Introduction

Immunity It is the ability of the body to defend itself against specific invading agents such as bacteria, toxins, viruses etc.

Introduction
COMPONENTS OF THE IMMUNE SYSTEM B - Lymphocytes T Lymphocytes
CD4+ cells ( T helper cells) CD8+ cells (Cytotoxic T cells) Memory T cells

The NKCs Macrophages Dendritic cells The MHC antigens (HLA) Cytokines

Introduction
Innate immune response :
First line of defense Non specific Examples : Physical skin, mucosa
Biochemical complement, Lysozyme, IFNs Cellular NKCs, Neutrophils, Monocytes, Macrophages

Adaptive immune response

Specific towards a particular antigen

Tolerance
It refers to a state in which an individual is incapable of developing an immune response against a specific antigen. Self tolerance refers to the lack of immune responsiveness to ones own tissue antigens. Self tolerance mechanisms
Central tolerance - deletion of self reactive T &B lymphocytes during their maturation in central lymphoid organs Peripheral tolerance Back up mechanisms

Autoimmunity
Is the condition when the immune response takes place against the normal endogenous proteins. The disease resulting from this phenomenon is called as an AUTOIMMUNE DISEASE. Mainly seen in young adults. Females are at a higher risk of developing an autoimmune

response. But the reactions occurring in men are more

severe.

Classification of Autoimmune diseases

SYSTEMIC (Not tissue specific)
Systemic lupus erythematosus (SLE)
Sjgren's syndrome Scleroderma

LOCAL SYNDROMES (Tissue specific)

Endocrinologic : IDDM, Hashimotos disease Gastrointestinal : Crohns disease Dermatologic : Vitiligo Hematologic : Idiopathic Thrombocytopenic purpura Neurologic : Myasthenia gravis

Pathogenesis
Failure of Activation-Induced Cell Death Breakdown of T-Cell Anergy Molecular Mimicry Dendritic cell malfunctioning Cryptic self exposure

Triggers
GENES INFECTIONS
Viruses : Hepatitis C virus, Hepatitis D virus, Coxsackie B virus Bacteria : Treponema pallidum , Streptococcus pyrogenes Other: Trypanosoma cruzi, Ochocerca volvulus

DIET
Cows milk Gluten

Chemicals
Mercury, Copper, Iron, Iodine

DRUGS
Hydralazine and Procainamide Quinidine

Diagnosis
INFLAMMATORY MARKERS
ESR CRP Ferretin

AUTOANTIBODIES AND IMMUNOLOGIC STUDIES

ELISA Anti nuclear antibody Anti neutrophil cytoplasmic antibody Anti phospholipid antibody

FLOW CYTOMETRY CYTOKINE STUDIES MHC

Treatment
IMMUNOSUPPRESSANTS
Corticosteroids
Prednisone Prednisolone

Immunophilin ligands
Cyclosporine Tacrolimus Sirolimus

Mycophenolate mofetil (MMF) Thalidomide

Treatment
CYTOTOXIC AGENTS

Azathioprine Mercaptopurine Cyclophosphamide Leflunomide Methotrexate Vincristine

Immunoglobulin Intravenous Adalimumab Infliximab Etanercept Alefacept

IMMUNOSUPPRESSIVE ANTIBODIES

Treatment
OTHER DRUGS
Chlorambucil Hydroxychloroquine Gold compounds Interleukin -1 antagonists Sulfasalazine