02.17.09(a): Types I - IV Immunopathology

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02.17.09(a): Types I - IV Immunopathology

  1. 1. Attribution: University of Michigan Medical School, Department of Microbiology andImmunologyLicense: Unless otherwise noted, this material is made available under the terms ofthe Creative Commons Attribution–Noncommercial–Share Alike 3.0 License:http://creativecommons.org/licenses/by-nc-sa/3.0/We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability touse, share, and adapt it. The citation key on the following slide provides information about how you may share and adaptthis material.Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions,corrections, or clarification regarding the use of content.For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use.Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or areplacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to yourphysician if you have questions about your medical condition.Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.
  2. 2. Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicyUse + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (USC 17 § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation LicenseMake Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (USC 17 § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (USC 17 § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. Classification of Immune Mediated Tissue Injury: Gell Coombs Classification Mechanisms of Immune-Mediated Disorders (4- types) J. Fantone: Host Defense 2/17/09 10:00-12:00amWinter 2009
  4. 4. The four types of hypersensitivity reaction type l type ll allergen cell surface antigen lgG target K cell lgE cytotoxic action Fc receptor antibody complement target mast cell degranulation complement cell mediator release mediated lysis type lll type lV immune-complex deposition antigens complement T inflammatory lymphokines mediators tissue blood basement membrane activated macrophage vessel Source Undetermined
  5. 5. Type I Anaphylactic Type•  Prototype •  Immune Disorders Mechanisms –  Allergic rhinnitis –  IgE-Mast cells –  Allergic asthma –  Vascular –  Anaphylaxis permeability (insect venom) –  Eosinophils
  6. 6. Type II, Cytotoxic Type•  Prototype Disorders •  Immune –  Hemolytic reactions Mechanisms –  Goodpastures –  IgG Syndrome –  Complement –  Myasthenia Gravis –  Phagocytic cells –  Grave s Disease –  ADCC (hyperthyroidism)
  7. 7. Type III, Immune Complex Disease•  Prototype Disorders •  Immune Mechanisms –  Post-streptococcal –  Ab-Ag reactions glomerulonephritis –  Complement –  Vasculitis –  Neutrophils •  Polyarteritis nodosa –  Fibrin, hemorrhage
  8. 8. Type IV, Cell-Mediated (Delayed) Hypersensitivity•  Prototype Disorders •  Immune –  Poison Ivy Mechanisms –  Tuberculosis –  T-lymphocytes (granulomatous –  Monocyte/macro- inflammation) phage –  Cytotoxic T-cell •  Dr. King s lectures
  9. 9. Antibody-Mediated Cell and TissueInjury: IgE Mediated Hypersensitivity Reactions Objectives:To understand the pathophysiologicmechanisms associated with Type Ianaphylactic hypersensitivityreactions
  10. 10. Objectives (cont.)•  The role of IgE-mediated Mast cell degranulation in Type I reactions•  The primary effector mediators released during Mast cell stimulation•  The pathologic changes observed in tissues associated with anaphylactic hypersensitivity reactions•  The modulatory role of eosinophils in these reactions•  To correlate the effect of mediators on target organs with the clinical expression of anaphylactic reactions
