Antigen-presentation, B- and T-cell effector mechanisms; The basis of immunological tolerance; Autoimmunity in general; B cell and T cell autoreactivity

12 important questions on Antigen-presentation, B- and T-cell effector mechanisms; The basis of immunological tolerance; Autoimmunity in general; B cell and T cell autoreactivity

What is the prevalence and incidence of Diabetes mellitus in the NL?

Prevalence 600.000 in The Netherlands (90 % Type 2, non-autoimmune). 
Annually ~72.000 new cases (36.000 male, 36.000 female).
Type 1 (autoimmune) ~600 new cases (0-14jr) per annum.

What is the prevalence and incidence of RA in NL?

Rheumatoid arthritis
Prevalence around 158.100 in The Netherlands
Annually 22.200 new cases (7.300 male, 14.900 female)

How are T cell receptors generated?

Germline DNA (recombination) rearranged DNA (transcription, splicing, translation) protein TCR -> for alpha and eta chain
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On what is the classifiaction of autoimmune diseases based?

Classification based on location of the antigen against which the autoimmune response is directed

What types of Classification of autoimmune diseases are there?

Organ-specific: response against (compontents of) cells that are present in only one particular organ or tissue.

Non-organ-specific (also called: Systemic): directed against common components that can be found in mulptiple organs or throughout the body.

The entire adaptive immune system is involved in autoimmune diseases. Name the role of Tcells, Bcells and antibodies for systemic lupus ertthematosus.

systemic lupus ertthematosus.
Tcells: Help for antibody production
Bcells: Antibody production, Ag presentation to T cells
Antibodies: pathogenic

What is the definition of immunological tolerance? 

Specific suppression of immune responses as a result of previous encounter with an antigen

The chance of developing tolerance depends on certain aspects of the antigen. Which?

presence  constantly present/time of release
dose  very high dose or very low dose
route  in particular orally
presentation  lack of costimulatie results in anergy(“immunological deafness”)

Explain how the central tolerance of Bcells works.

Immature Bcell in bone marrow -> no self-reaction -> migrates to periphery -> matures
Immature Bcell in bone marrow -> multivalent self-antigen -> clonal deletion -> apoptosis
Immature Bcell in bone marrow -> soluble self-antigen ->  migrates to periphery -> anergic B cell

Name 4 characteristics of CD4+T suppressor cells

Expression of FoxP3 transcription factor

Bind MHC/peptide complexes in the thymus with low affinity  autoantigen-specific
High surface expression of CD25 (IL-2R  chain)

Produce IL-4, IL-10, TGF-b (non-inflammatory cytokines)

Name the 3 mechanisms to suppress or turn-off autoreactive lymphocytes. How do they do it, and with which cells.

Clonal deletion: deletion of autoreactive lymphocytes. Bcells<Tcells.
Clonal anergy: Functional inactivation of lymphocytes. Mostly bcells
Suppression: Control of T-helper cell activation. Regulatory Tcells

Name the 9 mechanisms that contribute to immunological self-tolerance.

1) negative selection in the thymus
2) expression of tissue-specific proteins in the thymus
3) lack of lymphocytes access to some tissues
4) restriction of HLA class II expression to few cell types
5) suppression of autoimmune responses by regulatory T cells
6) induction of anergy in autoreactive B- and T cells
7) requirement of Bcell responses for Tcell help
8) requirement for co-stimulation in naive Tcell activation
9) oral tolerance to food and commensal organisms.

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