00:00
The good example of this is Goodpasture's
disease, which is shown here.
00:05
In that case, the host who
has developed Goodpasture's
has developed auto antibodies
that recognise components
of the basement membrane
in both lungs and in
the kidney glomeruli.
00:18
And that's what
we're looking at.
00:19
We're basically looking at a
capillary loop on the left hand side,
and a basement membrane to
which antibodies have bound.
00:27
You can see them
there, the little green guys.
00:29
And we are going to
now recruit neutrophils,
recruit complement,
recruits macrophages,
that will try to eat that and all
they're going to end up doing
is destroying the
basement membrane.
00:41
And then we will have a
filtration process that doesn't work.
00:44
That's Goodpasture's disease.
00:46
The figure on the right hand
side is just demonstrating
an immunofluorescence pattern for
bound antibody, in that glomerulus.
00:57
So all those little tiny
loops and things like that,
we're just highlighting the capillaries
that the antibody has bound to.
01:04
And you can see that there
would be substantial damage,
and why now that would destroy
the filtration process in the kidney.
01:11
That's Goodpasture's disease.
01:14
Another example of antibody against fixed
tissue antigen, this time on the heart.
01:19
And this is a good example.
01:20
This is acute rheumatic fever.
01:22
So if you've had a strep
throat, streptococcal pharyngitis.
01:27
You elaborate antibodies
against the group A streptococci.
01:31
That's what's being shown and
that's an appropriate response.
01:35
Unfortunately, in
some of the cases,
the antibodies that are formed
against the streptococcal antigens,
cross react with similar not identical,
but similar protein confirmations
on the surface of the
myocytes and on the valves.
01:53
Oh, my goodness.
01:54
Now I have antibodies bound
to myocardium or bound valves,
and it's predictable
what's going to happen.
02:02
We're going to recruit and activate
neutrophils and macrophages
and Fc receptors, we're going
to have complement activation,
we're going to be punching holes,
we're going to get major damage.
02:12
And that's exactly what
happens in acute rheumatic fever.
02:15
In a small set of sub subset of
patients who develop these antibodies,
they do happen to cross
react with self antigens.
02:22
And this is just showing you an
example of what this looks like.
02:25
So we have now antibody
that's bound to the myocardium
and it is causing the recruitment and
activation of T cells and macrophages
to form a so called
Aschoff nodule.
02:38
So the larger pinker cells
in the panel on the left
are macrophages
that have bound up.
02:45
And all this is happening
because of cross reactivity
between the streptococcal organism
and antigens present on the heart.
02:55
When it happens on the valves,
we will cause inflammation,
damage, and destruction.
03:01
As that heals,
we'll get scarring.
03:04
And you can see on the left hand
side, thickening of the mitral valve
in a patient who had multiple bouts
of rheumatic fever over the lifetime.
03:13
As a result, it have damaged that valve
to the point where it's no longer pliable,
and soft, but rather
fibrotic and scarred,
and doesn't function
very well as a valve.
03:23
Again, Type 2
hypersensitivity response.
03:28
Another way to have a type
two hypersensitivity response,
in this case, without much
associated inflammation or damage
is shown here with
Pemphigus Vulgaris.
03:40
These in people who have this
disorder, they have auto antibodies
that recognise
desmosomal components.
03:48
So the dark black things in the
middle panel are desmosomes
that hold the
keratinocytes together.
03:56
You can develop antibodies
to those desmosomal proteins.
04:02
And when that happens, and
you bind and crosslink them,
you induce the production of
urokinase plasminogen activator,
that will cause a breakdown
of those desmosomal proteins.
04:15
And you will therefore get
separation of the keratinocytes.
04:20
And you get a characteristic
blistering that happens at a certain level
within the skin.
04:28
And this is just
showing you that pattern.
04:30
The characteristic area
for pemphigus vulgaris
is at the cells at
the basal layer.
04:37
So it's a very specific region
with specific desmosomes
that are being recognised and you
get one basal layer stuck to the dermis,
and then you have a blister above that
because we broken all the desmosomes
that connected the basil
layer to the next layer up.
04:53
And it's not happening because
of complement activation.
04:58
It's not happening because of
macrophages and neutrophils coming in.
05:02
It's happening because of the
activation of the plasminogen activator.
05:08
So you see the blister on the
right hand side in the upper corner,
you're also seeing the
immunoglobulin deposition pattern.
05:15
So you get a lace like
deposition of immunoglobulin
on this immunofluorescence
panel on the lower right,
that shows where the
antibody is being bound.
05:24
Grossly, what does this look like,
areas of ulceration and blistering.
05:32
You can also have antibodies
that bind to fixed antigen
that don't drive
any form of injury.
05:39
That in fact, act like stimulating
molecules, or blocking molecules.
05:46
In this particular case,
on the left hand side,
we're showing antibodies
that are directed against
the thyroid stimulating hormone
receptor, the TSH receptor.
05:55
Those antibodies when they buy the TSH
receptor, stimulate the thyroidal cells.
06:01
So the patient, or the
thyroid in this case,
thinks it's been stimulated
with a bunch of TSH
when in fact, it's an antibody that
just happens to recognise the receptor.
06:10
So we're going to get massive
activation of the thyroid.
06:14
This is Grave's
disease, a thyrotoxicosis
related to too much stimulation
driven by the antibody.
06:21
There's no damage here.
06:22
There's no
complement activation.
06:24
The antibody type is such that
we're not getting any phagocytosis,
we're not getting opsonization, we're
not getting complement activation.
06:33
Another example, is
on the right hand side.
06:37
In this particular case, the
patient has developed antibodies
to the acetylcholine receptor.
06:41
Acetylcholine
receptor, as you'll recall,
is what allows the neuromuscular
junction to transmit a signal.
06:47
Nerve signal comes
along from the nerve.
06:50
You then get to the terminus,
you release acetylcholine into the
synapse between the nerve and muscle,
you get muscle contraction
via the interaction
of acetylcholine
with its receptor.
07:02
If you make an antibody
that blocks that receptor,
the neurons firing all at once and the
muscles not responding because it can't.
07:09
The antibody has blocked the ability of
the acetylcholine to get to its receptor.
07:16
There's no damage here.
07:17
The isotype again is not going
to activate much compliment.
07:21
It's not going to recruit
Fc receptor bearing cells
but it's going to
block the movement.
07:27
This disease is
Myasthenia gravis.