  11. 11. Clinical•  Type I reactions are usually the result of exposure to environmental allergens in genetically susceptible individuals•  1/10 persons in USA affected to varying degrees•  Genetics not clearly defined, although there is a familial association•  Atopy: a genetic predisposition for developing IgE responses to many antigens•  Local or systemic symptoms
  12. 12. Clinical (cont.)•  Most common form - allergic rhinnitis –  Also •  Certain types of asthma •  Atopic dermatitis (eczema) •  Certain gastrointestinal food allergies•  Allergens –  Pollens, molds, house dust mite, animal dander
  13. 13. Source Undetermined
  14. 14. Pathophysiology Induction and effector mechanisms in Type l Hypersensitivity antigen pharmacological effects blood vessels processing airways etc. APC and presentation cell infiltration (see Fig. 19.22) lgE Ca2+ l preformed and newly formed clinical effects asthma mediators TH Be eczema IL-4 hay fever lL-3, lL-4 cytokines (see Fig. 19.23) lL-4, lL-5, lL-6 GM-CSF, TNFa feedback effects IFNy lL-8/9, inflammatory on the immune cell activation system (see FSig. 19.23) mast cellantigen presentation lgE production mediator release clinical effects activation Source Undetermined
  15. 15. Sensitization to Ag B-cell proliferation with production of IgE (IL-4 driven process) IgE binds to surface of mast cell or basophil Second Ag challenge Multivalent Ag binds IgE on mast cells: crosslinking IgEDegranulation and release De novo synthesis of preformed mediators of mediators
  16. 16. Degranulation and release De novo synthesis of preformed mediators of mediators Histamine Leukotrienes (C4, D4, E4) Chemotactic factors Prostaglandins Proteases Platelet activating factor Cytokines Smooth muscle: bronchial, GI,vascular Vascular endothelium Secretory glands (e.g. mucous) Eosinophils
  17. 17. Resting mast cell Activated mast cellFce receptor lgE antibody Resting mast cell shows Multivalent antigen crosslinks granules containing serotonin bound lgE antibody causing release and histamine of granule contents
  18. 18. Effects of Mediators in Anaphylaxis: Reversible Response•  Histamine - vascular permeability, vasodilation (post-capillary venule), smooth muscle contraction•  Chemotactic Factors•  Cytokines•  Lipid mediators
  19. 19. Effects of Mediators in Anaphylaxis: Reversible Response (cont.)•  Lipid Mediators: Arachidonic acid metabolites –  Leukotriene C4, D4, E4 - smooth muscle contraction –  Prostaglandins - vasodilation
  20. 20. Effects of Mediators in Anaphylaxis: Reversible Response (cont.)•  Lipid Mediators: PAF - platelet activating factor - low molecular weight lipid –  Acetylated glycerol ether phosphocholine (AGEPC) –  Activates phagocytic cells –  Smooth muscle contraction
  21. 21. Role of Eosinophils in Anaphylaxis:•  Normal levels 2 to 3% circulating leukocytes•  Type 1 response: up to 10%+ circulating leukocytes•  Secretory products include: –  NADPH oxidase-derived oxidants –  Prostaglandins and Leukotrienes (LTC4) –  Major basic protein (MBP): cytotoxic –  Cytokines –  others
  22. 22. J. Fantone
  23. 23. Pathologic Changes Associated with Anaphylactic Reactions: Reversible•  Symptoms depend on target organ: skin –  Gross: swelling, wheal and flare response •  early response: preformed mediators •  late response: synthesized mediators –  Light microscopic: edema, eosinophils –  Electron microscopic: edema, endothelial cell gaps
  24. 24. Source Undetermined
  25. 25. Pathologic Changes Associated with Anaphylactic Reactions: Reversible•  Mucous and serous glands –  Increased secretion•  Bronchial and GI smooth muscle –  Contraction
