IMMUNE INJURY
Ed Friedlander, M.D., Pathologist
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Courtesy of CancerWEB

Learning Objectives

Review the major players in the immune system, both cellular and humoral. Be sure you can explain what a hapten is.

For each of the following, describe the essential mechanism and mention some real-life illustrations: Type I, Type II, Type III, and Type IV hypersensitivity injury.

Briefly describe each of the following:

Describe and recognize the various anatomic signs of transplant rejection and graft versus host disease.

Critique the following statement, overheard at a party: "By strengthening our immune system, we prevent or cure most diseases. We strengthen our immune system by nutritional supplements and mental imagery to reduce stress."

Immune Disease
Iowa Virtual Microscopy
Have fun

Immune Pathology
Photos, explanations, and quiz
Indiana U.

KCUMB Students
"Big Robbins" -- Immuno
Lectures follow Textbook

QUIZBANK

LEARN FIRST: TYPES OF IMMUNE INJURY ("HYPERSENSITIVITY")

HAPTENS are atoms or small molecules that elicit an immune response when, and only when, they are bound to a larger carrier molecule, generally a protein. The body's rejection of the hapten-protein adduct does the damage. Some famous examples are:

CELLS OF THE IMMUNE SYSTEM

{14252} lymphocytes
{14720} lymphocyte
{14716} lymphocyte, large (i.e., a little bit turned-on)
{14718} lymphocyte, small (i.e., resting)
{16197} lymphocyte, small
{26001} lymphocytes in sputum
{26226} lymphocyte and neutrophil
{39919} lymphocytes (there's also a nice plasma cell right at the center)


Osmosis Jones

{46429} plasma cell, electron micrograph

{08230} macrophage containing leishmania (Baghdad boil)

{09205} mast cell granules (electron micrograph)
{13733} mast cells
{14539} mast cells (purple ones) and fibroblasts
{14542} mast cell degranulating
{15117} mast cell city!
{46472} mast cell, electron micrograph, intact
{46473} mast cell, electron micrograph, degranulating

{09207} eosinophil granules
{14099} eosinophils
{14708} eosinophil

IMMUNOGLOBULINS and COMPLEMENT should be familiar to you. For a pathologist's perspective on complement today, see Am. J. Path. 171: 715, 2008.

CYTOKINES

TYPE I IMMUNE INJURY IN HUMAN DISEASE

Local anaphylaxis: more often a nuisance than a real danger

{09716} urticaria
{09719} urticaria
{09720} urticaria; this is a variant with pressure-sensitive mast cells ("dermographism")
{12238} urticaria
{12240} urticaria
{25474} urticaria

{08161} atopic dermatitis ("eczema")
{12301} atopic dermatitis ("eczema"); this was probably contact dermatitis

Allergic to packed red cells
Pittsburgh Pathology Cases

TYPE II IMMUNE INJURY IN HUMAN DISEASE

Lewis A antibody
Pittsburgh Pathology Cases

Transfusion reaction
Pittsburgh Pathology Cases

{00049} Goodpasture's, immunofluorescent view of antibody along glomerular basement membrane

Goodpasture's disease
Linear fluorescence
WebPath photo

TYPE III IMMUNE INJURY IN HUMAN DISEASE

Lupus kidney
Antibodies deposited in glomerulus
Urbana Atlas of Pathology

TYPE IV IMMUNE INJURY IN HUMAN DISEASE

{24955} dermatologist skin test; the guy was allergic to the ramrod (no, I don't know how it happened or what it was made of)

TRANSPLANT REJECTION

Transplant Immunology
Great site
Transplant Pathology Internet Services

Renal allograft rejection
Pittsburgh Pathology Cases

Acute transplant rejection
Vessel changes
KU Collection

Acute rejection
Kidney
WebPath photo

Acute rejection
Kidney
WebPath photo

Acute rejection
Antigen-antibody complexes
WebPath photo

Acute rejection
Heart
WebPath photo

Acute rejection
Immune complexes
WebPath photo

Acute rejection
T-cells
WebPath photo

Chronic rejection
Kidney
WebPath photo

Chronic rejection
Kidney
WebPath photo

GRAFT VS. HOST DISEASE ("GVH")

{12006} graft vs. host, skin lesions
{12007} graft vs. host, skin lesions

Graft vs. Host in the lung
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Graft vs. host disease
Trust me; dead and dying cells
KU Collection

Graft vs. host disease
Trust me
KU Collection

Graft vs. host
Jaundice and rash
WebPath photo

Graft vs. host
Cloudy swelling and apoptosis
WebPath photo

Graft vs. host
Biliary scarring and obstruction
WebPath photo

Graft vs. host
Biliary scarring and obstruction
WebPath photo

FINAL NOTES:

* Sir Winston Churchill, in hospital with an infection during World War II, looked at his hospital chart and asked his physician, "What are these lymphocytes?" He was told: "We don't know, Prime Minster." "Then why do you count them?" Churchill retorted. Retold in Nature 333: 804, 1988.

BIBLIOGRAPHY / FURTHER READING

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