Pathology of The

Pathology of The

Immune System

Immune System
DR. Willy Sandhika,dr.,M.Si,
Sp.PA(K) DR. Willy
Sandhika,dr.,M.Si, Sp.PA(K)

Hypersensitivity Reaction
Both exogenous and
endogenous antigens
The development of
hypersensitivity diseases is
associated with the inheritance
inheritance of of particular
particular susceptibility
susceptibility genes.​
imbalance between the effector
mechanisms of immune
responses and the control
mechanisms that serve to
normally limit such responses​.
Immediate Immediate (type
(type I) I) hypersensitivity
hypersensitivity
• Production of IgE antibody ​→
immediate release of vasoactive
amines and other mediators
from mast cells; later recruitment
of inflammatory cells cells
Type Type I I
Hypersensitivity
Hypersensitivity Reaction
Reaction ​Primary Mediator :
● Histamine : vascular permeability​↑​,
vasodilatation, bronchospasm, mucus
secretion​↑ ​Secondary Mediator :
 ● ● Prostaglandin Prostaglandin D2
D2 : : bronchospasm bronchospasm
+ + mucus mucus secretion Bronchial
reaction: mucosal edema, mucus
secretion, leucocytes infiltration,
epithelial damage and bronchospasm
Systemic: shock anaphylaxis Local:
urticaria, allergic rhinitis, bronchial
asthma
Antibody
Antibody-mediated
mediated (type (type II) II)

hypersensitivity
hypersensitivity
• Production of IgG, IgM ​→ ​binds
to antigen on target cell or tissue
→ ​phagocytosis or lysis of target
cell by activated activated
complement complement or or
Fc Fc receptors; receptors;
recruitment of leukocytes
Immune Immune complex
complex–mediated

mediated ​(type (type III) III)

hypersensitivity

hypersensitivity
• Deposition of antigen-antibody
complexes ​→ ​complement
activation ​→ ​recruitment of
leukocytes by complement
complement products products
and and Fc Fc receptors
receptors ​→ ​release of enzymes
and other toxic molecules
1. Systemic Immune Complex
Disease
–Acute Necrotizing Vasculitis
–Fibrinoid Necrosis –Immune
Complex Deposit on various
tissue 2. 2. Local Local Immune
Immune Complex Complex Disease
Disease (Arthus (Arthus Reaction)
–Local Immune Complex Vasculitis
on
particular organ – Exp: Farmer’s lung
– Hypersensitivity
Reaction to “molds and hay”
(Intrapulmonal Arthus Reaction)
Cell Cell-mediated
mediated (type (type IV) IV)

hypersensitivity
hypersensitivity
Activated T lymphocytes : ​(i)
release of cytokines ​→
inflammation
and and macrophage
macrophage activation activation
(ii) ​T cell–mediated cytotoxicity
1. Delayed-type Hypersensitivity
(DTH)
• antigens processed by APC,
presented with class II MHC,
recognized by TH1-cells
• TH1-cells produce cytpkines:
→ ​macrophages activation
→ ​fibroblast proliferation
• GRANULOMA formation composed
of epitheloid epitheloid cells cells
(derived (derived from from
macrophage) macrophage)
surrounded by lymphocytes,
fibroblast ​± ​multinucleated giant cells
(Langhans giant cells) Exp:
granulomatous inflammation caused
by
Mycobacteria tbc, M.lepra and fungal
infection
2. T CELL – MEDIATED
CYTOTOXICITY
– target cells expressed antigen
presented
with class I MHC –Antigen presented
by MHC 1 recognized
by CTL (Cytotoxic T Lymphocyte) -
CD 8+ –CTL destroy target cells Exp
Exp : : –Transplant graft rejection
–Lyses of viral-infected cells –Lyses
of tumor cells
-​Antigen​-​presenting ​cell
DE​L

Antigen
IL​-​12
CD4​+ ​Th1 ​cell ​Gia​n​t ​cell
Epithelioid
cell

IL​-​2

IFN​-​Y
Monocytes

Fibroblast

Lymphocyte
​ crophage
Ma