1. AUTOIMMUNITY FE A. BARTOLOME, MD, FPASMAP Department of Microbiology Our Lady of Fatima University

9. Clonal deletion in thymus A A A Cell death B B B Antigen Two immature T cells (A and B) with different antigen receptors Binding of self antigen to T-cell A in thymus but not to T-cell B Death of self-reacting T-cell A; survival of T-cell B that reacts against foreign antigen

12. PERIPHERAL TOLERANCE APC Helper T cell Class II MHC Antigen TCR B7 protein CD28 protein CD4 protein APC Helper T cell Class II MHC Antigen TCR CD28 protein CD4 protein B7 protein on APC interacts with CD28 on helper T cells. Full activation of helper T cells occur. B7 protein on APC is not produced. CD28 on helper T cell does not give a co-stimulatory signal. Anergy occurs.

31. Microbial infections associated with autoimmune diseases Microbe Autoimmune disease BACTERIA Streptococcus pyogenes Campylobacter jejuni Escherichia coli Chlamydia trachomatis Shigella sp. Yersinia enterocolitica Borrelia burgdorferi Rheumatic fever Guillain-Barre syndrome Primary biliary cirrhosis Reiter’s syndrome Reiter’s syndrome Grave’s disease Lyme arthritis VIRUSES Hepatitis B virus Hepatitis C virus Measles virus Cytomegalovirus Multiple sclerosis Mixed cryoglobulinemia Allergic encephalitis Scleroderma

32. ORGAN-SPECIFIC AUTOIMMUNE DISEASES Type of Immune Response Autoimmune Disease Target of Immune Response Antibody to receptors Myasthenia gravis Grave’s disease Acetylcholine receptor TSH receptor Antibody to cell components other than receptors Pernicious anemia Goodpasture’s synd. IDDM Addison’s disease Male infertility Pemphigus Hashimoto’s Primary myxedema Intrinsic factor and parietal cells BM of kidney & lung Islet cell Adrenal cortex Sperm Desmoglein in tight junctions of skin Thyroglobulin Thyroid peroxidase

33. NON-ORGAN SPECIFIC AUTOIMMUNE DISEASES Type of Immune Response Autoimmune Disease Target of Immune Response Antibody to cell components other than receptors Rheumatoid arthritis SLE Sjogren’s syndrome (Sicca syndrome) Guillain-Barre synd. IgG in joints dsDNA, histones RNP antigens (SS-A/Ro and SS-B/La) Myelin protein