IMMUNOPATHOLOGY OF ORAL DISEASESBYDR. FAMUREWA B.A.OUTLINEIntroductionReview of baic I!!uno"o#$Ora" cavit$ and i!!une $te!I!!uno%at&o"o#$ of co!!on ora" "eion'onc"uion()*)*+,* * FAMUREWA B.A. B'&DIntroduction Immunology is ot! t!" study o# t!" immun" syst"m $nd t!" %"ld t!$t tr"$ts dis"$s"s o# t!" immun" syst"m& Immunity is t!" ody's $ility to r"sist $ dis"$s"( $nd t!" immun" syst"m is $ ody )id" n"t)or* o# int"r$cting syst"ms+ on" m$rro)( )!it" lood c"lls( t!" "ntir" lym,! syst"m $nd "-"n mucos$l sur#$c"s ()*)*+,* - FAMUREWA B.A. B'&DNORMAL IMMUNE .Y.TEMT&e i!!une $te! function i to reco#nie %otentia""$ infectiou !icrobia" a#ent /virue0 bacteria0 fun#i0 %roto1oa0 and %araite a forei#n and to e"i!inate t&e! fro! t&e bod$.An i!!une re%one invo"ve two functiona" $te!2,.T&e innate $te!0 or 3rt "ine of defene.*.T&e ac4uired or ada%tive $te!0 t&e %eci3c re%one.()*)*+,* 5 FAMUREWA B.A. B'&DInnate veru ac4uired i!!unit$Inornnon.s,"ci%c+ /ody r"s,onds t!" s$m" )$y to $ll antigensIn-ol-"s phagocytes N$tur$l *ill"r c"lls in-ol-"dInclud"s c!"mic$ls suc! $s lyso0ym"( l$cto#"rrin "tc&E,it!"li$l $rri"r in-ol-"d Alt"rn$t" com,l"m"nt ,$t!)$y in-ol-"d&Inn$t" immunityAc1uir"d immunityAd$,ti-"D"ri-"d during li#"S,"ci%cIn-ol-"s ,rior s"nsiti0$tionD","nds on g"n"r"$rr$ng"m"nts 2lon$l "3,$nsion im,ort$nt2onst$ntly "-ol-"s/$sis o# -$ccin$tionM$y " $cti-" or ,$ssi-"()*)*+,* 6 FAMUREWA B.A. B'&DIMMUNE .Y.TEMT&e !a7or contituent of innate i!!unit$ are oT&e ce""u"ar co!%onent0 re%reented b$ 8&a#oc$te.Natura" 9i""er /N:;ce"".oT&e !o"ecu"ar co!%onent inc"ude t&e co!%"e!ent cacade.'$to9ine.()*)*+,* < FAMUREWA B.A. B'&D'o!%"e!ent $te!2om,l"m"nt syst"m i a bioc&e!ica" cacade t&at attac9 t&e urface of forei#n ce"". It contain at "eat *+ di=erent %rotein and i na!ed for it abi"it$ to >co!%"e!ent? t&e 9i""in# of %at&o#en b$ antibodie. 'o!%"e!ent i t&e !a7or &u!ora" co!%onent of t&e innate i!!une re%one()*)*+,* @ FAMUREWA B.A. B'&D'o!%"e!ent $te!8at&wa$ of co!%"e!ent activation2'"aica" %at&wa$A"ternate %at&wa$MannanAbindin# "ectin %at&wa$ Classical pathway by antigen-antibody immunecomplexes, apoptotic cells, C-reactive protein boundto ligand and certain viruses and bacteria.Alternative pathway by bacterial endotoxin, fungal cellwalls, viruses and tumour cells.Fro! '"inica" i!!uno"o#$ in :u!ar B '"ar9()*)*+,* ( FAMUREWA B.A. B'&DIMMUNE .Y.TEM()*)*+,* C FAMUREWA B.A. B'&DIMMUNE .Y.TEMT&e ada%tive i!!une $te! conit of2 'e""u"ar i!!unit$ /"$!%&oc$te and t&eir %roduct;. Du!ora" i!!unit$ /Antibodie;.