TYPE III ā€“ Immune complex mediated
diseases
ā€¢ IgG and IgM antibodies bind antigens
usually in the circulation, and the
antigen- antibody complexes deposit
in tissues and induce inflammation
ā€¢ TYPE IV ā€“ Cell mediated immune
Hypersensitivit
y
HYPERSENSITIVITY
TYP
E I
Steps in Type I
HS reaction
Immediate reaction
ā€¢ Vasodilation, vascular leakage,
and depending on the location,
smooth muscle spasm or
glandular secretions
ā€¢ Within minutes after exposure to
an allergen
ā€¢ Subside in a few hours
Late-phase reaction
ā€¢ Sets in 2 to 24 hours later
ā€¢ Without additional exposure to
antigen
ā€¢ May last for several days
ā€¢ Characterized by infiltration of tissues
with eosinophils, neutrophils,
basophils, monocytes, and CD4+ T
cells, as well as tissue destruction,
typically in the form of mucosal
epithelial cell damage
IMMEDIATE REACTION
1. Activation of TH2 Cells
and Production of IgE
Antibody
1.Activation of TH2
Cellsand Production
of IgEAntibody
ā€¢ Presentation of the
antigen to naive CD4+
helper T cells by
dendritic cells
ā€¢ T cells differentiate into
TH2
cells
ā€¢ TH2 cells produce IL4
acts on B cells to
stimulate class
switching to IgE
IMMEDIATE REACTION
2. Sensitization and Activation of Mast Cells
2. Sensitization andActivation
of MastCells
ā€¢ Mast cells
ā€¢ They are bone marrow derived counterparts of
basophils in tissues
ā€¢ Various mediators secreted -
Vasoactive amines (Histamine)
- Intense smooth muscle contraction
- increased vascular permeability
Lipid mediators
- Leukotrienes - Increase vascular permeability
- bronchial smooth muscle
contraction
- Prostaglandins ā€“ intense bronchospasm
- Increased mucus secretion
- Cytokines - TNF, IL-1, and chemokines
- promote leukocyte recruitment
LATE PHASE REACTION
LATE PHASE REACTION
ā€¢ In the late-phase reaction, eosinophils that are recruited
amplify and sustain the inflammatory response without
additional exposure to the triggering antigen
ā€¢ TH2 cytokine IL-5 is the most potent eosinophil-activating
cytokine known
ā€¢ Late-phase reaction is a major cause of symptoms allergic
asthma
ā€¢ Treatment of these diseases requires the use of steroids,
rather than anti-histamine drugs, which are of benefit in the
immediate reaction
TYPE II
HYPERSENSITIVITY
GENERAL FEATURES
General
features
ā€¢ Caused by antibodies that react
with antigens present on cell
surfaces or in the extracellular
matrix
ā€¢ Cause disease by destroying these
cells, triggering inflammation, or
interfering with normal functions
ā€¢ The antibodies may be
ā€¢ Specific for normal cell or tissue
antigens (autoantibodies)
ā€¢ Specific to exogenous antigens, such
as chemical or microbial proteins, that
bind to a cell surface or tissue matrix
MECHANISMS
1. Opsonization and phagocytosis
1. Opsonization and Phagocytosis
IgG and C3b
1. Opsonization and Phagocytosis
Antibody dependent cellular cytotoxicity - ADCC
ā€¢ Contribution of ADCC to common hypersensitivity diseases is uncertain
ā€¢ Occur in the following situations
ā€¢ Transfusion reactions, in which cells from an incompatible donor react with
and are opsonized by preformed antibody in the host
ā€¢ Hemolytic disease of the newborn (erythroblastosis fetalis), in which
there is an antigenic difference between the mother and the fetus, and
IgG antierythrocyte antibodies from the mother cross the placenta and
cause destruction of fetal red cells
ā€¢ Autoimmune hemolytic anemia, agranulocytosis, and
thrombocytopenia, in which individuals produce antibodies to their own
blood cells, which are then destroyed
ā€¢ Drug reactions, in which adrug acts asaā€œhaptenā€ by attaching to plasma
membrane proteins of red cells and antibodies are produced against the
MECHANISMS
2. Inflammation
2. Inflammation
ā€¢ When antibodies deposit in fixed tissues,
such as basement membranes and
extracellular matrix, the resultant injury is
due to inflammation
MECHANISMS
3. Cellulardysfunction
3.Cellulardysfunction
ā€¢ Antibodies directed against cell surface receptors
impair or dysregulate function without causing cell
injury or inflammation
EXAMPLES
HYPERSENSITIVITY
TYPE
III
INTRODUCTION
INTRODUCTION
Immune complexes may
be formed when
ā€¢ Antigen combines with antibody in
the circulation and deposits in
vessel walls
ā€¢ Complexes may be formed at sites
where antigen hasbeen ā€œplantedā€
previously (called in situ immune
complexes)
Antigens that form
immune
complexes may be
ā€¢ exogenous, such as a foreign protein
that is injected or produced by an
infectious microbe
ā€¢ endogenous, if the individual
produces antibody against self
antigens (autoimmunity)
Systemicimmune
complex disorders
(Acute)
Pathogenesis
ā€¢ Complement protein C3
plays an active role in
Type III reaction
ā€¢ Serum C3 levels can be
used to monitor disease
activity
ā€¢ Protein antigen triggers an
immune response that
results in the formation of
antibodies, typically about
a week after the injection
of the protein.
