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March 6th, 2006 Ricky Chang Know the mechanism of Type I hypersensitivity Know the mediators of Type I hypersensitivity Know the diseases associated with Type II hypersensitivity
Hypersensitivity
Adaptive immunity is important against microbial infections, but it is also capable of causing tissue injury and disease (autoimmune diseases) Occurs when immune responses are directed against self-ag and also from uncontrolled or selfexcessive responses to against foreign ag, ag, such as microbes and allergens
Hypersensitivity
Common cause is failure of self-tolerance, self- tolerance, which ensures that individuals do not respond to their own antigens Leads to tissue injury that occurs in autoimmune diseases due to the same effector mechanisms used to protect against microbes
Hypersensitivity
Type I: IgE antibodies bind to Fc receptors on mast cells. IgE induces mast cell degranulation and release inflammatory mediators Type II: Ab mediated immune response against self antigen or foreign antigen (ie ag on transfused RBC) Type III: Immune complexes are deposited in tissue Type IV: T-cell mediated response where Ag sensitized T-cells release lymphokines
Hypersensitivity
Hypersensitivity
Type I (Immediate)
1) 2) Ag/allergen stimulate CD4+ Th2 Th2 releases IL-4, which promote B-cells specific for that Ag to differentiate into IgE producing cells Circulating IgE binds to Fc receptors on mast cells and basophils Elicits a transduction event to release mediators stored in granules (Degranulation) Immediate hypersensitivity response (5-10 minutes)
3)
Mast Cell
4)
Basophil
5)
Activation of Mast-cells
Cross-linking
Mast-Cell Mediators
Inflammatory Mediators released
-Histamine -Proteases (tryptase or chymase), acid hydrolases -Proteoglycans (heparin, chondroitin sulfate)
Mast-Cells: Cytokines
IL-3: Promote mast cell proliferation IL-4, IL-5: Promote Th2 differentiation and IgE AB production TNF-, MIP-1 : Enhance inflammatory reaction
Atopy
Atopy: Describes individuals that produce IgE AB in response to various environmental Ag and develop immediate hypersensitivity (Type I) responses.(Asthma, eczema, hay fever, and urticaria) These individuals normally have a strong family history (autosomal transmission of atopy)
Atopy
HLA vs. Allergen Responsiveness -Some allergens response have a relationship to HLA -HLA-DR2 and HLA-A2: high responder to low dos of ragweed -HLA-B8: high responder to ragweed and also associated to other forms of hyperimmunity (autoimmunity)
IgE
IgE blood concentrations are often increased in allergic disease and are grossly elevated in parasitic infections IL-4: promote B-cells to differentiate into IgE-producing specific cells
Eosinophil
Th2 produce IL-5: Promotes the synthesis and secretion of IgA from Bcells and also important in stimulating eosinophil development and activation IL-4 and IL-5 production by Th2 cells may account for the eosinophilia seen in type I hypersensitivity and parasitemia
Degranulation
C products of C3a and C5a are very active in degranulating mast cells Compounds that affect Ca+2 influx into mast cells can induce degranulation Drugs such as morphine, codeine, synthetic ACTH can create clinical manifestations related to mast cells
2) Blocking mediator release, such as sodium cromolyn: mechanism not clear, but seem to antagonize IgE-induced mediator release.
Therapeutics
Direct Inhibitors -Theophyllines, Xanthines -Sodium cromolyn -Epinephrine -PGE1, PGE2 Indirect Inhibitor -Glucocorticoids
Histamine Receptors
H1 - Bronchial constriction - Musous secretion - Intestinal smooth muscle contraction - Itching and pain at sensory nerve endings H1 and H2 - Reduces BP - Increase permeability in skin H2 - Gastric secretion in stomach
Antihistamines
Nausea,vertigo,motion sickness H1 Antagonists
-Promethazine (Phenergan) -Cetirizine (Zyrtec) -Desloratadine (Clarinex) -Fexofenadine (Allegra) -Loratadine (Claritin)
Type II Hypersensitivity
Type II
Antibodies are directed against ag on particular cells/tissue or extracellular matrix, causing damage (ie RBC transfusion) These cell- or tissue-specific Ab cause diseases -Myasthenia Gravis: Ab blocks Ach-binding and cause muscle weakness and paralysis -Graves Disease: Ab stimulate TSH and casue hyperthyroidism)
Type II
Type II
Type II causes disease by 3 mechanism 1) Opsonization and phagocytosis of cells 2) Complement and Fc receptormediated inflammation and tissue injury 3) Interference of normal cellular function by binding to important molecules or receptors