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1 Être ou ne pas être... The Immune system dilema Sam Khalil, PhD
The immune system
Innate and Acquired Immunity
Vasodilatation Inflammation – Innate immunity 1 Actual Inflammatory response 2 Inflammatory mediators 2 1 3 3 Vascular permeability and dilation 4 4 Neutrophil and macrophage chemotaxis 5 6 5 Antigen  Removed Phagocytosis 6 Proinflammatory cytokine release
Communication via cytokines
Inflammatory disease / Autoimmunity The Immune Response ,[object Object],	Cells recognize the presence of foreign antigen ,[object Object],	Immune cells expand to mount an attack ,[object Object],	Immune cells perform functions to eliminate antigen ,[object Object],	Numbers of immune cells diminish following destruction of the antigen
Chronic inflammation Actual Inflammatory response Inflammatory mediators Chronic Inflammation Vascular permeability and dilation Innate Immunity Adaptive Immunity Macrophages  +  Lymphocytes recruited Neutrophil and macrophage chemotaxis Phagocytosis Proinflammatory cytokine release Antigen  Remains
The adaptive immune system http://www.biolegend.com/pop_pathway.php?id=88
The adaptive immune system http://www.biolegend.com/pop_pathway.php?id=88
Innate Immunity  Key step to antigen recognition Adaptive Immunity RECOGNIZE ONLY FOREIGN  ANTIGENS
Antigen Presenting Cell
Antigenic peptide Front view Top view Side view MHC class II molecules
MHC class II molecules Not any peptide will fit in the groove but multiple possibilities per molecule (20-24 aa) Some peptide will have a better “fit” in one isotype vs the other
MHC peptide T-Lymphocytes TCR
T-cell receptor 5x1015 combinations How to select only the ones that do not react with self antigens?
Thymus 5x1015 combinations 2x107 combinations
Autoimmunity
Rheumatoid arthritis
Genetic Onset of Autoimmunity Environmental Inflammation & Bone Erosion CCP RA Timeline Birth Pre-clinical Clinical Symptoms Adult Life
Genetic Genetic Factors in RA Genetic Factors have a substantial impact on susceptibility to RA McGregor et al. Arthritis Rheum, 43:30-37 Birth
Genetic Genetic Factors in RA Strongest Associations: HLA-DRw4 alleles Birth
Genetic Antigenic Peptide Genetic Factors in RA HLA-DRw4 alleles Shared Epitope (SE) Birth Imboden J. Annu. Rev. Pathol. Mech. Dis. 2009. 4:417-434
Genetic Onset of Autoimmunity Environmental Inflammation & Bone Erosion CCP RA Timeline Birth Pre-clinical Clinical Symptoms Adult Life
BREAKTHROUGH IN RA Autoimmunity to citrullinated protein antigens has specificity for RA and identifies a clinically and genetically distinct form of RA Environmental 70% of RA patients are anti-CCP+ Environmental Factors in RA Adult Life
Environmental Environmental Factors in RA Process exist constitutively and occurs in healthy individuals. Citrullinated proteins are found in sites of inflammation including joints but are not specific to RA Adult Life However the loss of tolerance is the event specific for RA
Environmental Environmental Factors in RA Adult Life
Production of anti-CCP antibodies Genetic Environmental Citrullinated Peptide Combination of Genetic & Environmental factors HLA-DRw4 alleles Shared Epitope (SE) Birth Adult Life 27 27
Combination of Genetic & Environmental factors Annu. Rev. Immunol. 2008. 26:651–75
Genetic Onset of Autoimmunity Environmental Inflammation & Bone Erosion Observed up to 10 years before onset of disease* CCP RA Timeline + = Therefore  Joint inflammation is not a requirement for the development of anti-CCP antibodies Birth Pre-clinical Clinical Symptoms Adult Life * Klareskog et al. Ann Rheum Dis 2004; 63(Suppl II): ii28-ii33
Pathologic inflammatory response ? Annu. Rev. Immunol. 2008. 26:651–75
Chronic rheumatoid arthritis Annu. Rev. Immunol. 2008. 26:651–75
Chronic inflammation Actual Inflammatory response Inflammatory mediators Chronic Inflammation Vascular permeability and dilation Innate Immunity Adaptive Immunity Macrophages  +  Lymphocytes recruited Neutrophil and macrophage chemotaxis Phagocytosis Proinflammatory cytokine release Antigen  Remains
Pathogenesis of RA J. Clin. Invest. 118:3537–3545 (2008). doi:10.1172/JCI36389
Current Biologic agents in RA Infliximab Adalimumab Golimumab CertolizumabPegol Etanercept Ustekinumab Tocilizumab Abatacept Rituximab Infliximab Adalimumab Rituximab Adapted from Chan et al. Nature Reviews Immunology, May 2010; v10; p301-316
Current Biologic agents in RA - - - - Abatacept Rituximab Tocilizumab Anti-TNF Anakinra - - Nature Reviews Rheumatology 5, 531-541 (October 2009)
Genetic Susceptibility (HLA-DRw4) Inflammation Cytokines Pathways Citrullination of antigens in the joints Bone Erosion Environment (e.g Smoking) Immune Complexes Activation of the complement Summary Anti-CCP antibodies Insult in the joints
Genetic Susceptibility (HLA-DRw4) Inflammation Cytokines Pathways Citrullination of antigens in the joints Bone Erosion Environment (e.g Smoking) Immune Complexes Activation of the complement Summary Anti-CCP antibodies Insult in the joints ?
