Lecture outline • Self-tolerance: concept, significance • Mechanisms of central and peripheral tolerance: deletion, anergy, regulatory T cells • Pathogenesis of autoimmunity: roles of susceptibility genes and environmental factors
Dec 18, 2015
Lecture outline
• Self-tolerance: concept, significance
• Mechanisms of central and peripheral tolerance: deletion, anergy, regulatory T cells
• Pathogenesis of autoimmunity: roles of susceptibility genes and environmental factors
ActivationEffector T cells
Normal: reactions against pathogens
Pathologic: inflammatory
disease, e.g. caused by reactions against self
ToleranceRegulatory T cells
No response to selfControlled response
to pathogens
The immunological equilibrium: balancing lymphocyte activation
and control
The problem of self-nonself discrimination
• The immune system responds to many foreign (microbial) antigens but not to self antigens
• Developing lymphocytes express a large number of antigen receptors, not biased by specificity
• Therefore, all individuals produce lymphocytes with the ability to recognize self antigens
• Self antigens have access to the immune system
• Therefore, self-reactive lymphocytes must be selected against (eliminated or inactivated) to prevent autoimmunity
Immunological tolerance
• Definition: – specific unresponsiveness to an antigen
that is induced by exposure of lymphocytes to that antigen (implies antigen specificity, in contrast to “non-specific immunosuppression”)
• Significance:– All individuals are tolerant of their own
antigens (self-tolerance); breakdown of self-tolerance results in autoimmunity
– Therapeutic potential: Inducing tolerance may be exploited to prevent graft rejection, treat autoimmune and allergic diseases, and prevent immune responses in gene therapy, perhaps stem cell transplantation
The principal fate of lymphocytes that recognize self antigens in the generative organs is death (deletion), BUT:
Some B cells may change their specificity (called “receptor editing”)
Some T cells may differentiate into regulatory (suppressor) T lymphocytes
Central and peripheral tolerance
Mechanisms of unresponsiveness to self antigens
• Central tolerance: Immature self-reactive lymphocytes that recognize self antigens in generative (“central”) lymphoid organs die by apoptosis; other fates
• Peripheral tolerance: Mature self-reactive lymphocytes that recognize self antigens in peripheral tissues are inactivated (anergy), killed (deletion) or suppressed
• “Clonal ignorance”: Mature self-reactive lymphocyte clones do not encounter or respond to self antigens
• In normal individuals it is not known which self antigens induce tolerance by which mechanism
Central T cell tolerance
Consequences of AIRE mutation
• Human disease: autoimmune polyendocrinopathy with candidiasis and ectodermal dysplasia (APECED), also called autoimmune polyendocrine syndrome (APS-1)– Associated gene identified by positional
cloning, named AIRE (“autoimmune regulator”)
• Mouse knockout: autoantibodies against multiple endocrine organs, retina– Failure to express many self antigens in the
thymus --> failure of negative selection
Deletion of self-reactive T cells in the thymus:how are self antigens expressed in the thymus?
AIRE (autoimmune regulator) is a regulator of gene transcription that stimulates thymic expression of many self antigens which are largely restricted to peripheral tissues
Discovered as the genetic cause of a human autoimmune disease (APS-1)
Central tolerance: fates of immature self-reactive lymphocytes
• Induced by antigen in generative lymphoid organs (thymus for T cells, bone marrow for B cells), and high-affinity (“strong”) recognition of the antigens
• Immature lymphocytes undergo apoptosis upon encounter with antigens (negative selection)– Eliminates high-affinity self-reactive (potentially
most dangerous) lymphocytes• Some self-reactive T cells that encounter
self antigens in the thymus develop into regulatory T cells and immature B cells in the bone marrow change their receptors (rendered harmless)
APC TCR
T cellCD28
ActivatedT cells
APC TCR
Functionalunresponsiveness
Normal T cellresponse
Anergy
Apoptosis(activation-induced
cell death)APC
Deletion
APC
Block in
activationSuppression
RegulatoryT cell
Peripheral tolerance
Off signals
ActivatedT cell
APCTCR
NaïveT cell
Immunogenic antigen
(microbe, vaccine)
Tolerogenic antigen
(e.g. self)
Effector and memory cells
Tolerance: functional inactivation or cell
death, or sensitive to suppression
Antigen (peptide +
HLA): signal 1
Costimulation (signal 2)
Peripheral tolerance 12
T cell anergy
T cell anergy (“clonal anergy”)
• Induced by self antigens that are displayed to the immune system without inflammation or innate immune responses (prolonged signal 1, i.e. antigen, inadequate signal 2)
• Recognition of such antigens may lead
to signaling block and/or engagement of inhibitory receptors
• Role of anergy in self-tolerance in humans is unclear; therapeutic potential?