ā€¢ These antibodies are
secreted into the blood,
where they react with the
antigen still present in the
circulation and form
antigen-antibody
complexes
ā€¢ The circulating antigen-
antibody complexes are
deposited in various
tissues
ā€¢ Organs where blood is
filtered at high pressure
to form other fluids, like
urine and synovial fluid,
are sites where immune
complexes become
concentrated and tend
to deposit; hence,
immune complex
disease often affects
glomeruli and joints.
ā€¢ Once immune complexes
are deposited in the
tissues, they initiate an
acute inflammatory
reaction
ā€¢ During this phase
(approximately 10 days after
antigen administration),
clinical features such as
fever, urticaria, joint pains
(arthralgias), lymph node
enlargement, and
proteinuria appear
ā€¢ Resultant inflammatory lesion
is termed vasculitis if it
occurs in blood vessels,
glomerulonephritis
ā€¢ if it occurs in renal glomeruli,
arthritis if it occurs in the
joints
Acute vasculitis
ā€¢ Necrosis of the
vessel wall and
intense neutrophilic
infiltration
ā€¢ The necrotic tissue
and deposits of
immune complexes,
complement, and
plasma protein
appear as a smudgy
eosinophilic area of
tissue destruction,
termed fibrinoid
necrosis
HYPERSENSITIVITY
TYPE
IV
INTRODUCTION
INTR
ODUC
TION
ā€¢ The cell-mediated type of hypersensitivity is caused
by inflammation resulting from cytokines produced
by CD4 and CD8 T cells
CD4+ T Cellā€“Mediated Inflammation
CD4+T Cellā€“Mediated Inflammation
(Delayed type Hypersensitivity -DTH)
ā€¢ DTH is a tissue reaction to in immune individuals
ā€¢ In this reaction, an antigen administered into the
skin of a previously immunized individual results in
a detectable cutaneous reaction within 24 to 48
hours (hence the term delayed, in contrast to
immediate hypersensitivity)
ā€¢ Both TH1 and TH17 cells contribute to organ-
specific diseases
ā€¢ The inflammatory reaction associated with TH1 cells
is dominated by activated macrophages, and that
triggered by TH17 cells has a greater neutrophil
component
Stagesof CD4+TCellā€“MediatedInflammation
APCs produce
1. IL6 ā€“ TH1 cells
2. IL1/6/23 ā€“ TH17
cells
TH1 cells
Secrete IFN-Ī³, augments
the ability of
macrophages to kill
microorganisms
TH17 cells
secrete IL-17, IL-22 -
recruit neutrophils and
monocytes to the
reaction
Clinical examplesof TypeIVhypersensitivity
Tuberculin
reaction
and
granuloma
formation
Contact
dermatiti
s
Tuberculin reaction
(Mantoux test)
ā€¢ Used to check whether
the individual has been
previously exposed to
tuberculous antigen
ā€¢ Intracutaneous injection
of purified protein
derivative (PPD, also
called tuberculin), is
given
ā€¢ In a previously sensitized
individual, reddening and
induration of the site
appear in 8 to 12 hours,
reach a peak in 24 to 72
hours, and thereafter
slowly subside
ā€¢ Morphologically,
characterized by the
accumulation of
mononuclear cells,
mainly CD4+ T cells
and macrophages,
around venules,
producing perivascular

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Immune System (2).pptx