38 QUESTIONS ? http://www.samkhalil.ca

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Autoimmunity - Basic Immunology

  • 1. 1 Être ou ne pas être... The Immune system dilema Sam Khalil, PhD
  • 4. Vasodilatation Inflammation – Innate immunity 1 Actual Inflammatory response 2 Inflammatory mediators 2 1 3 3 Vascular permeability and dilation 4 4 Neutrophil and macrophage chemotaxis 5 6 5 Antigen Removed Phagocytosis 6 Proinflammatory cytokine release
  • 6.
  • 7. Chronic inflammation Actual Inflammatory response Inflammatory mediators Chronic Inflammation Vascular permeability and dilation Innate Immunity Adaptive Immunity Macrophages + Lymphocytes recruited Neutrophil and macrophage chemotaxis Phagocytosis Proinflammatory cytokine release Antigen Remains
  • 8. The adaptive immune system http://www.biolegend.com/pop_pathway.php?id=88
  • 9. The adaptive immune system http://www.biolegend.com/pop_pathway.php?id=88
  • 10. Innate Immunity Key step to antigen recognition Adaptive Immunity RECOGNIZE ONLY FOREIGN ANTIGENS
  • 12. Antigenic peptide Front view Top view Side view MHC class II molecules
  • 13. MHC class II molecules Not any peptide will fit in the groove but multiple possibilities per molecule (20-24 aa) Some peptide will have a better “fit” in one isotype vs the other
  • 15. T-cell receptor 5x1015 combinations How to select only the ones that do not react with self antigens?
  • 16. Thymus 5x1015 combinations 2x107 combinations
  • 19. Genetic Onset of Autoimmunity Environmental Inflammation & Bone Erosion CCP RA Timeline Birth Pre-clinical Clinical Symptoms Adult Life
  • 20. Genetic Genetic Factors in RA Genetic Factors have a substantial impact on susceptibility to RA McGregor et al. Arthritis Rheum, 43:30-37 Birth
  • 21. Genetic Genetic Factors in RA Strongest Associations: HLA-DRw4 alleles Birth
  • 22. Genetic Antigenic Peptide Genetic Factors in RA HLA-DRw4 alleles Shared Epitope (SE) Birth Imboden J. Annu. Rev. Pathol. Mech. Dis. 2009. 4:417-434
  • 23. Genetic Onset of Autoimmunity Environmental Inflammation & Bone Erosion CCP RA Timeline Birth Pre-clinical Clinical Symptoms Adult Life
  • 24. BREAKTHROUGH IN RA Autoimmunity to citrullinated protein antigens has specificity for RA and identifies a clinically and genetically distinct form of RA Environmental 70% of RA patients are anti-CCP+ Environmental Factors in RA Adult Life
  • 25. Environmental Environmental Factors in RA Process exist constitutively and occurs in healthy individuals. Citrullinated proteins are found in sites of inflammation including joints but are not specific to RA Adult Life However the loss of tolerance is the event specific for RA
  • 27. Production of anti-CCP antibodies Genetic Environmental Citrullinated Peptide Combination of Genetic & Environmental factors HLA-DRw4 alleles Shared Epitope (SE) Birth Adult Life 27 27
  • 28. Combination of Genetic & Environmental factors Annu. Rev. Immunol. 2008. 26:651–75
  • 29. Genetic Onset of Autoimmunity Environmental Inflammation & Bone Erosion Observed up to 10 years before onset of disease* CCP RA Timeline + = Therefore Joint inflammation is not a requirement for the development of anti-CCP antibodies Birth Pre-clinical Clinical Symptoms Adult Life * Klareskog et al. Ann Rheum Dis 2004; 63(Suppl II): ii28-ii33
  • 30. Pathologic inflammatory response ? Annu. Rev. Immunol. 2008. 26:651–75
  • 31. Chronic rheumatoid arthritis Annu. Rev. Immunol. 2008. 26:651–75
  • 32. Chronic inflammation Actual Inflammatory response Inflammatory mediators Chronic Inflammation Vascular permeability and dilation Innate Immunity Adaptive Immunity Macrophages + Lymphocytes recruited Neutrophil and macrophage chemotaxis Phagocytosis Proinflammatory cytokine release Antigen Remains
  • 33. Pathogenesis of RA J. Clin. Invest. 118:3537–3545 (2008). doi:10.1172/JCI36389
  • 34. Current Biologic agents in RA Infliximab Adalimumab Golimumab CertolizumabPegol Etanercept Ustekinumab Tocilizumab Abatacept Rituximab Infliximab Adalimumab Rituximab Adapted from Chan et al. Nature Reviews Immunology, May 2010; v10; p301-316
  • 35. Current Biologic agents in RA - - - - Abatacept Rituximab Tocilizumab Anti-TNF Anakinra - - Nature Reviews Rheumatology 5, 531-541 (October 2009)
  • 36. Genetic Susceptibility (HLA-DRw4) Inflammation Cytokines Pathways Citrullination of antigens in the joints Bone Erosion Environment (e.g Smoking) Immune Complexes Activation of the complement Summary Anti-CCP antibodies Insult in the joints
  • 37. Genetic Susceptibility (HLA-DRw4) Inflammation Cytokines Pathways Citrullination of antigens in the joints Bone Erosion Environment (e.g Smoking) Immune Complexes Activation of the complement Summary Anti-CCP antibodies Insult in the joints ?
  • 38. 38 QUESTIONS ? http://www.samkhalil.ca