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The immunogenicity of liver transplant is hard to understand. For me at least, This is how I am going to attempt the long question in examination
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Liver Immunogenicity- Basics

1. After liver transplant the lymphocytes of the recipient consider the cells of transplanted organ as foreign and the process of rejection begins.

2. The foreign antigen is presented to the host lymphocytes by antigen presenting cells (APC) like macrophages and dendritic cell. These APC phagocytose the foreign cells and present them as epitopes on their surface

3. The lymphocyte during its development in thymus can recognice only a specific type of epitope

4. Stimulation of a resting lymphocyte by the antigen for which it is specific causes it to transform into a large active cell that secretes chemical communicators called cytokines

5. Cytokines lead to the immune reaction and ultimately allograft rejection

6. The immuno suppresants can act at three stages

a) Simply deplete circulating lymphocytes by destroying them.

b)  Interrupt the early events of antigen-induced T-lymphocyte activation and cytokine production crucial for the subsequent cascade of immunologic events leading to graft rejection

c) Metabolic inhibition to inhibit lymphocyte production




Cells involved in Immuno Reactivity

1. T cells B cells and APC cells - all are produced by haematopoietic stem cells

2. T cells mature in thymus and become mature by positive and negative selection. They achieve T cell receptor (TCR) in thymus

3. Self tolerance is achieved in thymus by both central and peripheral mechanisms. In thymus cells either bind to CD4 or CD8. Those who bind to neither CD4 or CD8  die out by positive selection. If they react too strongly to self-antigen MHC complexes, they are deleted from the immune repertoire, a phenomenon termed negative selection

3. Markers associated with T cell receptors are CD3, 4, 5, 8 , 28 etc

4. Important are CD4 and CD8

CD4 express class II MHC and CD8 express class I MHC





Apoptosis

Not all activated cells proliferate. Apoptosis is a form of regulated cell death. In apoptosis, the nucleus of the cell condenses and becomes fragmented, the plasma membrane becomes vesiculated, and the dead cell is rapidly phagocytosed. There is subsequently no release of the cellular contents, and an inflammatory response does not occur. This programmed cell death is an important homeostatic mechanism that limits the lymphoid pool, allowing it to remain relatively constant throughout a lifetime.

Fas is a surface receptor expressed on activated T cells. The expression of FasL occurs in response to increased levels of IL-2 secreted by activated T cells. This expression of Fas and FasL leads to cell death through apoptosis. The Fas/FasL system is believed to be one mechanism to control immune responses from being too robust.



Interaction between cells

1. Cells that play a role- T cells, B cells, APC, Cytokines

2. Activated macrophages produce IL1 which further amplifies the response and stimulates activation of T cells and B cells

3. TCR complex on the host binds to MHC on the APC ( Tcell complex= T cell + CD3)  . This is stabalized by co stimulatory molecules

4. This interaction leads to intra cellular signalling resulting in cell activation

5. Activated T cells produce IL 2 exerting an autocrine and paracrine response

6. IL 2 binds with IL2 receptors and cell proliferation starts

7. Co stimulatrory pathways also take part in the above
Major HIstocompatibility Cells ( MHC)

1. MHC is the region of highly conserved polymorphic genes. They are located on chromosome 6 The proteins they form are attached to a variety of cell surface

2. They are important because recipient T cells do not recognise antigens as free or soluble form. They recognise antigen only bound to MHC molecule

3. Two types of cell surface MHC molecule Type I which bind to CD8 and Type II which bound to CD4 cells

Now then what are HLA

4. Human Leukocyte antigen are the protein products of MHC genes

5. They are of mainly two types HLA I and HLA II

a) Class I molecules important to transplantation in humans are expressions of HLA-A, HLA-B, and HLA-C genes. HLA-E, HLA-F, and HLA-G are more conserved but may later demonstrate importance in transplantation.

b) The class II molecules are expressions of HLA-DR, HLA-DQ, HLA-DP, and HLA-DM genes.

c) There are class III molecules, but they are not cell surface proteins involved in antigen recognition.


6. Class I and class II HLA are vital for T cell and B cell interactions.

7.  HLA class I molecules are present on all nucleated cells. In contrast, class II molecules are found almost exclusively on cells associated with the immune system (macrophages, dendritic cells, B cells, and activated T cells). Resting T cells do not express class II molecules

8. Class I molecules contain peptides that originate inside the cell whereas class II molecules hold peptides that were outside the cell, have been internalized, and were degraded in lysozymes



29th Sept 11- Hydatid Cyst Liver

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