  • 5. Innate immunity Introductio n Components ā€¢ Epithelia ā€¢ Neutrophils and monocytes ā€¢ Dendritic cells ā€¢ NK cells ā€¢ Mast cells ā€¢ Complement system Receptors of innate immunity (Pattern recognition receptors) ā€¢ Toll like receptors ā€¢ NOD like receptors ā€¢ C lectin type receptors ā€¢ RIG like receptors ā€¢ G protein coupled receptors ā€¢ Mannose receptors Reactions of innate immunity ā€¢ Inflammation ā€¢ Anti viral defense ā€¢ Stimulate adaptive immunity
  • 7. Introduction ā€¢ Innate immunity is always present, ready to provide defence against microbes and to eliminate damaged cells ā€¢ Does not have memory or fine antigen specificity ā€¢ Innate immunity uses about 100 different receptors to recognize 1,000 molecular patterns ā€¢ In contrast, adaptive immunity uses two types of receptors (antibodies and T-cell receptors, described later), each with millions of variations, to recognize millions of antigens.
  • 9. Components ā€¢ Epithelia ā€¢ Neutrophils and monocytes ā€¢ Dendritic cells ā€¢ NK cells ā€¢ Mast cells ā€¢ Complement system
  • 10. Epithelia ā€¢ Provide mechanical barriers to the entry of microbes ā€¢ Also produce antimicrobial molecules such as defensins
  • 11. Neutrophils and monocytes ā€¢ Monocytes and neutrophils are phagocytes in the blood ā€¢ All tissues contain resident macrophages, the professional phagocytes of the body
  • 12. Dendritic cells ā€¢ Dendritic cells are involved in the initiation of innate immune responses, but, unlike macrophages, they are not key participants in the destruction of microbes ā€¢ Present in epithelia, lymphoid organs ā€¢ They capture protein antigens and display peptides for recognition by T lymphocytes
  • 13. Natural Killer cells ā€¢ Early protection against many viruses and intracellular bacteria
  • 14. Mast cells ā€¢ Capable of producing many mediators of inflammation
  • 17. Tolllike receptors ā€¢ All these receptors signal by a common pathway that culminates in the activation of two sets of transcription factors: ā€¢ NF-ĪŗB ā€“ critical for the recruitment and activation of leukocytes through ā€¢ synthesis and secretion of cytokines ā€¢ expression of adhesion molecules ā€¢ Interferon regulatory factors (IRFs) - antiviral cytokines
  • 19. Reactionsof innate immunity The innate immune system provides host defence by ā€¢ Inflammation ā€¢ Vascular and cellular components of inflammation ā€¢ Stimulate adaptive immunity
  • 21. Adaptive immunity ā€¢ Introductio n ā€¢ Type s ā€¢ Humoral ā€¢ Cell mediated ā€¢ Cells of adaptive immunity ā€¢ Lymphocytes ā€¢ T lymphocytes ā€¢ B lymphocytes ā€¢ Dendritic cells ā€¢ Macrophage s ā€¢ NK cells ā€¢ Tissues of adaptive immunity ā€¢ Generative lymphoid organs ā€¢ Thymus ā€¢ Bone marrow ā€¢ Peripheral lymphoid organs ā€¢ Lymphnode s ā€¢ Spleen ā€¢ MALT
  • 23. INTRODUCTION ā€“ TYPESOFADAPTIVE IMMUNITY Humoral immunity Mediated by Blymphocytes by secreting antibodies Protect against extracellular microbes and their toxins Cell mediated immunity Mediated by Tlymphocytes Protect against intracellular pathogens
  • 25.
