Serology Lect 13

Front 1

Condition of being resistant

Back 1

immunity

Front 2

Condition of being resistant to onesself

Back 2

autoimmunity

Front 3

conditions in which damage to organs or tissues results from the presence of autoantibody or auto-reactive cells

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autoimmune disease

Front 4

Principle Mechanism for Preventing Autoimmunity

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Elimination of self-reactive lymphocytes

Front 5

Mechanisms for Eliminating Self-reactive Cells (t-cell)

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Negative selection in thymus.
Regulatory T cells (“suppressor” cells ?)

Front 6

Mechanisms for Eliminating Self-reactive Cells (B cells)

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During development in bone marrow, binding to self antigen induces death.
Regulation by T cells

Front 7

Factors Affecting Susceptibility to Autoimmunity

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Age, Gender, Antigenic Exposure, Genetics

Front 8

Mechanisms that Facilitate Autoimmune Responses

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Molecular Mimicry, Loss of immune suppression, Release of sequestered antigens, Altered antigen presentation

Front 9

The structural similarity between a foreign body and self that results in an autoimmune response

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Molecular Mimicry

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Autoimmune diseases can be classified as

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systemic or organ specific

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Some autoimmne diseases may start out as ___ and later affect other organs

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organ-specific

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Affects 1 in 2000 individuals
Affects women 10:1 more than men
Peak age of onset is 20 – 40 years
Patients may have flare-ups and remissions

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Systemic Lupus Erythmatosus

Front 13

Immune response is directed against a broad range of autoantigens.

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Systemic Lupus Erythmatosus

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Target tissues of SLE

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Skin
Joints
Kidneys
Brain
Heart
Lungs

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Begins with a broad range of nonspecific symptoms

>90% of patients develop arthritis
Usually hands, wrists, & knees

Skin manifestations are 2nd most common sign

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SLE

Front 16

____ may develop on any part of the body exposed to UV light
(SLE)

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Erythmatous Rash

Front 17

Telltale sign of SLE is

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Butterfly Rash

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In SLE as many as 2/3 of patients show evidence of ____ involvement

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renal

Front 19

Most dangerous renal problem in SLE

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diffuse proliferative glomerulonephritis

Front 20

May also see immune complexes deposited in subendothelial tissues leading to a thickening of the basement membrane
(sle)

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renal involvement

Front 21

Cardia involvement in SLE is:

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Pericarditis, tachycardia, or ventricular enlargement

Front 22

Lung involvement of SLE may cause:

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pleurisy and chest pain

Front 23

Neuropsychiatic involvement and hematologic abnormalities may be seen in:

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SLE

Front 24

__% of patients with SLE survive at least 5 years after disease onset

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90

Front 25

Milder form of the disease
Usually consists of arthritis & rashes
Goes away when drug is discontinued

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Drug induced lupus

Front 26

Common causative drugs
that induce lupus

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Procainamide
Quinidine
Methyldopa
Some oral contraceptives

Front 27

is usually done by fluorescent testing (FANA)

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antinuclear antibodies.

Front 28

Testing is extremely sensitive but only semi-specific

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ANA

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If ___ testing is positive, then it can be followed up with testing for specific types of antinuclear antibodies

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ANA

Front 30

Mouse kidney cell or human epithelial cells are fixed to a slide & allowed to react with patient serum of different dilutions

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SLE FANA testing (IIF)

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SLE patients usually have ___ ANA titers

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high

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homogenous, discrete speckled pattern, specked pattern, nucleolar pattern,

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Immunofluorescent staining patterns

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Staining of entire nucleus

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homogenous

Front 34

staining of centromeres

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discrete speckled pattern

Front 35

staining throughout the nucleus

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specked pattern

Front 36

staining of the nucleolus

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nucleolar pattern

Front 37

Found in up to 60% of lupus patients

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antiphosphlipid antibodes

Front 38

2 types of antiphosphlipid antibodes

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anticardolopin, lupus anticoagulant

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causes false positive results for syphilis

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anticardopolin

Front 40

causes falsely prolonged PT & APTT results

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lupus anticoag

Front 41

Systemic disease

Affects women 3:1 over men

Age of onset is usually 30 – 50 years

May see spontaneous remissions

May result in joint deformity

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Rheumatoid arthritis

Front 42

Morning joint stiffness
Swelling of soft tissue around joints
Swelling of joints
Joint involvement spreads to larger joints
Joint pain results in muscle spasm which limits motion
Joint deformity results

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symptoms of R.A

Front 43

in about what percent of R.A patients have nodules over the bones?

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25

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____ consist of necrotic areas surrounded by large mononuclear cells with an outer zone of granulation tissue containing plasma cells & lymphocytes

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nodules

Front 45

Tissue damage results from hydrolytic enzymes from neutrophils as they attempt to phagocytize the immune complexes.

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Rhematoid Factor

Front 46

Testing for rheumatoid factor can be done by

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hemagglutination, latex agglutination

Front 47

can be used to test for IgG & IgA isotypes of rheumatoid factor.

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EIA

Front 48

ESR is elevated

CRP is elevated

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Rheumatoid Arthritis

Front 49

Causes thyroid to be under-active (hypothyroidism

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Hashimoto’s Thyroiditis

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Causes thyroid to be over-active (hyperthyroidism)

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Grave’s Disease

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Hypothalamus secretes Thyrotropin Releasing Hormone (TRH) in response to decreasing ____ levels.

