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  • Imunologi

  • Interactions between the two systems

  • Innate/non spesifikAdaptive/spesifik Imunitas nonspesifik yang tidak memerlukan kontak dengan antigen

    First line of defenseSecond line of defenseImunitas yang didapat dengan cara pemaparan antigen pada penjamu yang responsif.

    Third line of defense

  • humoral biokimia

  • No memory No time lagNot antigen specificA lag periodAntigen specificDevelopmentof memory

  • DEVELOPMENT OF CELLS OF THE IMMUNE SYSTEMBone Marrow

    Lymphoblasts

    Bone marrow maturation Thymus Regulator Effector B lymphocytes T cells T cells

    Memory Cells Plasma Cells Helper Supressor Cytotoxic T Cells T Cells T Cells Antobodies HUMORAL RESPONSES CELLULAR RESPONSE

  • Myeloid Cells - Granulocytic CellsInnate immunity/second line of defense Celluler Components

  • Myeloid Cells - Granulocytic CellsInnate immunity/second line of defense Celluler Components

  • Myeloid Cells - Monocytic CellsInnate immunity/second line of defense Celluler Components

  • Lymphoid CellsInnate immunity/second line of defense Celluler Components

  • Innate immunity/second line of defense Celluler Components

  • *

    InterferonProduce by virus infected cells, Enhance the activity of phagocytes and NK cellsInhibit cell growthSupress tumor formation

  • COMPLEMENTProtein yang meningkatkan fungsi respon terhadap infeksi/inflamasiClassical pathway requires an antibody and antigen to form a complexAlternate pathway requires certain polysacharrides on the surface

  • Innate immunity/second line of defense Humoral Components

  • Lysis of bacteria and some virusesOpsoninIncrease in vascular permeabilityRecruitment and activation of phagocytic cells

  • CytokinesMediator yang dihasilkan oleh sel dalam reaksi radang atau imunologik

  • Biocarta.comInnate immunity/second line of defense Humoral Components

  • Innate immunity/ second line of defense Humoral Components

  • Adaptive immunity /third line of defense Cellular dan Humoral ComponentsThree important aspects

    SpecificitySystemicProssesses memory

  • Cell-Mediated Immunity (CMI) T cellsFungi, ParasitesViruses, Some cancer cellsForeign tissue transpalantsAntibody-Mediated (Humoral) Immunity (AMI) B cellsAntigens dissolved in body fluidsExtracellular pathogens

  • Th lymphocytes (CD4, T4) T.helper immune respon yang awal

    Tc lymphocytes (CD8, T8) T.cytotoxic - responsible for cellular immunity

    Ts lymphocytesT.suppressor - menurunkan immune respon; # ThTs

    TDH lymphocytes delayed hypersensitivity

  • *CD4 T cells: Th1 , Th2 classification:----------------------------------------------------------------------------------------------CD4 T cellsTh1 cell: cytokines secreted: IL-2, IFN-g, IL-12inflammatory T cells: involved in activatingMacrophages

    NK cells

    CD8 T cells

    B cells

    Th2 cell: cytokines secreted: IL-4, IL-5, IL-6, IL-10, TGF- b helper T cells: involved in activating

    B cells4

  • CD4 T cells: Th1 , Th2 classification:

  • Antibodi

  • Class variation 1o - IgM 2o - IgG, IgA or IgE

  • Perubahan Ab 1o and 2o Responses

  • * Primary and secondary antibody responses to protein antigens differ qualitatively and quantitatively

  • Perubahan Ab 1o and 2o Responses

  • Complete antigenImmunogenecityreactivityHapten (incomplete antigen)Not immunogenicAntigen yang dapat melakukan reaksi spesifik Ag - Ab, tetapi tidak dapat merangsang pembentukan antibodi

  • Bahan asing (keasingan) Ukuran molekul BM > 10,000 ( protein, nucleoprotein, lipoprotein, glycoprotein, polysaccharida)Kerumitan struktur kimiawiKonstitusi genetikMetode pemasukan antigenDosis

  • Bagian tertentu dari molekul yang terlibat menimbulkan ikatan antibodi (biasanya pada permukaan) ; antigen binding site

  • Major Histocompatability Complex (MHC) Ag = human leucocyte-associated antigen (HLA)Kompleks aloantigen pada permukaan sel manusia = Kode yg terikat pd permukaan membran sel; khas pd setiap individu

  • MHC(Major Histocompatibility Complex)MHC class IMHC class IIMHC class IIIHLA-AHLA-BHLA-CHLA-DPHLA-DQHLA-DRExpressed to cell surfaceResponsible to endogenous antigenResponsible to exogenous antigenReleased into body solutionPredicted to be involved in complement activities

  • Dendritic cellsLangerhanscellsMacrophagesB cells

  • IMMUNE RESPONSE

  • IMMUNE RESPONSE

  • adaptive immunityIMMUNE RESPONSE

  • HoursDaysTime after infectionComplement612135NK cellsPhagocytesEpithelial barriersMicrobeT lymphocytesB lymphocytesAntibodiesEffector T cellsAdaptive immunityInnate immunity0Innate and adaptive immunityIMMUNE RESPONSE