  • 26. T Lymphocytes Type s Helper T cells (CD4) -stimulate B lymphocytes to make antibodies and activate other leukocytes (e.g., phagocytes) to destroy microbes -60% of all T cells Cytotoxic T cells (CD8) - kill infected cells - 30% of all T cells Regulator T cells - limit immune responses and prevent reactions against self antigens Mature T cells are found in the blood, where they constitute 60% to 70% of lymphocytes, and in T- cell zones of peripheral lymphoid organs
  • 28. Introduction ā€¢ Also called Human leukocyte antigens (HLA) because they were initially detected on leukocytes ā€¢ Clustered on a small segment of chromosome 6 ā€¢ MHC molecules are ā€¢ Fundamental to the recognition of antigens by T cells; display peptide fragments of protein antigens
  • 29. T ypes ā€¢ Class I MHC ā€¢ Display peptides from viral and tumour antigens; that are located in the cytoplasm; recognized by CD8+ T lymphocytes ā€¢ Class II MHC ā€¢ Present antigens that are internalized into vesicles, typically derived from extracellular microbes and soluble proteins; recognized by CD4+ T cells
  • 30. Roleof MHC antigens ā€¢ Organ transplantation ā€¢ MHC system is highly polymorphic, meaning that there are many alleles of MHC genes (in the thousands) in humans and each individualā€™s alleles differ from those inherited by most other individuals in the population. ā€¢ This constitutes a formidable barrier in organ transplantation and graft rejection ā€¢ Autoimmune diseases ā€¢ Number of autoimmune diseases are associated with the inheritance of particular HLA alleles ā€¢ Immune response ā€¢ Individual mounts an immune response against a protein antigen only if he or she inherits the genes for those MHC molecules that can bind peptides derived from the antigen and present it to T cells ā€¢ By segregating cytoplasmic and internalized antigens, MHC molecules ensure that the correct immune response is mounted against different microbes ā€¢ Allergic reactions ā€¢ If the antigen is a peptide from ragweed pollen, the individual who expresses class II molecules capable of binding the antigen would be genetically prone to allergic reactions against pollen
  • 32. Introduction ā€¢ All adaptive immune responses develop in steps, consisting of: ā€¢ Antigen recognition, activation of specific lymphocytes ā€¢ Differentiation into effector and memory cells ā€¢ Elimination of the antigen ā€¢ Decline of the response, with memory cells being the long-lived survivors
  • 36. Humoral immunity ā€¢ Each plasma cell is derived from an antigen- stimulated B cell and secretes antibodies that recognize the same antigen that was bound to the BCR and initiated the response ā€¢ T cell dependent response ā€“ ā€¢ B cells ingest protein antigens into vesicles, degrade them, and display peptides bound to class II MHC molecules for recognition by helper T cells ā€¢ T-dependent responses show features such as immunoglobulin isotype switching and affinity maturation ā€¢ T cell independent response ā€“ ā€¢ Many polysaccharide and lipid antigens are able to engage receptor molecules on B cell and initiate the process of B-
  • 37. Wayshumoral response works an important goal of vaccination
  • 39. Hypersensitivity General features And Classification Type I ā€¢ Localised reaction ā€¢ Immediate reaction ā€¢ Activation of TH2 Cells and Production of IgE Antibody ā€¢ Sensitization and Activation of Mast Cells ā€¢ Mediators of Immediate Hypersensitivit y ā€¢ Late-Phase Reaction ā€¢ Allergy ā€¢ Systemic Anaphylaxis ā€¢ CLINICAL MANIFESTATIO NS Type II ā€¢ Introduction ā€¢ Mechanisms ā€¢ Opsonization and Phagocytosis ā€¢ Inflammation ā€¢ Cellular dysfunction ā€¢ Examples Type III ā€¢ Introduction ā€¢ Immune complex diseases ā€¢ Systemic Immune Complex Disease ā€¢ Acute ā€¢ Chronic ā€¢ Morphology ā€¢ Local Immune Complex Disease (Arthus Reaction) Type IV ā€¢ Introduction ā€¢ CD4+ T Cellā€“Mediated Inflammation ā€¢ Responses of Differentiated Effector T Cells ā€¢ Clinical Examples of CD4+ T Cellā€“ Mediated Inflammatory Reactions ā€¢ CD8+ T Cellā€“Mediated Cytotoxicity
  • 41. General features ā€¢ Hypersensitivity implies an excessive or harmful reaction to antigen ā€¢ Can be elicited by ā€¢ Exogenous environmental antigens ā€“ Allergy ā€¢ Dust, pollens, foods, drugs, microbes, and various chemicals ā€¢ Immune responses to such antigens range from itching of the skin, to potentially fatal diseases, such as bronchial asthma and anaphylaxis ā€¢ Endogenous self antigens ā€“ Autoimmune diseases ā€¢ Results from an imbalance between the effector mechanisms of immune responses and the control mechanisms that serve to normally limit such responses ā€¢ Often associated with the inheritance of particular susceptibility genes Hypersensitivit y
