1. Immunotolerance Christoph Mueller christoph.mueller@pathology.unibe.ch
Molecular mechanisms of immune tolerance
Central tolerance induction in the B cell and T cell compartment
Immune tolerance in the periphery
Immunopathology vs. Autoimmunity
Immune Tolerance vs. Immune Privilege vs. Immune Ignorance

3. Selection of T cells in the Thymus based on
the affinity of their TCR for MHC + peptide
Number of T cells
Positive Selection
Negative Selection
No Selection
No or very low
Intermediate
High
Affinity of TCR for MHC + peptide

7. AutoImmune Regulator AIRE

8. Central and peripheral Tolerance in B cells

10. Peripheral naive CD4+ T cell precursor cells (THp) can differentiate into three subsets of effector T cells (TH1, TH2 and TH-17) and several subsets of Treg cells, including induced Treg cells (iTreg), Tr1 cells and TH3 cells. Naturally occurring Treg cells (nTreg) are generated from CD4+ thymic T cell precursors. The differentiation of these subsets is governed by selective cytokines and transcription factors, and each subset accomplishes specialized functions.

11. Rregulatory T cell subsets
Natural regulatory T cells express the cell-surface marker CD25 and the transcriptional repressor FOXP3 (forkhead box P3). These cells mature and migrate from the thymus and constitute 5–10% of peripheral T cells in normal mice. Other populations of antigen-specific regulatory T cells can be induced from naive CD4+CD25- or CD8+CD25- T cells in the periphery under the influence of semi-mature dendritic cells, interleukin-10 (IL-10), transforming growth factor- (TGF-) and possibly interferon- (IFN-). The inducible populations of regulatory T cells include distinct subtypes of CD4+ T cell: T regulatory 1 (TR1) cells, which secrete high levels of IL-10, no IL-4 and no or low levels of IFN-; and T helper 3 (TH3) cells, which secrete high levels of TGF-. Although CD8+ T cells are normally associated with cytotoxic T-lymphocyte function and IFN- production, these cells or a subtype of these cells can secrete IL-10 and have been called CD8+ regulatory T cells.

12. Postulated mechanisms of autoimmunity
Various genetic loci may confer susceptibility to autoimmunity in part by influencing
The maintenance of self-tolerance. Environmental triggers, such as infections and other stimuli
promote the influx of lymphocytes into the tissues and the activation of self-reactive T cells

13. Role of infections in the development of autoimmunity

14. Examples of Diseases caused by cell and tissue specific antibodies

15. Examples of T cell-mediated Immunological diseases

16. Examples of Gene Mutations that Result in (an Enhanced Risk for) Autoimmunity
Table 18-6

17. Autoimmune: general principles and observations
Autoimmunity results from a failure or breakdown of the mechanisms normally responsible for maintaining self-tolerance in B cells, T cells, or both.
The major factors that contribute to the development of autoimmunity are genetic susceptibility and environmental triggers, such as infections.
Autoimmune diseases may be either systemic or organ specific.
Various effector mechanisms are responsible for tissue injury in different autoimmune diseases.
Epitope spreading: Autoimmune reactions initiated against one self antigen that injure tissues may result in the release and alterations of other tissue antigens, activation of lymphocytes specific for these other antigens, and exacerbation of the disease.

18. Autoimmune disease vs. Immunopathology: Crohn‘s disease

19. Inflammatory Bowel Diseases (IBD) Ulcerative colitis Crohn’s disease
Continuous inflammation of the colonic mucosa
Hyperemic, edematous mucosa, often associated with crypt abscesses
Incidence: 2-3 new cases per 100'000 persons per year
Entire gastrointestinal tract may be affected
Discontinuous, transmural, granulomatous inflammation
Incidence: 4-5 new cases per 100'000 persons per year
CM 4/2007

20. Inflammatory Bowel Diseases: Incidence rates
(based on prospective studies)
Wisconsin (USA):
CD: 4.56 per 100’000
UC: 2.14 per 100’000
IBD: per 100’000
J. Pediatr. 2003; 143:
Stockholm (Sweden):
CD: 4.9 per 100’000
UC: 2.2 per 100’000
IBD: 7.4 per 100’000
Gut. 2003; 52:

21. Mutant mice that spontaneously develop colitis
TCR-a-/-
TCR-b-/-
MHC class II-/-
TGF- b -/-
IL-2-/-
IL-10-/-
Smad3-/-
GFAP- targeted
enteric glia cell
depletion
N-cadherin
dominant
negative mutant
cathepsin D-/-
Gai2-/-
NF-kB p55-/-
TNF DARE
trefoil factor -/-

22. Etiology of Inflammatory Bowel Disease
Psychosocial
Factors
Bacterial / Viral
Infections
Vascular
factors
Immunological
Factors
Environ-
mental
Factors
Genetic
Predisposition
Nutrition

23. Etiopathogenesis of Inflammatory Bowel Diseases
Induction and perpetuation of IBD is generally considered to depend on:
- aberrant local immune responses to luminal antigens
- in genetically predisposed individuals.

24. Genetic loci identified in inflammatory bowel disease linkage studies
Locus name Chromosomal region Disease type Genetic association
IBD1 Chromosome 16q CD only NOD2/CARD15
IBD2 Chromosome 12q UC>CD Not established
IBD3 Chromosome 6p CD and UC HLA, TNF or IRF4?
IBD4 Chromosome 14q CD Not established
IBD5 Chromosome 5q CD; UC (?) OCTN1/SLC22A4, OCTN2/SLC22A5
IBD6 Chromosome 19 CD>UC Not established
IBD7 Chromosome 1p CD and UC IL23R
IBD8 Chromosome 16p CD and UC Not established
IBD9 Chromosome 3p CD and UC Not established

25. Inflammatory Bowel Diseases (IBD) Ulcerative colitis Crohn’s disease
Continuous inflammation of the colonic mucosa
Hyperemic, edematous mucosa, often associated with crypt abscesses
Incidence: 2-3 new cases per 100'000 persons per year
Entire gastrointestinal tract may be affected
Discontinuous, transmural, granulomatous inflammation
Incidence: 4-5 new cases per 100'000 persons per year
CM 4/2007

26. Generalized pathway of the mucosal inflammation underlying inflammatory bowel disease (IBD) and potential points of therapeutic intervention.

27. Immune Tolerance vs. Immune Privilege Immune Ignorance

28. Maintaining immune homeostasis: To respond, or not to to respond....
Nature Reviews Immunology 8, 74-80, 2008

29. Immune Tolerance:
Central tolerance mechanisms
- Peripheral tolerance mechanisms

30. Immune Privilege vs. Immune Ignorance

31. Immune privilege
Organs with limited access to effector cells of the adaptive (and innate) immune system (passive)
and/or
Organs with enhanced immunoregulatory properties that generally prevent the induction of effector immune functions (active)

32. Nature Reviews Immunology 8, 74-80, 2008

33. Nature Reviews Immunology 8, 74-80, 2008

34. Immune Ignorance

35. Immune ignorance by the adaptive immune system outside the GALT of antigens, taken-up in the intestinal mucosa
Functional anatomy of induction of immune responses by intestinal antigens. Abundant protein antigens and live commensal bacteria are present in the intestine. Antigenic peptides can pass into the bloodstream through one of the tributaries of the hepatic portal vein or are taken up by DCs in the subepithelial region of the Peyer's patches and carried to the MLNs via the afferent lymphatics. Although it is possible for circulating peptides to tolerize T cells in the liver or peripheral lymph nodes, presentation in the MLNs is the dominant tolerogenic pathway. Commensal bacteria are also sampled by intestinal DCs and induce IgA responses in the Peyer's patches; although very small numbers of commensals can be carried to MLN by DC, systemic tolerance to these organisms is not induced. Because the commensal laden DCs do not penetrate further than the MLN, the systemic immune system is protected from unwanted priming reactions from live bacteria.
Macpherson & Smith J Exp Med. 203(3): 497–50; 2006