Disorders of Immunity and Inflammation

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Disorders of Immunity and Inflammation : 

Disorders of Immunity and Inflammation

Hypersensitivity : 

Hypersensitivity Exaggerated Immune Response

Hypersensitivity Types : 

Hypersensitivity Types Allergy Exogenous, non-human antigen Isoimmunity (alloimmunity) Exogenous, human antigen Autoimmunity Endogenous antigen

Hypersensitivity Mechanisms : 

Hypersensitivity Mechanisms Type I: IgE mediated Type II: Tissue specific Type III: Immune complex mediated Type IV: Cell mediated

Type I : 

Type I Immediate hypersensitivity IgE mediated Exogenous antigen Most (but not all) Allergies

Type I: Mechanism : 

Type I: Mechanism Repeated antigen exposure causes increased IgE production IgE binds to mast cells Sensitization occurs

Type I: Mechanism : 

Type I: Mechanism Antigen binds to IgE on mast cell membrane Mast cell releases histamine, chemotaxic factors Inflammatory response occurs

Type I: Signs/Symptoms : 

Type I: Signs/Symptoms Clinical signs, symptoms = response to histamine release GI, skin, respiratory system High mast cells numbers Most sensitive

Type I: Signs/Symptoms : 

Type I: Signs/Symptoms Histamine effects Vasodilatation Increased capillary permeability Non-vascular smooth muscle spasm

Type I: Signs/Symptoms : 

Type I: Signs/Symptoms Skin: flushing, itching, edema, urticaria, hives Respiratory: bronchospasm, laryngospasm, laryngeal edema Cardiovascular: tachycardia, hypotension GI: nausea, vomiting, cramping, diarrhea

Type I: Atopia : 

Type I: Atopia “Allergy prone” individuals Genetic predisposition More IgE More mast cell receptors for antibodies than normal

Type I: Anaphylaxis : 

Type I: Anaphylaxis Severe, generalized Type I reaction Life-threatening Loss of airway Ventilatory failure Hypoperfusion

Type II : 

Type II Tissue specific Reaction to tissue-specific antigens Causes target cell destruction, dysfunction Exogenous or endogenous antigen

Type II : 

Type II Most commonly affected cells Red blood cells Thyroid cells

Type II: Mechanisms : 

Type II: Mechanisms Antibody binds to cell membrane, triggers compliment-mediated lysis Examples Reaction to transfused blood Hemolytic disease of newborn

Type II: Mechanisms : 

Type II: Mechanisms Antibodies promote target cell clearance by macrophages

Type II: Mechanisms : 

Type II: Mechanisms Antibodies bind to target cells and cytotoxic T-cells Trigger release of toxins to destroy target cells

Type II: Mechanisms : 

Type II: Mechanisms Antibody binds to cell membrane, causes alterations in target cell function Example: Graves' disease Antibody binds to thyroid cell membrane Mimics Thyroid Stimulating Hormone action Causes production of excessive amounts of thyroid hormone Results in common form of hyperthyroidism

Type III : 

Type III Mediated by antigen/ antibody complex deposition in tissues Exogenous or endogenous antigen

Type III: Mechanism : 

Type III: Mechanism Ag-Ab complex deposited in tissues Especially sensitive tissues are blood vessels, GI, respiratory system Causes complement activation, increased neutrophil activity Neutrophils have trouble digesting complexes, release lysosomes causing damage

Type III : 

Type III Immune complex quantity varies over time Symptomatic periods alternate with periods of remission

Type III: Serum Sickness : 

Type III: Serum Sickness Repeated intravenous antigen injections Immune complexes deposited in tissues Fever, rash, pain, lymphadenopathy

Type III: Raynaud’s Phenomenon : 

Type III: Raynaud’s Phenomenon Temperature governs immune complex deposition in peripheral circulation Exposure to cold causes redness, pain of fingers, toes followed by numbness, cyanosis, gangrene

Type III: Arthus Reaction : 

Type III: Arthus Reaction Occurs after repeated LOCAL exposure to exogenous antigen Immune complexes in vessel walls Examples Celiac disease from wheat protein Hemorrhagic alveolitis from moldy hay inhalation

Type IV : 

Type IV Delayed Mediated by Td (lymphokine-producing) or Tc (cytotoxic) cells No antibody involved

Type IV : 

Type IV Examples Graft rejection Contact allergic reactions (poison ivy)

Hypersensitivity Targets : 

Hypersensitivity Targets Allergins Pollen (hay fever) Drug reactions Foods

Hypersensitivity Targets : 