  26. 26. Therapeutic Approaches•  Avoid antigen•  Mediator antagonists –  anti-histamines: receptor antagonist –  leukotriene inhibitors: lipase inhibitors, receptor antagonists –  functional: sympathetic stimulants•  Inhibit mast cell degranulation –  cromolyn•  Non-specific anti-inflammatory agents –  corticosteroids•  Immunotherapy ( allergy shots )
  27. 27. Comparison of Skin TestsHypersensitivity Type Time Features Type 1 Wheal: edema Minutes Flare: vasodilation Eosinophils
  28. 28. Diagnosis•  Skin test - most frequently used Source Undetermined
  29. 29. Serologic Tests: RAST - Radioallergosorbent Test - Specific IgE + Patient s serum Anti-human (Ab)Bead with Ag IgE J. Fantone
  30. 30. RIST - Radioimmunosorbent Test - Total IgE + Patient s serum (Ab)Bead + Anti human IgE Anti-human IgE J. Fantone
  31. 31. Summary: Type I Reaction•  Antibody: IgE•  Effector Cells: Mast Cell & Eosinophil•  Complement: No•  Reaction: Minutes
  32. 32. Antibody-Mediated Cell and Tissue Injury (Type II and Type III Reactions)
  33. 33. The four types of hypersensitivity reaction type l type ll allergen cell surface antigen lgG target K cell lgE cytotoxic action Fc receptor antibody complement target mast cell degranulation complement cell mediator release mediated lysis type lll type lV immune-complex deposition antigens complement T inflammatory lymphokines mediators tissue blood basement membrane activated macrophage vessel Source Undetermined
  34. 34. Pathophysiology•  Cytotoxic or Type II Reactions: Binding of Antibody (IgG or IgM) with cell membrane or tissue antigens –  Red blood cell membrane antigens - hemolytic anemias –  Platelet antigens - thrombocytopenia cell membrane - petechial hemorrhage –  Basement Membrane - Goodpasture s syndrome •  Kidney - proteinuria •  Lung - hemorrhage
  35. 35. Mechanisms•  Opsonin dependent phagocytosis•  Complement-dependent Ab lysis•  Antibody-dependent cell cytotoxicity
  36. 36. J. Fantone
  37. 37. Rh Incompatibility in Newborn: Hemolytic Anemia Sensitized during birth of Rh+ First child Pregnant woman Rh- 2nd pregnancy forms circulating Rh+ child lgG antibody (Anti-D) IgG crosses placenta RBC hemolysis Preventative Therapy: Block sensitization by giving mother anti-D (Rho) Immunoglobulin within 72J. Fantone hours after first birth or abortion
  38. 38. Mechanisms (cont.)•  Antibody directed to tissue antigens: examples –  Goodpasture s syndrome: antigen = basement membrane of kidney and lung –  Dermatitis Herpetiformis: antigen = epidermis basement membrane reticulin –  Bullous Pemphigoid: antigen = epidermis basement membrane –  Pemphigus vulgaris: antigen = epidermis keratinocyte membranes
  39. 39. Goodpasture s Syndrome•  Hemoptysis•  Pulmonary infiltrates•  Renal failure•  Anemia
  40. 40. Pathology•  Circulating anit-GBM antibodies•  Lightmicroscopy: frequently neutrophils, hemorrhage•  Immunofluorescence: immunoglobulin and complement deposition; linear immunoflourescence•  Electron microsocpy: no electron dense deposits
  41. 41. Goodpastures Syndrome: Anti-GBM Disease + ComplementC3b deposition C3a + C5a Proteases  + PMN recruitment reactive oxygen metabolites  tissue injuryJ. Fantone lung: hemorrhage, hemoptysis, alveolar infiltrates kidney: proteinuria, hematuria, renal failure
  42. 42. Goodpastures Syndrome: Anti-GBM Disease + complement C3a,C5a PMNsJ. Fantone proteasesLung: hemorrhage, hemoptysis, oxygen metabolites alveolar infiltratesKidney: proteinuria, hematuria, tissue injury renal failure
  43. 43. J. Fantone
  44. 44. glomerulus J. Fantone
  45. 45. Source Undetermined
  46. 46. Source Undetermined
