CELL MEDIATED

HYPERSENSITIVITY
MODERATOR-----DR .VARSHA.A.SINGH

cell mediated hypersensitivity

Hypersensitivity

cell mediated hypersensitivity

Immune system
Human bodys way of keeping its host safe from
disease and foreign invaders

cell mediated hypersensitivity

cell mediated hypersensitivity

Immune response

I.

Antibody mediated / humoral Immune response

II.

Cell mediated Immune response

Hypersensitive

reactions-

Exaggerated

immune response

cell mediated hypersensitivity

Classification
I.

Traditional classification

II. Coombs and Gell classification

III. Clinical classification

cell mediated hypersensitivity

I. Traditional classification
Immediate

Delayed

Rapid

Slow

Antibody

cell mediated

Circulating Abs present

Absent

Transferred by serum

Not transferred

Desensitization

difficult

cell mediated hypersensitivity

II. Coombs and Gell classification

cell mediated hypersensitivity

III. Classification based on Clinical

manifestaions
Immediate-anaphylaxis

Atopy
Antibody mediated cell damage
Arthus phenomenon
Serum sickness
Delayed-infection(tuberculin)

Contact dermatitis type

cell mediated hypersensitivity

10

Type v hypersensitivity
Type V hypersensitivity is the final type of

hypersensitivity
produced

with

in
the

which
property

antibodies
of

are

stimulating

specific cell targets.

Graves

disease

stimulate

the

caused

by

antibodies

thyroid-stimulating

that

hormone

receptor, leading to overactivity of the thyroid

gland.
Type II hypersensitivity
cell mediated hypersensitivity

11

Type IV hypersensitivity
Or
Cell mediated hypersensitivity
reactions

cell mediated hypersensitivity

12

Cell mediated hypersensitivity reactions / type IV

hypersensitivity

Guests who come, stay eat and react

cell mediated hypersensitivity

13

Immunological Mechanism of Type IV

hypersensitivity
1. Sensitization phase
2. Effector phase

cell mediated hypersensitivity

14

cell mediated hypersensitivity

15

Cytokines in sensitization phase

macrophage engulfs Allergen
IL2
Peptide epitopes with MHC II

IL12
Activate TH CELLS
IFN gamma & TNFb
TH
Th1(CD4 cells) & Th2(CD8cells) & activated
macrophages
cell mediated hypersensitivity

16

cell mediated hypersensitivity

17

riants

I.

of delayed hypersensitivity

Contact dermatitis

II. Infection type

III. Granulomatous

cell mediated hypersensitivity

48-72hrs
48-72hrs
21-28days

18

Contact dermatitis
Antigens

Metals-jewelry
Poisons
Ivy
Urushiol
Nickel
Chromium

cell mediated hypersensitivity

19

20

1.

Sensitization phase

cell mediated hypersensitivity

21

Effector phase

cell mediated hypersensitivity

22

Contact dermatitis

cell mediated hypersensitivity

23

Infection
Organisms-Mycobacterium tuberculosis

myco. Leprae

listeria monocytogenes
FUNGI-candida albicans

histoplasma capsulatum
VIRUS-Herpes simplex

measles
PARASITE-Leishmania spp.

cell mediated hypersensitivity

24

Tuberculin test
PPD
Intradermally

APCs engulf
memory T cells

Lymphokines

macrophages

induration and erythma

cell mediated hypersensitivity

25

Tuberculin test

cell mediated hypersensitivity

26

Granuloma
non-specific type of inflammatory response

antigenic agents or by inert foreign materials.

T lymphocytes and macrophage
granulomas are formed as the result of the
complex interaction of cytokines produced by
these cells.
(mycobacteria, fungi, etc.)
beryllium, the unknown antigen responsible for
sarcoidosis

cell mediated hypersensitivity

27

Disease manifesting type iv

granulomatous hypersensitivity
TUBERCULOSIS
LEPROSY
SCHISOTOSOMIASIS
SARCOIDOSIS
CROHNS DISEASE

cell mediated hypersensitivity

28

APC
T CELLS
TH1
IMMATURE MACRPOPHAGE
EPITHELIOID CELL
MULTINUCLEATE GIANT CELL

cell mediated hypersensitivity

29

Borderline leprosy reaction

hypopigmented skin lesions

Swollen and inflamed

IFN y secreting lymphocyets

MITSUDA REACTION M.LEPRAE ANTIGENS
KVEIM TEST-SARCOIDOSIS

cell mediated hypersensitivity

30

Autoimmune diseases associated with TYPE IV

hypersensitivity
Diabetes mellitus type 1
Multiple sclerosis
Rheumatoid arthritis
peripheral neuropathies
Hashimoto's Thyroiditis
Crohn's disease
cell mediated hypersensitivity

31

Type 1 diabetes
ISLETS OF LANGERHANS

TRAGET ANTIGENS ARE-GAD,ICA-512/IA2,PHOGRIN

AMINOACID SEQUENCE
COXSACKIE VIRUS PROTIEN AND ISLET CELL
AUTOANTIGENS

cell mediated hypersensitivity

32

Multiple sclerosis

cell mediated hypersensitivity

33

MULTIPLE SCLEROSIS
Autoreactive T cells injure brain tissue
Destruction of myelin sheath
Auto antigens are formed against

myelin basic protien

proteiolipoprotein

oligodendrocyte

cell mediated hypersensitivity

34

cell mediated hypersensitivity

35

Rheumatoid arthritis
Chronic inflammatory disease
Viruses
Mechanism- autoantibodies are directed

endothelial cells

levels of adhesion molecules

extravasation of leucocytes

CD4 T cells are predominant

CD8 cells scattered in synovial

tissue
cell mediated hypersensitivity

36

CD4 T cells IL2,TNFa,IL6,IL10,IL13,GM-CSF

tissue inflammation , proliferation ,
Cartilage damage

cell mediated hypersensitivity

37

Hashimotos thyroiditis
auto-antigens against thyroglobulin and thyroid
peroxidase.

CD8 + cytotoxic T cell mediated cell death

Recruitment of macrophage and damage to

follicles.
Goiter-an inflammatoy response

cell mediated hypersensitivity

38

Allograft rejection
Allograft as antigen
T cells are activated

MHCII CD4T Cells

IL2 release
Recognition of specific antigen
Perforins and granyzymes
Apoptosis
Monocytes by DTH

cell mediated hypersensitivity

39

Recipient antigen presenting cell

CD4+HELPER T CELLS

IFNy

graft cells
B LYMPHOCYTE
PLASMA CELL

ANTIBODIES

ACTIVATED MACROPHAGES
RENAL BLOOD VESSELS
cell mediated hypersensitivity

40