1. Immunology Dr. Refif S. Al-Shawk
Tolerance and Autoimmunity and Transplants
Immunology Dr. Refif S. Al-Shawk

2. “Horror Autotoxicus”
Failure of host’s humoral and cellular immune systems to distinguish self from non-self
Autoimmunity
Can result in tissue and organ damage, can be fatal

4. Tolerance
This term applies to the many layers of protection imposed by the immune system to prevent the reaction of its cells and antibodies against host components.
Central tolerance – deleting T or B clones before maturity if they have receptors that recognize self-antigens with great affinity
Peripheral tolerance – kills lymphocytes in secondary lymphoid tissue
Also, life span of lymphocytes regulated by apoptosis

5. Some antigens can produce tolerance
Termed tolerogens rather than immunogens
High dosages of antigen
Persistance of antigen in host
IV or oral introduction
Absence of adjuvants
Low levels of costimulators
CD28 on T cell will bind to B7 on APC and provide activating signals; however, it was discovered that another receptor, CTLA-4 (negative) will bind to B7 and inhibit it

7. Central Tolerance Limits Development of Autoreactive T and B Cells
Peripheral Tolerance Regulates Autoreactive Cells in the Circulation

9. lymphocytes with specificity for self antigens are not uncommon in the periphery
not all self antigens are expressed in the central lymphoid organs where negative selection occurs,
there is a threshold requirement for affinity to self antigens before clonal deletion is triggered, allowing some weakly self-reactive clones to survive

10. Peripheral Tolerance May be induced by Treg cells
Unique group of CD4+ T cells
Recognize self-antigens on immune system cells and seem to be able to suppress immune system
Induce cell death in some immune cells

11. In order for T cells to become activated
TCR must bind antigen presented by self-MHC (major histocompatibility complex molecules) (signal 1)
T cell must undergo costimulatory engagement {CD28 on the T cell and CD80/86 (B7) on the APC} (signal 2).
without costimulation, they become anergic (Unresponsiveness to antigenic stimulus)

12. In T cells, a third mechanism for maintaining tolerance, in addition to T-cell anergy and apoptosis, is through the activity of regulatory T cells (TREG cells)
they down-regulate immune processes when they engage with these antigens in the periphery
These cells can be generated both naturally, in the thymus (nTREG cells,), and after induction by antigen in the periphery (iTREG cells;)
these cells up-regulate the transcription factor FoxP3

14. How TREG cells can be generated??
They can generated both naturally, in the thymus (nTREG cells,)
and after induction by antigen in the periphery (iTREG cells;).

15. In fact, many of the circulating T cells with specificity for self antigens may be such regulatory cells. nTREG cells specializing in regulating responses against self antigen to inhibit autoimmune disease
and iTREG cells controlling reactions against benign foreign antigens at mucosal surfaces, where the immune system comes in constant contact with the outside world (e.g., gut commensals or respiratory allergens).

16. Factors that favor the development of iTREG cells include:
the presence of certain cytokines (TGF-β) during antigenic stimulation,
chronic low-dose antigen exposure, and
lack of costimulation or the presentation of antigen by immature dendritic cells (DCs).

18. mechanisms by which TREG cells inhibit immune responses: both contact-dependent and contact independent processes have been observed.
CD4+ TREG cells have been shown to kill APCs or effector T cells directly, by means of granzyme and perforin.
TREG cells may also modulate the function of other cells responding to antigen by surface receptor engagement. -- expression of CTLA-4. TREG cells express high levels of this immune inhibitory receptor. interaction of CTLA-4 on TREG cells with CD80/86 on an APC can lead to inhibition of APC function,
including reduced expression of costimulatory molecules
proinflammatory cytokines, such as IL-6 and tumor necrosis factor-α (TNF-α).
these targeted APCs begin to express soluble factors that inhibit local immune cells.
TREG cells themselves also secrete immune inhibitory cytokines, such as IL-10, TGF-β, and IL-35, suppressing the activity of other nearby T cells and APCs.
Finally, because TREG cells express only the low-affinity IL-2R α (CD25) but not the β or γ subunits, which are required for signal transduction prevent expansion of local immunostimulatory effector T cells.

19. Evidence for Central tolerance
The F1 mouse does not have any B cells that
Express anti-HEL antibodies

20. Evidence for Peripheral tolerance