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Slide 1 - Autoimmune Diseases Immunology Unit Department of Pathology College of Medicine
Slide 2 - Reference Kuby Immunology 7th Edition 2013 Chapter 16 Pages 525-531
Slide 3 - Objectives To know that the inflammatory processes in auto immune diseases are mediated by hypersensitivity reactions (type II, III and IV) To know that autoimmune diseases can be either organ specific or may be generalized involving many organs or tissues To understand that the manifestations of autoimmune diseases depend upon the organ and the degree of damage inflicted on the target tissues
Slide 4 - Disease processes and tissue damage are due to Type II Type III and Type IV hypersensitivity reactions
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Slide 8 - Mediated by stimulating or blocking auto-antibodies Graves’ disease (Stimulating antibodies) Myasthenia gravis (Blocking Antibodies) Organ Specific Autoimmune Diseases
Slide 9 - 1. Graves’ Disease (Thyrotoxicosis) Production of thyroid hormones is regulated by thyroid-stimulating hormones (TSH) The binding of TSH to a receptor on thyroid cells stimulates the synthesis of two thyroid hormones: thyroxine and triiodothyronine
Slide 10 - A person with Graves’ Disease makes auto-antibodies to the receptor for TSH. Binding of these auto-antibodies to the receptor mimics the normal action of TSH leading to over-stimulation of the thyroid gland
Slide 11 - 2. Myasthenia Gravis Clinically characterised by weakness and fatigability on sustained effort Antibodies directed against acetylcholine receptor (AChR) IgG Ab interact with the postsynaptic AChR at the nicotinic neuromuscular junction (NMJ) There is reduction in the number of functional AChR receptors by increasing complement mediated degradation of receptors
Slide 12 - Myasthenia gravis Motor end-plates of muscles
Slide 13 - Systemic Autoimmune diseases Systemic lupus erythematosus (SLE) Systemic lupus erythematosus is the prototype of systemic autoimmune disorder The characteristic “butterfly rash” is made worse by exposure to sunlight Lupus is a potentially fatal autoimmune disease
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Slide 16 - Auto antibodies The anti-nuclear antibody (ANA) test is the best screening test for SLE and is determined by immunofluorescence The ANA is positive in significant titer (usually 1:160 or higher) in virtually all patients with SLE
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Slide 18 - Other investigations Anti-double-stranded DNA titers Complement Levels (CH50, C3, C4) ESR CRP Complement Split products Decreased complement C1q
Slide 19 - Treatment NSAIDs (Non-steroidal anti-inflammatory drugs) Antimalarials (Hydroxychloroquine) Immunosuppressive agents
Slide 20 - 2. Rheumatoid Arthritis Rheumatoid arthritis is a common autoimmune disease in which the normal immune response is directed against an individual's own tissue, including the : Joints Tendons Bones Resulting in inflammation and destruction of these tissues with progressive disability, systemic complications (cardiovascular, pulmonary ..) and early death.
Slide 21 - Both prevalence and incidence are 2-3 times greater in women than in men. The cause of rheumatoid arthritis is not known: complex interplay among genotype, environmental triggers. Genetic factors: HLA-DR B1 locus alleles that contain a common amino acid motif (QKRAA) in the HLA-DRB1 region, termed the shared epitope, confer particular susceptibility Rheumatoid Arthritis (Contd.)
Slide 22 - Rheumatoid arthritis (RA) affects peripheral joints is characterized by an inflammation of the synovium: synovitis that may cause destruction of both cartilage and bone. Rheumatoid Arthritis
Slide 23 - Inflammatory cells produce pro inflammatory cytokines/ TNF-α, IL-1 that induce the secretion of metalloproteinases; which are known to cause joint destruction T cell activation due to unknown antigens also contributes to the inflammation in RA There is a lack of tolerance to citrullinated proteins and the appearance of autoantibodies directed against citrullinated proteins Pathogenesis (Type III hypersensitivity reaction)
Slide 24 - In rheumatoid arthritis, many individuals produce another group of auto-antibodies known as rheumatoid factor These antibodies react with determinants in the FC region of IgG Pathogenesis (Type III hypersensitivity reaction)
Slide 25 - Rheumatoid Factor The classic rheumatoid factor is an IgM antibody Directed against Fc region of IgG
Slide 26 - Such auto-antibodies bind to normal circulating IgG, forming IgM-IgG complexes which may be deposited in joints. This leads to activation of synovial macrophages The macrophages engulf the immune complexes and then release TNF and other pro-inflammatory cytokines e.g., IL-1 Pathogenesis (Type III hypersensitivity reaction)
Slide 27 - Diagnosis: Anti–citrullinated protein/peptides(ACP) antibodies/ anti-CCP : specific markers Rheumatoid factor Medications NSAIDS (Non-steroidal anti-inflammatory drugs) Disease-modifying drugs (eg, gold, hydroxychloroquine, sulfasalazine, penicillamine) Immunosuppressive therapy: Corticosteroids Methotrexate Surgery Physical therapy
Slide 28 - Take home message The spectrum of autoimmune disorders is wide ranging from single organ involvement to a systemic disease The disease process is usually prolonged and is generally associated with significant morbidity and mortality The mainstay of the treatment is to maintain immunosuppression
Slide 29 - Thank You