  • IMMUNE RESPONSE

  • IMMUNE RESPONSE

  • *Fungsi Efektor AntibodiAbbas.A, Basic Immunology, 2 ed, 2004AIMMUNE RESPONSE

  • IMMUNE RESPONSE

  • AgIMMUNE RESPONSEIL-12/1L-1FASTTNF-, IFN-IL-2, IFN-IL-16Th-2IL-4IL-6IL-5Abnormal cellIFN-Th-1IL-2NK cellActivated NK cellLysis cellCYTOKINEAbnormal cellFC-RCTLB-lymphMemory cellMHC-IMHC-IIAPC

  • infectionimmunity

  • respon imunitas yang berlebihan atau tidak sesuai.menimbulkan manifestasi klinik dan patologik yang sangat heterogenkontak yang kedua dengan antigen spesifik (alergen)

  • Gell & CombsTIPE 1 anaphylactic reactionTIPE 2cytotoxic reactionTIPE 3Immune complex reactionTIPE 4Delayed hypersensitivity reaction

  • Reaksi Tipe I, II, III terjadi karena:interaksi antigen-antibodi reaksi humoralreaksi tipe segera (immediate)Reaksi Tipe IV terjadi karena:interaksi antigen-reseptor limfosit Treaksi selularreaksi tipe lambat (delayed)

  • Contoh immediate hypersensittivity: type IANAPHYLAXISRespons anafilaktik yang mengancam jiwa akibat sensitisasi oleh alergen spesifik yang dalam hitungan menit dapat diikuti oleh kegagalan napas, edema larings dan spasme bronkhus, kolaps pembuluh darah atau renjatan, manifestasi gastrointestinal (nausea, vomiting, nyeri abdomen, diare) serta manifestasi kulit (pruritis, urtikaria, angioedema) (Austen, 2005)

  • Clinical manifestations of immediate hypersensitivity reactions

    CLINICAL SYNDROMECLINICAL AND PATHOLOGIC MANIFESTATIONSAllergic rhinitis, sinusitis (hay fever)Increased mucus secretion,;inflammation of upper airways, sinusesFood allergiesIncreased peristalsis due to contraction of intestinal musclesBronchial asthmaBronchial hyper-responsiveness caused by smooth muscle contraction; inflammation and tissue injuery caused by late hase reactionAnaphylaxis (may be caused by drugs, bee sting, food)Fall in blood pressure (shock) caused by vascular dilatation; airway obstruction due to laryngeal edema

  • Treatment of immediate hypersensitivity reactions

    SYNDROMETHERAPYMECHANISM OF ACTIONAnaphylaxisEpinephrineCauses vascular smooth muscle contraction; increase cardiac output (to counter shock); inhibits further mast cell degradationBronchial asthmaCorticosteroidsPhosphodiesterase inhibitorsReduce inflammationRelax bronchial smooth musclesMost allergic diseaseDesensitization (repeated administration of low doses of allergens)Anti-IgE antibody (in clinical trials)Antihistamines Cromolyn Unknown; may inhibit IgE production and increase production of other Ig isotypes; may induce T cell toleranceNeutralized and eliminate IgE

    Block actions of histamines on vessels and smooth musclesInhibits mast cell degranulation

  • Rasa gatal dimulai telinga dan kulit kepalaAngioedema, sesak napas, urtikaria, lemah, tekanan darah menurun, shockKematian akibat gagal pernapasan/ respiratory failureAnapylactic shock sering pada orang dengan atopik alergy (predisposisi familial/genetik)

  • Pengobatan dan pencegahan :Menghentikan aksi mediator dengan mempertahankan jalan nafas, memberikan ventilasi buatan dan mempertahankan fungsi jantungInjeksi adrenalin 1 : 1000, sebanyak 0,1 0,3 ml i.c, kortikosteroid, antihistaminPencegahan : tes kulit dan menghindari alergen

  • Reaksi IgM / IgG dengan Ag yang berikatan pada sel aktivasi komplemen (jalur klasik) fagositosis & lisis sel sasaran (ADCC / Antibody dependent cellular cytotoxicity)

  • Diperani oleh IgG dan IgMAntigen pada dinding sel, dapat berupa haptenAntibodi spesifik terikat pada antigenKadang-kadang mengikat komplemenSel mengalami lisis

  • Yang termasuk tipe II : Reaksi transfusiRhesus incompatibilityTransplantasi organAuto reaksi

  • Immune complex reaction.Diperani oleh IgG dan IgMReaksi imun terbentuk antigenantibodi kompleks pada dinding pembuluh darah dan cairan lainnya reaksi inflamasi

  • AntigenNon-Self antigens ; infeksi virus (hepatitis B), bakteri (streptococcus dan staphylococcus), jamur ( Aspergillus), protozoa (malaria), dan protein asing (serum).Self antigens : DNA, RNA, cytoplasm, dan jaringan.

  • Kompleks imun pada keadaan normal segera disingkirkan secara efektif oleh jaringan retikuloendot