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T3 and T4

Front 52

acts on the pituitary gland to release Thyroid Stimulating Hormone

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Thyrotropin Releasing Hormone (TRH)

Front 53

acts on the thyroid gland to release T3 and T4.

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TSH

Front 54

Also known as chronic autoimmune thyroiditis

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Hashimoto's

Front 55

It is a chronic, inflammatory autoimmune disease of the thyroid gland.

The thyroid follicles are attacked & destroyed by both a cellular and a humoral immune response.

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Hashimoto's

Front 56

Antibodies to thyroglobulin and/or thyroid peroxidase are present

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Hashimoto's

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is the precursor for hormones produced by the thyroid (T3 & T4

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thyroglobulin

Front 58

is found in microsomes in the cytoplasm of thyroid epithelial cells

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thyroid peroxidase

Front 59

Hormone replacement therapy
Synthetic T4 daily

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Treatment for Hoshimoto's

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Hormone therapy can be monitored with periodic

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TSH levels

Front 61

Autoimmune disease of the thyroid which causes hyperthyroidism

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Grave's Disease

Front 62

Most significant autoantibody of Grave’s disease is

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TSH receptor antibody (TSHRab

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Commonly called thyroid stimulating immunoglobulin (TSI

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TSH receptor antibody (TSHRab

Front 64

Binding of TSHRab to its antigen, the TSH receptor, mimics the normal action of TSH.

The thyroid cells respond by releasing T3 & T4 hormones.

A goiter develops that is soft instead of rubbery.

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Grave's Disease

Front 65

Half of the patients develop bulging eyeballs

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Grave's or hyperthyroidism

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Treatment for Grave's Diesase

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Radioactive Iodine, Removal of part of thyroid

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Destroys part of the thyroid

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radioactive iodine

Front 68

is a chronic autoimmune disease that occurs in a genetically susceptible individual as a result of environmental factors.

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Type IA Diabetes (Autoimmune Diabetes Mellitus

Front 69

About 10% of people with diabetes mellitus have the ____ form

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immune-mediated

Front 70

Recent research indicates that susceptibility genes may occur in the HLA-DQ region, especially in the coding of the

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DQ beta chain

Front 71

Results in the destruction of insulin-producing beta cells of the pancreas

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Type 1 Diabetes

Front 72

It is believed that beta cell destruction occurs as a result of molecular mimicry from exposure to viral antigens, especially those of the

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Coxsackie viruses

Front 73

Disease is not detectable until about 80% or more of the beta cells are destroyed.
This may take several years.

Beta cell destruction results in an insufficient amount of insulin being produced.

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Type 1 diabetes mellitus

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Treatment for diabetes

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insulin replacement (must be injected)

Front 75

Inflammatory autoimmune disorder of the CNS

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Multiple sclerosis

Front 76

Lesions called plaques form in the white matter of the brain & spinal cord.

This results in progressive destruction of the myelin sheath of axons

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Multiple sclerosis

Front 77

Immune response is initiated when antibodies bind to the myelin membrane.

This stimulates macrophages and T cells which are responsible for demyelination

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MS

Front 78

Ab binds > inflammation > axon injury with demyelination > structural repair > postinflammatory neurodegeneration

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Disease progression of MS

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Neuromuscular disorder

Caused by antibodies to acetylcholine receptors

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Myasthenia gravis

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Normally, _____ is released from nerve endings to generate an action potential that causes muscle fiber to contract

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acetylcholine

Front 81

When antibodies bind to receptors, acetylcholine binding is blocked.

Damage to these receptors in skeletal muscle leads to progressive muscle weakness.

Respiratory muscle weakness can be life-threatening.

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MG

Front 82

Autoantibodies are present to the basement membranes of

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Glomeruli
Renal tubules
Alveoli

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In goodpastures, primary injury occurs in

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glomeruli

Front 84

injury to the glomeruli can rapid prgress into ____

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renal failure

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Begins with some type of injury to a basement membrane, exposing the α3 subunit of type IV collagen

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Goodpastures

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Tissue damage is caused by the binding of anti-GBM to the basement membranes of glomeruli and alveoli, which activates effector cell responses

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Goodpastures

Front 87

Goodpastures is likely to occur in ___ age ____

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males. 15-40

Front 88

Chronic inflammatory reaction is directed against the hepatocytes
And sometimes against the bile ducts

Occurs predominately in females

Both liver and non-liver autoantibodies may be found in the serum

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Chronic Hepatitis

Front 89

Diagnosis is based on:
Characteristic histological features
Hypergammaglobulinemia
Presence of autoantibodies

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autoimmune chronic hepatitis

Front 90

Autoantibodies that may be present are:
Antinuclear antibody (ANA)
Anti-smooth muscle antibody (ASTHMA)
Anti-liver-kidney microsomal antibody type 1 (anti-LKM1)
Anti-soluble liver antigen antibody (anti-cytokeratin antibody)

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autoimmune chronic hepatitis

Front 91

positive for ASTHMA

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type 1 autoimmune chronic hepatits

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positive for anti-LKM1

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type 2 autoimmune chronic hepatitis

Front 93

Steroid therapy can induce remission in more than 70% of cases
Cyclosporine is typically given to those that do not respond to steroids.

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autoimmune chronic hepatitis