  47. 47. Goodpastures Syndrome J. Fantone•  Linear antigen distribution•  Linear antibody + complement distribution•  Linear secondary anti-human antibody to IgG or complement containing a fluorescent marker
  48. 48. Source Undetermined
  49. 49. Mechanisms (cont.)•  Antibody Binds to Cell Receptor (Type V Reactions) –  Hyperthyroidism (Grave s Disease): Thyroid follicle cell - IgG antibody binds to thyroid stimulating hormone (TSH) receptor and stimulates cell –  Myasthenia Gravis: antibody to acetylcholine receptor at neuromuscular synapse antibody blocks neuromuscular transmission (decreased receptors) causing muscle weakness
  50. 50. Antibody to Cell ReceptorsJ. Fantone
  51. 51. J. Fantone
  52. 52. The four types of hypersensitivity reaction type l type ll allergen cell surface antigen lgG target K cell lgE cytotoxic action Fc receptor antibody complement target mast cell degranulation complement cell mediator release mediated lysis type lll type lV immune-complex deposition antigens complement T inflammatory lymphokines mediators tissue blood basement membrane activated macrophage vessel Source Undetermined
  53. 53. Type III: Immune Complex Mediated Tissue Injury antibody antigen Ag-Ab complexComplement Monocyte/macrophage activation activation Cytokines C5a (e.g. TNF, chemokines) Neutrophil influx J. Fantone
  54. 54. Summary: Immune Complex Mediated Tissue Injury Neutrophil influx Phagocytosis of immune complexesOxygen metabolites Lysosomal enzymes O2-, H2O2 etc. Proteases etc. Tissue injury J. Fantone
  55. 55. Pathology of Immune Complex Injury•  Fibrinoid necrosis•  Hemorrhage•  Neutrophils•  Antibody + Complement deposition•  EM: Electron dense depositis•  Granular immunofluorescence
  56. 56. Type III Hypersensitivity: Local I.C. Disease The Arthus reaction complement antigen immune mast cell complex degranulation neutrophil neutrophil chemotaxis antibody lysosomal enzymes endothelial cell retraction platelet aggregation vasoactive antibody amines Source Undetermined
  57. 57. Immune Complex-MediatedHypersensitivity (Type III) (cont.)•  Systemic immune complex disease Foreign Ag injected I.V.  Immune response w/Ab production (IgM, IgG)  Circulating immune complexes formed  Tissue deposition w/complement fixation  Arteritis Glomerulonephritis (w/proteinuria)
  58. 58. Source Undetermined
  59. 59. Immune Complex-MediatedHypersensitivity (Type III) (cont.)•  Pathology –  Light microscopy: neutrophils, hemorrhage, edema –  Electron microscopy: electron dense deposits –  Immunofluorescence: immunoglobulin and complement deposition, granular immunoflouresence pattern
  60. 60. Immune Complex-MediatedHypersensitivity (Type III) (cont.)•  Clinical - depends on target organ and/or site of immune complex deposition –  Synovium - rheumatoid arthritis –  Kidney - glomerulus •  Post-streptococcal glomerulonephritis •  Systemic lupus erythematosus –  Blood vessel walls - vasculitis •  Polyarteritis nodosa •  Early transplant rejection –  Lung - hypersensitivity pneumonitis
  61. 61. J. Fantone
  62. 62. J. Fantone
  63. 63. J. Fantone
  64. 64. J. Fantone
  65. 65. Source Undetermined
  66. 66. Immune Complex Disease (post-streptococcal glomerulonephritis) •  Irregular antigen distribution •  Irregular antibody + complement distribution •  Irregular secondary anti-human antibody to IgG or complement containing a fluorescent markerJ. Fantone
  67. 67. Immune Complex-MediatedHypersensitivity (Type III) (cont.)•  Diagnosis –  Skin tests for Type III reactions•  Therapy –  Elimination of antigen - as in transfusion reactions, hypersensitivity lung reactions to foreign antigens, and certain drug reactions –  Corticosteroid and immunosuppressive therapy (cytoxan, cylosporin) –  Plasmapheresis