Hypersensitivity Targets Neoantigens Hapten binds to protein molecule Changes its antigenicity Causes it to become an allergen

Hypersensitivity Targets : 

Hypersensitivity Targets Autoantigens Sequestered cells (cornea, testes) Foreign antigen triggered (infection) Suppressor T-cell malfunction Genetic causes

Hypersensitivity Targets : 

Hypersensitivity Targets Isoantigens Tissue grafts, transplants Rh negative sensitivity

Autoimmune Disease : 

Autoimmune Disease Clinical disorder produced by immune response to normal tissue component of patient’s body

Graves’ Disease : 

Graves’ Disease Antibody stimulates thyroid hormone over production Produces hyperthyroidism Antibody, disease can be passed through placenta

Rheumatoid Arthritis : 

Rheumatoid Arthritis Antibody reaction to collagen in joints Causes inflammation, destruction of joints

Myasthenia Gravis : 

Myasthenia Gravis Antibodies destroy acetylcholine receptors on skeletal muscle Produce episodes of severe weakness Antibodies can cross placenta, affect newborn

Immune Thrombocytopenic Purpura : 

Immune Thrombocytopenic Purpura Antibodies destroy platelets Produces clotting disorders, hemorrhaging Antibodies can cross placenta, affect newborn

Isoimmune Neutropenia : 

Isoimmune Neutropenia Antibodies attack, destroy neutrophils Can cross placenta, affect newborn

Other Autoimmune Diseases : 

Other Autoimmune Diseases Type I diabetes mellitus Primary myxedema Rheumatic fever Crohn’s disease Ulcerative colitis Systemic Lupus Erythematosis (SLE)

SLE : 

SLE Chronic, multi-system auto-immune disease Highest incidence Women, 20-40 years of age Black, Hispanic women Mortality after diagnosis averages 5% per year

SLE : 

SLE Antibody against nucleic acid components (ANA, anti-nuclear antibody) Immune complex precipitates in tissues, causes widespread destruction Especially affected are renal system, blood vessels, heart

SLE : 

SLE Signs/Symptoms Facial rash/skin rash triggered by sunlight exposure Oral/nasopharyngeal ulcers Fever Arthritis

SLE : 

SLE Signs/Symptoms Serositis (pleurisy, pericarditis) Renal injury/failure CNS involvement with seizures/psychosis Peripheral vasculitis/gangrene Hemolytic anemia

SLE : 

SLE Chronic management Anti-inflammatory drugs Aspirin Ibuprofen Corticosteroids Avoidance of emotional stress, physical fatigue, excessive sun exposure

Disorders of Immunity : 

Disorders of Immunity Immunodeficiency Diseases

Immunodeficiency Disease : 

Immunodeficiency Disease Patient unable to fight off infection Hallmarks Repeated infections Opportunistic infections

Immunodeficiency Disease : 

Immunodeficiency Disease Most are defects in T cells or B cells T cells, macrophage defects = fungal, viral infections B cells, complement defects = bacterial infections

Immunodeficiency Disease : 

Immunodeficiency Disease Congenital Acquired

Congenital : 

Congenital B-cell Deficiency IgA Deficiency DiGeorge’s Syndrome Severe Combined Immunodeficiency

B Cell Deficiency : 

B Cell Deficiency Agammaglobulinemia Hypogammaglobulinemia

IgA Deficiency : 

IgA Deficiency Most common immune deficiency disorder Genetic condition Failure of IgA synthesis Patient has repeated, recurrent sinus, lung, GI infections

DiGeorge’s Syndrome : 

DiGeorge’s Syndrome Thymic hypoplasia Severe decrease in T-cell production, function Defects of face, ears, heart

Severe Combined Immunodeficiency : 

Severe Combined Immunodeficiency Thymus development arrested at ~6-8 weeks gestation. Deficiency, defective maturation of stem cells that produce B and T cells Little to no antibody production


SCID Two types Autosomal recessive X-linked disease recessive


SCID Recurrent, frequently overwhelming infections Particularly respiratory, gastrointestinal Most die in first few years of life, usually by one year of age Death usually due to opportunistic infection

Acquired : 

Acquired Nutritional deficiency Iatrogenic (drugs, radiation) Trauma (prolonged hypoperfusion) Stress Infection (HIV)

Immune Deficiency Therapies : 

Immune Deficiency Therapies B-cell deficiency: Gamma globulin SCID: Bone marrow transplants, enzyme replacement DiGeorge’s Syndrome: Fetal thymus transplants Gene therapy

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