13. Penyakit Autoimun
-
Upload
dirga-rasyidin-l -
Category
Documents
-
view
55 -
download
9
description
Transcript of 13. Penyakit Autoimun
![Page 1: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/1.jpg)
Penyakit Autoimmune
Dr. E. Henny Herningtyas, MSi. PhD
Clinical Pathologi Department,
Faculty of Medicine, UGM Yogyakarta
Yogyakarta, 25 April 2012
4/25/2012 Kursus imunologi Dasar ke-11
![Page 2: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/2.jpg)
c
c
c
c
cc c
c
Mackay IR, 2000, BMJ 321: 93-96
![Page 3: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/3.jpg)
Central tolerance: role of AIREThymus
Negative
selection
AIRE (+) AIRE (-)
= self Ag-expressed
thymus medullary cell = self-reactive- T cell
= non-reactive T-cell= apoptotic T-cell
AIRE = autoimmune regulator, turn on many peripheral gene on thymus
= non-self Ag-expressed
thymus medullary cell
![Page 4: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/4.jpg)
Peripheral Tolerance
![Page 5: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/5.jpg)
Regulatory tolerance by T regulatory
Thymus Cytokine release
T regulatory
Periphery
Naïve T cell
Autoreactive T cell
Autoreactive T cell
![Page 6: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/6.jpg)
Clonal deletion B-cell in germinal center
Naïve B cell
B cell clones
self antigen
![Page 7: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/7.jpg)
Autoimmune diseases and mechanism
![Page 8: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/8.jpg)
Requirement for autoimmunity
Genetic factors
Infection and environmental
exposure
Breaking tolerance
Autoimmunity
![Page 9: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/9.jpg)
HLA typing and risk of disease
![Page 10: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/10.jpg)
Faktor genetik DM tipe 1
HLA DR3/4 increase susceptibility of
disease in type 1 DM
Shared HLA in sibling
increase susceptibility of
disease in type 1 DM
Autoimmunity is more
common in female
![Page 11: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/11.jpg)
Single gene and autoimmunity
![Page 12: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/12.jpg)
Infection induced autoimmunity
![Page 13: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/13.jpg)
Breaking of antigen segregation
Sympathetic
opthalmia
![Page 14: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/14.jpg)
Mechanism of autoimmune
![Page 15: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/15.jpg)
Cluster of
autoimmune
diseases
![Page 16: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/16.jpg)
Rheumatoid arthritis: 1% of general population, but female excess
SLE: 0.12% of general population, but female excess
Myasthenia gravis: 0.0% of general population, but female excess
Multiple sclerosis: 0.1% of general population but female excess
Primary Sjogren Syndrome: 0.6-3% of adult women
Thyroid disease: >3% of adult women
Type 1 diabetes: 0.1% of children
Prevalence of autoimmune diseases
Mackay IR, 2000, BMJ 321: 93-96
![Page 17: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/17.jpg)
RA prevalence globally
Country Total
C.Spain 1.6%
Minnesota 1.07%
UK 0.81%
N.Spain 0.7%
Sweden 0.51%
France 0.5%
Tudela Spain 0.37%
N.Greece 0.35%
Country Total
Cordoba 0.34%
Oslo 0.33%
Greece 0.32%
N. Italy 0.32%
France 0.3%
Indonesia 0.25%
Yugoslavia 0.19%
Nigeria 0%
Prevalence in developing country is much lower than develop country
Darmawan, 1993, British Journal of Rheumatology, 32: 537-540
![Page 18: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/18.jpg)
Systemic Lupus Erythematosus (SLE)
Autoantibody-mediated inflamation can lead to release of autoantigens from
damaged tissue and promotes further activation o f autoreactive B cells
Chronic stage
![Page 19: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/19.jpg)
Systemic Lupus Erythematosus (SLE)Epitope spreading: B cells specific for various component of a complex
antigen are stimulated by a single specific autoreactive T cell
![Page 20: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/20.jpg)
Rheumatoid Arthritis (RA)
![Page 21: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/21.jpg)
Myasthenia gravis
![Page 22: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/22.jpg)
Autoimmune Haemolytic Anemia (AIHA)
![Page 23: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/23.jpg)
AIHA cases in YogyakartaAIHA cases in Yogyakarta
0
2
4
6
8
10
12
14
1997 1998 1999 2000 2001 2002
Year
Ca
se
nu
mb
er
Warm type
Cold type
Mix type
64.47%
35.53%
Perempuan
Laki-laki
Mean age of AIHA cases in Yogyakarta
0
10
20
30
40
50
1997 1998 1999 2000 2001 2002
Year
Pati
en
t ag
e
Mean
Male : female ratio = 1: 1.8
Herningtyas EH, 2003, Research reports (unpublished data)
![Page 24: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/24.jpg)
Take home message:
Autoimmunity is a breaking of self-tolerance condition, influenced by genetic factor and environmental factor
Various mechanisms on autoimmune disease involving immune system at the level of T cell, B-cell and autoAbformation
Autoimmune disease prevalence vary in different type of disease and different countries
![Page 25: 13. Penyakit Autoimun](https://reader033.fdocuments.net/reader033/viewer/2022061520/55cf8c575503462b138b9571/html5/thumbnails/25.jpg)
Terima kasih atas perhatian yang
anda berikan