  • 42. Classification ā€¢ TYPE I ā€“ Immediate hypersensitivity ā€¢ Caused by TH2 cells, IgE antibodies, and mast cells and other leukocytes ā€¢ TYPE II ā€“ Antibody mediated disorders ā€¢ Secreted IgG and IgM antibodies injure cells by promoting their phagocytosis or lysis ā€¢ TYPE III ā€“ Immune complex mediated diseases ā€¢ IgG and IgM antibodies bind antigens usually in the circulation, and the antigen- antibody complexes deposit in tissues and induce inflammation ā€¢ TYPE IV ā€“ Cell mediated immune Hypersensitivit y
  • 44. Steps in Type I HS reaction
  • 45. Immediate reaction ā€¢ Vasodilation, vascular leakage, and depending on the location, smooth muscle spasm or glandular secretions ā€¢ Within minutes after exposure to an allergen ā€¢ Subside in a few hours
  • 46. Late-phase reaction ā€¢ Sets in 2 to 24 hours later ā€¢ Without additional exposure to antigen ā€¢ May last for several days ā€¢ Characterized by infiltration of tissues with eosinophils, neutrophils, basophils, monocytes, and CD4+ T cells, as well as tissue destruction, typically in the form of mucosal epithelial cell damage
  • 47. IMMEDIATE REACTION 1. Activation of TH2 Cells and Production of IgE Antibody
  • 48. 1.Activation of TH2 Cellsand Production of IgEAntibody ā€¢ Presentation of the antigen to naive CD4+ helper T cells by dendritic cells ā€¢ T cells differentiate into TH2 cells ā€¢ TH2 cells produce IL4 acts on B cells to stimulate class switching to IgE
  • 49. IMMEDIATE REACTION 2. Sensitization and Activation of Mast Cells
  • 50. 2. Sensitization andActivation of MastCells ā€¢ Mast cells ā€¢ They are bone marrow derived counterparts of basophils in tissues ā€¢ Various mediators secreted - Vasoactive amines (Histamine) - Intense smooth muscle contraction - increased vascular permeability Lipid mediators - Leukotrienes - Increase vascular permeability - bronchial smooth muscle contraction - Prostaglandins ā€“ intense bronchospasm - Increased mucus secretion - Cytokines - TNF, IL-1, and chemokines - promote leukocyte recruitment
  • 52. LATE PHASE REACTION ā€¢ In the late-phase reaction, eosinophils that are recruited amplify and sustain the inflammatory response without additional exposure to the triggering antigen ā€¢ TH2 cytokine IL-5 is the most potent eosinophil-activating cytokine known ā€¢ Late-phase reaction is a major cause of symptoms allergic asthma ā€¢ Treatment of these diseases requires the use of steroids, rather than anti-histamine drugs, which are of benefit in the immediate reaction
  • 55. General features ā€¢ Caused by antibodies that react with antigens present on cell surfaces or in the extracellular matrix ā€¢ Cause disease by destroying these cells, triggering inflammation, or interfering with normal functions ā€¢ The antibodies may be ā€¢ Specific for normal cell or tissue antigens (autoantibodies) ā€¢ Specific to exogenous antigens, such as chemical or microbial proteins, that bind to a cell surface or tissue matrix
  • 57. 1. Opsonization and Phagocytosis IgG and C3b
  • 58. 1. Opsonization and Phagocytosis Antibody dependent cellular cytotoxicity - ADCC ā€¢ Contribution of ADCC to common hypersensitivity diseases is uncertain ā€¢ Occur in the following situations ā€¢ Transfusion reactions, in which cells from an incompatible donor react with and are opsonized by preformed antibody in the host ā€¢ Hemolytic disease of the newborn (erythroblastosis fetalis), in which there is an antigenic difference between the mother and the fetus, and IgG antierythrocyte antibodies from the mother cross the placenta and cause destruction of fetal red cells ā€¢ Autoimmune hemolytic anemia, agranulocytosis, and thrombocytopenia, in which individuals produce antibodies to their own blood cells, which are then destroyed ā€¢ Drug reactions, in which adrug acts asaā€œhaptenā€ by attaching to plasma membrane proteins of red cells and antibodies are produced against the
  • 60. 2. Inflammation ā€¢ When antibodies deposit in fixed tissues, such as basement membranes and extracellular matrix, the resultant injury is due to inflammation
  • 62. 3.Cellulardysfunction ā€¢ Antibodies directed against cell surface receptors impair or dysregulate function without causing cell injury or inflammation
  • 64.