  68. 68. Summary: Type II/III Reaction•  Antibody: IgM & IgG•  Effector Cells: Phagocytic•  Complement: Yes•  Reaction: 6-24 hours
  69. 69. The four types of hypersensitivity reaction type l type ll allergen cell surface antigen lgG target K cell lgE cytotoxic action Fc receptor antibody complement target mast cell degranulation complement cell mediator release mediated lysis type lll type lV immune-complex deposition antigens complement T inflammatory lymphokines mediators tissue blood basement membrane activated macrophage vessel Source Undetermined
  70. 70. Type IV: Cell-Mediated Immune Reactions•  Objective –  To define the primary mechanisms involved in contact hypersensitivity and delayed type hypersensitivity reactions –  To review mechanisms of T-Cell mediated cytotoxicity (see Dr. King)•  Cell Components –  Mononuclear inflammatory cells: lymphocytes, monocytes/macrophages and antigen presenting cells
  71. 71. Source Undetermined
  72. 72. Source Undetermined
  73. 73. Source Undetermined
  74. 74. Source Undetermined
  75. 75. Source Undetermined
  76. 76. Source Undetermined
  77. 77. J. Fantone
  78. 78. J. Fantone
  79. 79. J. Fantone
  80. 80. Granulomatous Inflammatory Reactions J. Fantone
  81. 81. J. Fantone
  82. 82. Summary: Type IV Reaction•  Antibody: No•  Effector Cells: T-lymphocytes, Monocyte/Macrophage•  Complement: No•  Reaction: 48-72 hours (skin test)
  83. 83. Type IV: T-Cell Mediated Cytotoxicity (see Dr. King s presentation)•  Mechanisms –  CD8+ lymphocyte –  Antigen expressed with Class I MHC –  Interleukin-2 clonal expansion –  Cytotoxic effector cell •  Recognizes Ag+ class I MHC
  84. 84. T-Cell Mediated Cytotoxicity (cont.)•  Initiates programmed cell death (apoptosis) •  Perforins/cytolysins •  Proteolytic enzymes: granzymes •  FAS-induced apoptosis: CD8+ T cell: FAS ligand target cell:FAS receptor •  Cytokines –  Interferon γ –  Tumor Necrosis Factor α and β
  85. 85. The four types of hypersensitivity reaction type l type ll allergen cell surface antigen lgG target K cell lgE cytotoxic action Fc receptor antibody complement target mast cell degranulation complement cell mediator release mediated lysis type lll type lV immune-complex deposition antigens complement T inflammatory lymphokines mediators tissue blood basement membrane activated macrophage vessel Source Undetermined
  86. 86. Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicySlide 4: Source Undetermined Slide 62: J. FantoneSlide 13: Source Undetermined Slide 63: J. FantoneSlide 14: Source Undetermined Slide 64: J. FantoneSlide 17: J. Fantone Slide 65: Source UndeterminedSlide 22: J. Fantone Slide 66: J. FantoneSlide 24: Source Undetermined Slide 69: Source UndeterminedSlide 28: Source undetermined Slide 71: Source UndeterminedSlide 29: J. Fantone Slide 72: Source UndeterminedSlide 30: J. Fantone Slide 73: Source UndeterminedSlide 33: Source Undetermined Slide 74: Source UndeterminedSlide 36: J. Fantone Slide 75: Source UndeterminedSlide 37: J. Fantone Slide 76: Source UndeterminedSlide 41: J. Fantone Slide 77: J. FantoneSlide 42: J. Fantone Slide 78: J. FantoneSlide 43: J. Fantone Slide 79: J. FantoneSlide 44: J: Fantone Slide 80; J. FantoneSlide 45: Source Undetermined Slide 81: J. FantoneSlide 46: Source Undetermined Slide 85: J. FantoneSlide 47: J. FantoneSlide 48: Source UndeterminedSlide 50: J. FantoneSlide 51: J. FantoneSlide 52: Source UndeterminedSlide 53: J. FantoneSlide 54: J. FantoneSlide 56: Source UndeterminedSlide 58: Source UndeterminedSlide 61: J. Fantone

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