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12/4/2012Type II HypersensitivityPasuporn Po‐ngernnakType III HypersensitivityPasuporn Po‐ngernnakDownloaded from: Robbins Basic Pathology 9E (on 26 November 2012) © 2012 ElsevierType• Immune complex‐mediated hypersensitivityImmune Mechanisms• Deposition of antigen‐antibody complexes →complement activation → recruitment ofleukocytes by complement products and Fcreceptors → release of enzymes and other toxicmoleculesGrave’s diseaseMyasthenia gravisHistopathologic LesionsPrototypical Disorders• Inflammation, necrotizing vasculitis (fibrinoidnecrosis)•Systemic lupus erythematosus; some forms ofglomerulonephritis; serum sickness; Arthusreactionhttp://hyperthyroid‐symptoms.com/symptoms‐of‐graves‐diseasehttp://askdrmakkar.com/myasthen.htmType III HypersensitivityPasuporn Po‐ngernnakType III HypersensitivityPasuporn Po‐ngernnakImmune complex disease: The sequentialphases in the induction of systemic immunecomplex‐mediated.divided into three phases:(1) formation of antigen‐antibody complexesin the circulation(2) deposition of the immune complexes invarious tissues(3) an inflammatory reaction in various sitesthroughout the bodyhttp://see.visualdx.com/diagnosis/serum_sicknessSerum sickness typically occurs 7‐21 days afterexposure to exogenous proteins or chemicalhttp://biomed.brown.edu/Courses/BI108/BI108_2008_Groups/group06/pages/costeffectiveness.htmlSystemic Lupus Erythematosus (SLE)16
12/4/2012Type IV HypersensitivityPasuporn Po‐ngernnakType IV HypersensitivityMediated by specifically sensitizedT cellPasuporn Po‐ngernnakType•Cell‐mediated hypersensitivityHistopathologic Lesions• Perivascular cellular infiltrates; edema;granuloma formation; cell destructionImmune Mechanisms•Activated T lymphocytes → (1) release ofcytokines, inflammation and macrophageactivation; (2) T cell‐mediated cytotoxicityPrototypical Disorders•Contact dermatitis; multiple sclerosis;type 1 diabetes; tuberculosisDelayed‐type hypersensitivity reaction in theskin.Perivascular accumulation ("cuffing") ofmononuclear inflammatory cells (lymphocytesand macrophages), with associated dermaledema and fibrin deposition.Delayed‐type hypersensitivityInitiated by CD4+ T cells andmacrophage recruitment as majoreffector cellsTuberculin reaction, contactdermatitis, granulomatousinflammationDirect cell cytotoxicityMediated by CD8+ T cellsIntracellular infection (virus), tumorimmunity, graft rejectionPasuporn Po‐ngernnakPasuporn Po‐ngernnakDownloaded from: Robbins Basic Pathology 9E (on 26 November 2012) © 2012 ElsevierDownloaded from: Robbins Basic Pathology 9E (on 26 November 2012) © 2012 ElsevierMechanisms of T cell‐mediated (type IV) hypersensitivity reactionsIn cytokine‐mediated inflammatory reactions, CD4+ T cells respond to tissueantigens by secreting cytokines that stimulate inflammation and activatephagocytes, leading to tissue injury.e.g. Tuberculin reaction, contact dermatitis, granulomatous inflammationMechanisms of T cell‐mediated (type IV) hypersensitivity reactionsIn some diseases, CD8+ CTLs directly kill tissue cells. APC, antigenpresentingcell; CTLs, cytotoxic T lymphocytese.g. Intracellular infection (virus), tumor immunity, graft rejection17
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