  • 67. INTRODUCTION Immune complexes may be formed when ā€¢ Antigen combines with antibody in the circulation and deposits in vessel walls ā€¢ Complexes may be formed at sites where antigen hasbeen ā€œplantedā€ previously (called in situ immune complexes) Antigens that form immune complexes may be ā€¢ exogenous, such as a foreign protein that is injected or produced by an infectious microbe ā€¢ endogenous, if the individual produces antibody against self antigens (autoimmunity)
  • 68. Systemicimmune complex disorders (Acute) Pathogenesis ā€¢ Complement protein C3 plays an active role in Type III reaction ā€¢ Serum C3 levels can be used to monitor disease activity ā€¢ Protein antigen triggers an immune response that results in the formation of antibodies, typically about a week after the injection of the protein. ā€¢ These antibodies are secreted into the blood, where they react with the antigen still present in the circulation and form antigen-antibody complexes ā€¢ The circulating antigen- antibody complexes are deposited in various tissues ā€¢ Organs where blood is filtered at high pressure to form other fluids, like urine and synovial fluid, are sites where immune complexes become concentrated and tend to deposit; hence, immune complex disease often affects glomeruli and joints. ā€¢ Once immune complexes are deposited in the tissues, they initiate an acute inflammatory reaction ā€¢ During this phase (approximately 10 days after antigen administration), clinical features such as fever, urticaria, joint pains (arthralgias), lymph node enlargement, and proteinuria appear ā€¢ Resultant inflammatory lesion is termed vasculitis if it occurs in blood vessels, glomerulonephritis ā€¢ if it occurs in renal glomeruli, arthritis if it occurs in the joints
  • 69. Acute vasculitis ā€¢ Necrosis of the vessel wall and intense neutrophilic infiltration ā€¢ The necrotic tissue and deposits of immune complexes, complement, and plasma protein appear as a smudgy eosinophilic area of tissue destruction, termed fibrinoid necrosis
  • 72. INTR ODUC TION ā€¢ The cell-mediated type of hypersensitivity is caused by inflammation resulting from cytokines produced by CD4 and CD8 T cells
  • 74. CD4+T Cellā€“Mediated Inflammation (Delayed type Hypersensitivity -DTH) ā€¢ DTH is a tissue reaction to in immune individuals ā€¢ In this reaction, an antigen administered into the skin of a previously immunized individual results in a detectable cutaneous reaction within 24 to 48 hours (hence the term delayed, in contrast to immediate hypersensitivity) ā€¢ Both TH1 and TH17 cells contribute to organ- specific diseases ā€¢ The inflammatory reaction associated with TH1 cells is dominated by activated macrophages, and that triggered by TH17 cells has a greater neutrophil component
  • 75. Stagesof CD4+TCellā€“MediatedInflammation APCs produce 1. IL6 ā€“ TH1 cells 2. IL1/6/23 ā€“ TH17 cells TH1 cells Secrete IFN-Ī³, augments the ability of macrophages to kill microorganisms TH17 cells secrete IL-17, IL-22 - recruit neutrophils and monocytes to the reaction
  • 77. Tuberculin reaction (Mantoux test) ā€¢ Used to check whether the individual has been previously exposed to tuberculous antigen ā€¢ Intracutaneous injection of purified protein derivative (PPD, also called tuberculin), is given ā€¢ In a previously sensitized individual, reddening and induration of the site appear in 8 to 12 hours, reach a peak in 24 to 72 hours, and thereafter slowly subside ā€¢ Morphologically, characterized by the accumulation of mononuclear cells, mainly CD4+ T cells and macrophages, around venules, producing perivascular