2nd Workshop Part 1

SECOND WORKSHOP: 2009-02 R. Hugo Martínez Lozano, M.D. Sept-04-2009

Examples of innate immunity: -External barriers -Phagocytosis -Complement -TLR -NK cells

Forms of adpative immunity: -Humoral -Cellular

“missing self” -Viran inf. -Neoplasia -Transplant r.

Lymphocyte

PLASMA CELL Most prominent Organelle?

TISSUE?

Adaptive immunity: cells and tissues

Immune response   

Cells Tissues Mechanisms (vgr. HLA systems)

Disease

HLA Allele

Ankylosing spondylitis

B27

90

Postgonococcal arthritis

B27

14

Acute anterior uveitis

B27

14

Rheumatoid arthritis

DR4

4

Chronic active hepatitis

DR3

13

Primary Sjögren syndrome

DR3

9

Type-1 diabetes

DR3

5

DR4

6

DR3/DR4

Relative Risk

20

HYPERSENSITIVITY REACTIONS

HYPERSENSITIVITY REACTION II

Opsonins (& C)-mediated phagocytosis

Complement (& Fc R)-mediated inflammation

Anti-Receptor disease

SELECTED EXAMPLES OF H.R.-II      

HEMOLYTIC ANEMIAS GOODPASTURE SYNDROME PEMPHIGUS V. INSULIN-RESISTENT DIABETES MYASTHENIA GRAVIS GRAVES DISESASE

PATHOGENESIS: VASCULITIS (PHASES)

HYPERSENSITIVITY REACTION IV

CONTACT DERMATITIS: Perforins, granzymes laden T cells

SLE:

SKIN… ANTI-B.M. INJURY

IDEM “Wire-loops”

Idem…Diffuse Proliferative glomerulonephritis: Prognosis…

LIBMAN-SACHS ENDOCARDITIS

Pannus

Sjogren syndrome…

Stiffness of the skin. Types of sclerodermia…

CREST SX… Meaning?

Adaptive immunity 



Humoral (Abs.) -pyogenic bacteria. -some virus & protozoos (luminal) Cellular (cells & cytokines) -Many fungi -Many viruses -Other intracytoplasmic microbs

IMMUNE DEFICIENCY SYNDROMES. II.- PRIMARY: RECOMMENDED STUDY: - X-LINKED AGAMMAGLOBULINEMIA - COMMON VARIABLE IMMUNODEF. - ISOLATED IgA DEF. - DiGEORGE SYNDROME - SEVERE COMBINED IMMUNODEF - WISKOTT-ALDRICH SYNDROME

GIARDIA LAMBLIA

CANDIDIASIS

MEASLES’ PNEUMONIA

P.A.S.

“ASPERGILLOMA”

Idem

NEOPLASIA 

DEFINITIONS: - TUMOR - NEOPLASIA: “New growth” - CANCER - ONCOLOGY

NEOPLASIA I 

-

BIOLOGY (AND MORPHOLOGY) B M DIFFERENTIATION CAPSULE (OR PSEUDO) GROWTH RATE NUCLEAR ABNORMALITY MITOSES ARCHITECTURAL AB. METASTASIS

WELL ANAPLASIA +++ - OR + + +++ + +++ - 0R + +++ - OR + +++ NO COMMON

R. HUGO MARTINEZ

ADENOCARCINOMA

NEOPLASIA I 

NEOPLASTIC DISSEMINATION: I - LOCAL INVASION II- SPREAD: 1) SEEDING (IN CAVITIES) 2) METASTASIS – LYMPH NODES - BLOOD-BORN

Peritoneal carcinomatosis

REGULATORY GENES    

GROWTH-PROMOTING (PO) GROWTH-INHIBITING (TSG) APOPTOSIS DNA REPAIR

PROTOONCOGENES 

PHYSIOLOGIC REGULATORS OF CELL PROLIFERATION & DIFFERENTIATON - GROWTH FACTORS - GROWTH FACTOR RECEPTORS - REGULATORY PROTEINS –TRANSDUCER - NUCLEAR

- ETC. (Table 7-8, p. 295) - Examples: FGF, TGF, RAS, Abl, etc.

M.M. (PO fgf3/int-2)

Cholangiocarcinoma (K-ras)

TSG   

RB P53 OTHER… NF

P16 WT-1 WT-X BRCA AT (ATM)

COLPOSCOPY

CYTOLOGY: HPV SIGNS

RB GENE & RETINOBLASTOMA: “PARADIGM FOR THE 2 HIT HYPOTHESIS”

DNA REPAIR DEFECTS (GENOMIC INSTABILITY) XERODERMA PIGMENTOSUM

AT

Telomeres: Up to 2000 repeats of the 5’TTAGGG3’ sequence

DETACHMENT

VASCULAR DISS. & HOMING

Pancoast t. + SVC Sx.

Paraneoplastic syndromes

Syndrome

Mechanism

Example

Cushing's Syndrome

ACTH-like substance

Lung (oat cell) carcinoma

Hypercalcemia

Parathormone-like substance

Lung (SC) carcinoma, other carcinomas

Hyponatremia

Inappropriate ADH secretion

Lung (oat cell) carcinoma

Polycythemia

Erythropoietin-like substance

Renal cell carcinoma Liver cells carcinoma

Trousseau's Syndrome

Hypercoagulable state

Pancreatic carcinomas & other

Hypoglycemia

Insulin-like substance

Various carcinomas and sarcomas

Carcinoid Syndrome

5-hydroxy-indoleacetic acid (5-HIAA)

Metastatic malignant carcinoid tumors

FIBROSARCOMA: I-like substance

RENAL CELLS CARCINOMA

ACANTHOSIS NIGRICANS

ACANTHOSIS NIGRICANS 50% OR MORE… Most likely neop?

CACHEXIA

BACTERIOPHAGES, PLASMIDS & TRANSPOSONS

BACTERIOPHAGES & PLASMIDS = VIRULENCE

PLASMIDS & TRANSPOSONS = RESISTANCE

Coliphages T-1 Infecting a bacteria

 

 

TRANSIENT VIRAL INFECTIONS CHRONIC LATENT INF (HERPESVIRUS) CHRONIC PRODUCTIVE INF. TRANSFORMING

TRANSIENT V.I.

MEASLES

Denervation atrophy

CHRONIC LATENT INF.

ORAL HERPES SIMPLEX

HERPETIC ENCEPHALITIS

HERPESZOSTER

CHRONIC PRODUCTIVE

“ATYPICAL” LYPMHOCYTES IN BLOOD ETIOLOGIC AGENT?

T.I

MECHANISMS OF BACTERIAL INJURY     

ADHERENCE TO HOST CELLS TOXINS ENZYMES INTRACELLULAR B. (IMMUNE RESP.) VIRULENCE

IMMUNE EVASION BY MICROBES   

VARIATION SHEDDING INHIBITION OF IMMUNITY

MYCOPLASMAS ATACHED TO EPITHELIAL CELL.

Ehrlichia “morulae”