Autoimmunity CHAPTER 20 TABLE 20-1 Some autoimmune diseases in humans Disease Self-antige Immune response ORGAN-SPECIFIC AUTOIMMUNE DISEASES Adrenal cells Auto-antibodies Autoimmune hemolytic anemia RBC membrane proteins Auto-antibodies Goodpasture's syndrome Renal and lung basement membranes Auto-antibodies Graves'disease Thyroid-stimulating hormone receptor Auto-antibody(stimulating) Hashimoto's thyroiditis Thyroid proteins and cells Idiopathic thrombocyopenia purpura Platelet membrane proteins Auto-antibodies Insulin-dependent diabetes mellitus Pancreatic beta cells Toru cells, auto-antibodies asthenia gravis Acetylcholine receptors Auto-antibody(blocking) Myocardial infarction Heart Auto-antibodies Perni anemla Gastric parietal cells; intrinsic factor Auto-antibody Poststreptococcal glomerulonephritis Kidney Antigen-antibody complexes Spontaneous infertility Sperm Auto-antibodies SYSTEMIC AUTOIMMUNE DISEASES Ankylosing sponkylitis vertebrae Immune complexes Multipl Brain or white matter THI cells and Tc cells, auto-antibodies arthritis Connective tissue, IgG Auto-antibodies, immune complexe Scleroderma Nuclei, heart, lungs, gastrointestinal tract, kidney Auto-antibodies Sjogrens syndrome Salivary gland, liver, kidney, thyroid Auto-antibodies Systemic lupus erythematosus(SLE) DNA, nuclear protein, RBC and platelet membranes Auto-antibodies, immune complexes rectly by humoral or cell-mediated effector mechanisms. and sensitized THl cells specific for thyroid antigens. The Alternatively, the antibodies may overstimulate or block the DTH response is characterized by an intense infiltration of normal function of the target organ. the thyroid gland by lymphocytes, macrophages, and plasma cells, which form lymphocytic follicles and germinal centers (Figure 20-1). The ensuing inflammatory response causes a Some autoimmune Diseases are goiter, or visible enlargement of the thyroid gland, a phs c Mediated by Direct Cellular Damage to a number of thyroid proteins, including thyroglobulin and Autoimmune diseases involving direct cellular damage occur thyroid peroxidase, both of which are involved in the uptake when lymphocytes or antibodies bind to cell-membrane an- of iodine. Binding of the auto-antibodies to these proteins tigens, causing cellular lysis and/or an inflammatory response interferes with iodine uptake and leads to decreased produc in the affected organ. Gradually, the damaged cellular struc- tion of thyroid hormones(hypothyroidism) ture is replaced by connective tissue(scar tissue), and the fund tion of the organ declines. This section briefly describes a few AUTOIMMUNE ANEMIAS examples of this type of autoimmune disease Autoimmune anemias include pernicious anemia, autoim HASHIMOTO'S THYROIDITIS mune hemolytic anemia, and drug-induced hemolytic mia Pernicious anemia is caused by auto-antibodies to intrin- In Hashimoto's thyroiditis, which is most frequently seen in sic factor, a membrane-bound intestinal protein on gastric middle-aged women, an individual produces auto-antibodies parietal cells. Intrinsic factor facilitates uptake of vitamin B12rectly by humoral or cell-mediated effector mechanisms. Alternatively, the antibodies may overstimulate or block the normal function of the target organ. Some Autoimmune Diseases Are Mediated by Direct Cellular Damage Autoimmune diseases involving direct cellular damage occur when lymphocytes or antibodies bind to cell-membrane an￾tigens, causing cellular lysis and/or an inflammatory response in the affected organ. Gradually, the damaged cellular struc￾ture is replaced by connective tissue (scar tissue), and the func￾tion of the organ declines. This section briefly describes a few examples of this type of autoimmune disease. HASHIMOTO’S THYROIDITIS In Hashimoto’s thyroiditis, which is most frequently seen in middle-aged women, an individual produces auto-antibodies and sensitized TH1 cells specific for thyroid antigens. The DTH response is characterized by an intense infiltration of the thyroid gland by lymphocytes, macrophages, and plasma cells, which form lymphocytic follicles and germinal centers (Figure 20-1). The ensuing inflammatory response causes a goiter, or visible enlargement of the thyroid gland, a physio￾logical response to hypothyroidism. Antibodies are formed to a number of thyroid proteins, including thyroglobulin and thyroid peroxidase, both of which are involved in the uptake of iodine. Binding of the auto-antibodies to these proteins interferes with iodine uptake and leads to decreased produc￾tion of thyroid hormones (hypothyroidism). AUTOIMMUNE ANEMIAS Autoimmune anemias include pernicious anemia, autoim￾mune hemolytic anemia, and drug-induced hemolytic ane￾mia. Pernicious anemia is caused by auto-antibodies to intrin￾sic factor, a membrane-bound intestinal protein on gastric parietal cells. Intrinsic factor facilitates uptake of vitamin B12 Autoimmunity CHAPTER 20 463 TABLE 20-1 Some autoimmune diseases in humans Disease Self-antigen Immune response ORGAN-SPECIFIC AUTOIMMUNE DISEASES Addison’s disease Adrenal cells Auto-antibodies Autoimmune hemolytic anemia RBC membrane proteins Auto-antibodies Goodpasture’s syndrome Renal and lung basement membranes Auto-antibodies Graves’ disease Thyroid-stimulating hormone receptor Auto-antibody (stimulating) Hashimoto’s thyroiditis Thyroid proteins and cells TDTH cells, auto-antibodies Idiopathic thrombocyopenia purpura Platelet membrane proteins Auto-antibodies Insulin-dependent diabetes mellitus Pancreatic beta cells TDTH cells, auto-antibodies Myasthenia gravis Acetylcholine receptors Auto-antibody (blocking) Myocardial infarction Heart Auto-antibodies Pernicious anemia Gastric parietal cells; intrinsic factor Auto-antibody Poststreptococcal glomerulonephritis Kidney Antigen-antibody complexes Spontaneous infertility Sperm Auto-antibodies SYSTEMIC AUTOIMMUNE DISEASES Ankylosing sponkylitis Vertebrae Immune complexes Multiple sclerosis Brain or white matter TH1 cells and TC cells, auto-antibodies Rheumatoid arthritis Connective tissue, IgG Auto-antibodies, immune complexes Scleroderma Nuclei, heart, lungs, gastrointestinal tract, kidney Auto-antibodies Sjogren’s syndrome Salivary gland, liver, kidney, thyroid Auto-antibodies Systemic lupus erythematosus (SLE) DNA, nuclear protein, RBC and platelet membranes Auto-antibodies, immune complexes