“Activation-induced cell death”: death of mature T cells upon recognition of self antigens
Deletion (activation-induced cell death)
• Stimulation of T cells by self antigen triggers apoptosis by engagement of death receptors (“death receptor pathway”) or imbalanced expression of pro-apoptotic proteins (“mitochondrial pathway”)
• Evidence for the importance of AICD in maintenance of self-tolerance:– Mice with mutations in Fas or Fas ligand
develop a lupus-like autoimmune disease– Humans with mutations in Fas or enzymes
involved in death receptor-induced apoptosis (caspases): the autoimmune lymphoproliferative syndrome (ALPS)
– Eliminating both death pathways in mice --> “spontaneous” systemic autoimmune disease
Regulatory T cells
Abbas, Lichtman and Pillai. Cellular and Molecular Immunology, 7th edition, 2011 c Elsevier
Regulatory T cells
• Regulatory T cells are CD4+ cells that express high levels of CD25 (IL-2 receptor a chain)– Generated by self antigen recognition in
the thymus or peripheral tissues– Generation requires a transcription
factor called Foxp3 (mutations in Foxp3 are the cause of a severe autoimmune disease in humans and mice)
Regulatory T cells
• Regulatory T cells are CD4+ cells that express high levels of CD25 (IL-2 receptor a chain)
• Mechanism of action: may be multiple– Secretion of immune-suppressive
cytokines– CTLA-4 on Tregs blocks B7 on APCs
• Significance for self-tolerance:– Some autoimmune diseases may be
associated with defects in regulatory T cells or resistance of responding cells to suppression
– Therapeutic potential of cellular therapy (autoimmune diseases, graft rejection, etc)
Tolerance in B lymphocytes
• Central tolerance:– Deletion of immature cells by high-
affinity antigen recognition in the bone marrow
– Some immature cells may change their antigen receptors when they encounter antigens in the bone marrow (“receptor editing”)
• Peripheral tolerance:– Anergy– Exclusion from lymphoid follicles, death
because of loss of survival signals
Autoimmunity
• Definition: immune response against self (auto-) antigen, by implication pathologic
• General principles:– Pathogenesis: The development of
autoimmunity reflects a combination of susceptibility genes and environmental triggers (usually infections)
– Different autoimmune diseases may be systemic or organ-specific; may be caused by different types of immune reactions (antibody- or T cell-mediated)
Autoimmunity
• Definition: immune response against self (auto-) antigen• General principles:
– Pathogenesis: The development of autoimmunity reflects a combination of susceptibility genes and environmental triggers (usually infections)
– Different autoimmune diseases may be systemic or organ-specific; may be caused by different types of immune reactions
• Challenges in understanding pathogenesis of human autoimmune diseases:– Failure to identify target antigens,
heterogeneous disease manifestations, disease may present long after initiation
– Recent advances: identifying self antigens (MS, type 1 diabetes); genetic analyses; improved methods for studying immune system of patients
Pathogenesis of organ-specific autoimmunity
Abbas, Lichtman and Pillai. Cellular and Molecular Immunology, 7th edition, 2011 c Elsevier
Genetic basis of autoimmunity -- 1
• Genetic predisposition of autoimmune diseases– Increased incidence in twins (more in
monozygotic than in dizygotic twins)– Identification of disease-associated genes
by breeding and genomic approaches
• Multiple genes are associated with autoimmunity– Most human autoimmune diseases are
multigenic– Single gene mutations and mouse
knockouts reveal critical pathways
Genetic basis of autoimmunity -- 2
• MHC genes– Major genetic association with
autoimmune diseases (relative risk of disease in individuals with particular HLA haplotypes)
– Disease-associated alleles are present in normal individuals
• Non-MHC genes:– Many loci identified by genome-wide
association and linkage studies– Most are chromosomal locations; actual
genes and roles in disease are largely unknown
– Recent discoveries: NOD-2, PTPN-22, CD25
Genetic basis of autoimmunity -- 3
• Genome wide association studies are revealing genetic polymorphisms associated with autoimmune diseases – Crohn’s disease:
• NOD-2: microbial sensor in intestinal epithelial and other cells
• IL-23 receptor: involved in TH17 responses– Rheumatoid arthritis, others:
• PTPN-22 (tyrosine phosphatase): may control kinase-dependent lymphocyte activation
– Multiple sclerosis, others:• CD25 (IL-2 receptor): role in T cell activation
and maintenance of regulatory T cells
Genetics of autoimmunity: challenges
• Difficult to relate complex genotypes to phenotypic and functional abnormalities, to better understand pathogenesis
• Limitations of GWAS: misses rare mutations
• Identified disease-associated polymorphisms have small effects, therefore little predictive value
• Because of small effects of any one gene, targeting these genes therapeutically is unlikely to have significant benefit
Genes encoding antigen receptor specific for a myelin antigen
Transgenic mouse withmyelin-specific T cells
Normal mouse colony
CNS disease
Pathogen-free mouse colony
No disease
Infections predispose to autoimmunity
Infections and autoimmunity
• Infections trigger autoimmune reactions– Clinical prodromes, animal models– Autoimmunity may develop after
infection is eradicated (i.e. the autoimmune disease is precipitated by infection but is not directly caused by the infection)
– Some autoimmune diseases are prevented by infections (type 1 diabetes, multiple sclerosis, others? -- increasing incidence in developed countries): mechanism unknown; similar protection suggested for asthma• The “hygiene hypothesis”
Mechanisms by which infections may promote autoimmunity
Pathogenesis of autoimmunity
Immune-mediated inflammatory diseases
• Chronic diseases in which inflammation is a prominent component and the immune system reacts excessively against one or more tissues
• Immune-mediated inflammatory diseases develop because the normal controls on immune responses fail; typically due to autoimmunity but may be excessive reactions to microbes – MS, type 1 diabetes, RA: autoimmunity– Crohn’s: reaction against gut microbes?