()*)*+,* ,+ FAMUREWA B.A. B'&D()*)*+,* ,, FAMUREWA B.A. B'&DI!!une ce"" T&ee are ce"" invo"ved in %reventin# or co!batin# invaion b$ forei#n a#ent /biotic and abiotic; a we"" a !aintainin# #rowt& c$c"e &o!eotai b$ detruction of neo%"atic ce"". T&e$!a$ be c"ai3ed a2 anti#en %reentin# ce"" /A8'; and i!!une e=ector ce""()*)*+,* ,* FAMUREWA B.A. B'&DAnti#en %reentin# 'e""T&ee de#rade forei#n bodie and !icrobe into readi"$ identi3ab"e %artic"e and %reent t&e! for reco#nition b$ i!!une e=ector ce"". T&e$ inc"ude2Dendritic ce""Lan#er&an ce""Macro%&a#e()*)*+,* ,- FAMUREWA B.A. B'&D()*)*+,* ,5 FAMUREWA B.A. B'&DIMMUNE EFFE'TOR 'ELL./.lym,!ocyt"s 4 ,l$sm$ c"llsT.lym,!ocyt"sN$tur$l *ill"r c"llsIt is noteworthy that immunity is a specific responseto foreign agents (biotic and abiotic) in contrast to inflammation which is a non-specific response of vascularised tissue to injury. ()*)*+,* ,6 FAMUREWA B.A. B'&DT.lym,!ocyt"sMediate ce""u"ar i!!unit$. P!$gocyt" disord"rs2Disorder Inheritance Clinical Features herapy!) Chronic granu-lomatousdisease"-lin#ed ($$%)&autosomal re cessive (''%)Infections with catalase-positive bacteria and fungi affecting s#in( lungs( liver& granuloma formation& )* test is screening test+ntibiotics&,-interferon-).yelopero/idase deficiency+utosomal0ecessiveFungal infections (candidiasis) in deep tissues( especially in presence of diabetes+ntibiotics')1eu#ocyteadhesiondeficiency+uto somalrecessiveDelayed separation of the umbilical cord& s#in infections& otitis media& pneumonia& gingivitis& periodontitis+ntibiotics2)+bnormalchemota/is-3yper Ig4-chedia#-3igashi5ariable 0ecurrent s#in infections with staphylococci. enteric bacteria( )europathy( 6cculo cultaneous albinism in chedia# higashi+ntibioticsClinicalfeatures7+ffectedindividualsarepronetoinfectionswithlow-grade bacteria such as Staphylococcus aureus and gram-negative enteric bacteria. 8hagocyte Disorders in Children ()*)*+,* -( FAMUREWA B.A. B'&D-C=D> 2om,l"m"nt disord"rs!.Deficiencyofearlycomplementcomponents(C1,C4, C2)resultsinasymptomcomplexresemblingcollagen vasculardisorders(e.g.,systemiclupuserytematosus (!"#)$ and increased susceptibility to pyogenic infections.-.C'deficiencyresultsinseverepyogenicinfections. !everal patients ave also ad !"# and glomerulonepritis.'. Deficiency of late complement components (C%, C&, C', C()resultsinsystemicNeisseriainfectionssucas meningococcalsepsisandmeningitis,anddisseminated gonococcal infections.2. +bnormalities of the control proteins of the alternative pathway(factor),factor*,properdin)mayresultin recurrent infections.9.Deficiencyofcomplementinhibitors(C1esterase inibitor,carboxypeptidase+)leadstorecurrent angioedema.()*)*+,* -C FAMUREWA B.A. B'&D5+/.2"ll D"%ci"ncy Disord"rsDisorder Clinical Features herapy!- "-lin#ed agammaglobu-linemia (*ruton disease)0ecurrent pyogenic infections& infections of lungs( sinuses( middle ear( s#in( central nervous systemImmune serum globulin&antibiotics--ransient hypogamma-globulinemia of infancy (!st ' years of life)0ecurrent pyogenic infections& fre:uent in families with other immunodefi ciencies+ntibiotics& immune serum globulin (selected patients)'-;elective immuno-globulin deficiency(Ig+( Ig.( Ig< sub classes)0ecurrent infections of lungs( sinuses& gastrointestinal disease& allergy& fre:uent in families with common variable immunodeficiencies+ntibiotics& immune serum globulin (Ig< subclass defi ciencies only)2-Immunoglobulin defi ciency with increased Ig. (and IgD)Infections of lungs( sinuses( middle ear& increased fre:uency of autoimmune disease 4ctodermal displaseaImmune serum globulin& antibiotics9-Common variableimmunodeficiencyInfections of lungs( sinuses( middle ear& giardiasis& malabsorption& autoimmune diseaseImmune serum globulin& antibiotics()*)*+,* 5+ FAMUREWA B.A. B'&D5,T.2"ll $nd 2omin"d D"%ci"ncyDisorder Clinical Features herapy=;evere combined immuno deficiency= )e>elof syndrome0ecurrent infections& wasting& chronic diarrhea& failure to thrive7 graft versus host disease( anemia( +lopecia*one marrow transplantation+ntibiotics and I5 IgDefects of the purine sal vage pathway-+denosine deaminase deficiency-8urine nucleoside phosphorylase deficiency0ecurrent infections& dysostosis (adenosine deaminase deficiency)& anemia and mental retardation (purinenucleoside phosphory lase deficiency)0ib and ;capula abnormality in +D+*one marrow transplan tation& en>ymereplacement therapy=Diema& thrombocytopenia& susceptibility toinfections& malignancy& small( defective platelets*one marrow transplantation& antibiotics& splenectomy=;hort-limbed dwarfismCaltilage hair hypoplasia ;hort-limbed dwarfism& lymphopenia Immune serum globulinI5 Ig( +ntibotics()*)*+,* 5, FAMUREWA B.A. B'&D.econdar$ i!!unode3cienc$Modi3cation or u%%reion of i!!une $te! co!%onent b$ eFo#enou factor. T&ee are2 InfectionMa"i#nanc$Ma"nutritionDru#Trau!a A#ein# At&$!u deterioration [ no new Tce"" [ a"o a=ect antibod$ %roduction.()*)*+,* 5* FAMUREWA B.A. B'&D.econdar$ i!!unode3cienc$Infection\ Bacteria" S e.#. M$cobacteriu! "e%raeS Tubercu"oid "e%ro$2 antibod$ de3cienc$S Le%ro!atou "e%ro$2 evere TAce"" de3cienc$\ Rira"S Mea"e S tranient u%%reion of N:0 T B B ce""S Der%e /E%tein Barr0 D.R0c$to!e#a"oviru;S InUuen1aS DIR()*)*+,* 5- FAMUREWA B.A. B'&D.econdar$ i!!unode3cienc$Ma"i#nanc$I!!unode3cienc$ caued b$ "$!%&oid tu!our e.#"eu9ae!ia0 "$!%&o!a0 %"a!a ce"" d$craia\ Dod#9inT "$!%&o!a2 caue c"aic eFa!%"e ofTAce"" de3cienc$\ '&ronic "$!%&oc$tic "eu9ae!ia2 caue c"aic eFa!%"e of BAce"" de3cienc$.()*)*+,* 55 FAMUREWA B.A. B'&D.econdar$ i!!unode3cienc$Dru#'$totoFic dru# e.#. a1at&io%rine and c$c"o%&o%&a!ide 9i"" tu!our ce"" but a"o "$!%&oc$te 'orticoteroidS Down re#u"ate "$!%&oc$tic #eneS Mi!ic action of #"ucocorticoid()*)*+,* 56 FAMUREWA B.A. B'&D.econdar$ i!!unode3cienc$Trau!a L"ucocorticoid re"eaed natura""$ in re%one to burn0ur#er$ and an$ ot&er treor induceI!!unode3cienc$..$te!ic dieae "i9e diabeti !e""itu0 ne%&rotic $ndro!e ()*)*+,* 5< FAMUREWA B.A. B'&D.econdar$ i!!unode3cienc$Ma"nutrition\ Mot co!!on caue of *Z i!!une de3cienc$\ 8roteinA'a"orie !a"nutrition can "ead to abnor!a"itie of T ce""0 B ce""B %&a#oc$te\ Atro%&ic and 3brotic t&$!u\ Reduced "$!%&oc$te %ro"iferation in re%one to anti#en.()*)*+,* 5@ FAMUREWA B.A. B'&DDY8ER.EN.ITIRITY REA'TIONA tate of a"tered reactivit$ in w&ic& t&e bod$ react wit& an eFa##erated i!!une re%one to w&at i %erceived a a forei#n ubtance /eFo#enou a""er#en; or an endo#enou anti#en.()*)*+,* 5( FAMUREWA B.A. B'&DDY8ER.EN.ITIRITY REA'TIONTy," Prototy," Disord"rImmun" M"c!$nismsP$t!ologic L"sionsI!!ediate /t$%e I;&$%erenitivit$Ana%&$"aFiP a""er#ieP bronc&ia" at&!a/ato%ic for!;8roduction of I#E antibod$ A i!!ediate re"eae of vaoactivea!ine and ot&er !ediator fro! !at ce""P recruit!ent ofinUa!!ator$ ce"" /"ateA%&ae reactionRacu"ar di"ation0 ede!a0!oot& !uc"e contraction0!ucu %roduction0inUa!!ationAntibod$A!ediated /t$%e II;&$%erenitivit$Autoi!!une &e!o"$tic ane!iaP Lood%ature$ndro!e8roduction of I#L0 I#M A bind to anti#en on tar#et ce"" or tiue A%&a#oc$toi or "$i of tar#et ce"" b$ activated co!%"e!ent or Fc rece%torP recruit!ent of "eu9oc$te'e"" "$iP inUa!!ation()*)*+,* 5C FAMUREWA B.A. B'&DDY8ER.EN.ITIRITY REA'TIONTy," Prototy," Disord"rImmun" M"c!$nismsP$t!ologic L"sionsI!!une co!%"eFA!ediated/t$%e III; &$%erenitivit$.$te!ic "u%u er$t&e!atouP o!e for! of #"o!eru"one%&ritiP eru! ic9neP Art&u reactionDe%oition of anti#enAantibod$ co!%"eFe A co!%"e!ent activationA recruit!ent of "eu9oc$te b$ co!%"e!ent %roduct and Fc rece%tor A re"eae of en1$!e and ot&er toFic !o"ecu"eNecroti1in# vacu"iti/3brinoid necroi;PinUa!!ation'e""A!ediated /t$%e IR;&$%erenitivit$'ontact der!atitiP !u"ti%"e c"eroiP t$%e I0 diabeteP tran%"ant re7ectionP tubercu"oiActivated T "$!%&oc$te Are"eae of c$to9ine and !acro%&a#eactivationPT ce""A!ediated c$totoFicit$.8erivacu"ar ce""u"arin3"trateP ede!aP ce""detructionP #ranu"o!afor!ation()*)*+,* 6+ FAMUREWA B.A. B'&DAutoi!!une dieaeInvo"ve t&e "o of nor!a" i!!une &o!eotai uc& a t&at bod$ %roducean abnor!a" re%one to it own tiue8reence of e"fAreactive T ce""0 autoantibodie and inUa!!ation.EFa!%"e S 'e"iac dieae0 LraveT dieae0 AddionT dieae.Fai"ure of to"erance or inco!%"ete to"erance reu"t in autoi!!une dieae ()*)*+,* 6, FAMUREWA B.A. B'&DAutoi!!une dieae'"inica" feature,.'o!!oner in fe!a"e*.Onet i !idd"e a#e/V56$ear;-.Fa!i"$ &itor$ i fre4uent"$ %oitive5.Raied "eve" of I# autoantibodie6.'ircu"atin# antibod$ i fre4uent"$ detectab"e in una=ected fa!i"$ !e!ber()*)*+,* 6* FAMUREWA B.A. B'&DAutoi!!une dieae'"inica" feature2