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IMMUNO-PARASITOLGY
Immune Response and Immuno-diagnosis
In Parasitic Diseases
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Parasite :
Multicellular : Helminths
Unicellular : Protozoa
Intracellular : Plasmodium
Extracellular : Entamoeba
Large size : antigens >>
Multi stage : variation of antigens
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Parasite infection:
Have complex multistage life
cyclesthat involve several hosts.
Route of infection can differ from
oral to penetrate through the skin
directly (hookworm) or by
infectious bites of vector ( malaria)
Many parasites are long-lived and
cause chronic infections.
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Parasite infection(contd)
chronic parasite-infections are
common owing to weak innate
immunity and parasite capacity to
evade the immune response
The immune response that
develops often proceedsto cause
pathologic changes.
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Parasite survival Strategies
Locations: Paragonimus live in a cyst in the
lung ,
Toxoplasma and larva T.spiralislive in the muscle cyst,
Plasmodium live inside the redblood cell
Migration : Hookworn (A. duodenale)move to escape the reaction ofinflammation
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Parasite survival (contd)
Antigenic variation:
VSG (variant surface
glycoprotein ) is a surface
molecules which cover the entire
surface of Trypanosoma
gambiense / T. rhodesiense
(African Sleeping sickness)
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Parasite survival (contd)
Mimicry ( mimicking host antigens) ,ex: Schistosoma
Produced soluble antigen :
depressed the immune response(ex: lymphocytotoxic fc )
Produced immunomodulator toxins:
Leishmania produce anti-oxidaseinhibit IL-12 by the infectedmacrophages
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Target organ of helminths
infection
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Response to Helminths
Multicellular: couldnt bephagocyte
exist in different stages : eggs,
larvae, adult Variation of surface antigens
Independently triggered host
immune response
Difficult to eliminate
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Response to helminths(contd)
Induced both humoral andcellular response
immunity against helminthic
infections is mediated by Th2cells, mast cells / basophils
Effector mechanism are
eosinophiland produced Ig E
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Secreted immunomodulators : e.g.
cysteine protease inhibitors
(cystatins)
Inhibit antigen processing and
presentation
reduce T cell responses
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Response to the intestinal
nematodes
Inflammation
and increase
intestinal
motility is CD4
T-cell subset
Th2 dependent
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Exception :
In schistosomiasis and filariasis ,
induced Th1 and Th2
Schstosomiasis : in early infection,dominant induced Th1.
After the worm laying eggs :
induced Th2 cell (antigen releaseis omega 1 , a glycoprotein +
ribonucleic acid activity)
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Formation of granuloma:
Eggs that trapped in the tissue
release omega 1CD4 Th2 cell ,IL-13,
Macrophage, eosinophil
granuloma
fibrosis of the liver
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Filariasis :
The presence of Wolbachia (endo
symbiotic bacteria) induce Th1 and
Th2 cell
Wolbachia induced pro-inflamary
cytokine IL-6 , TNF, macrophage
and chemotactic activity bay
neutrophils
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Out comes associated with specific immune
response to Filaria
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Immunity to Protozoa
immunity against intracellular
protozoa is principally mediated by
Th1-triggered macrophages
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Innate immunity in Malaria
Genetic :
Play role in early infection:
malaria
RBC membrane disorder:
Antigen Duffy : a receptor forP. vivax.
People with Ag Duffy (-) moreresistant P. vivax infection
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Innate immunity(contd)
Glycophorine A: receptor for P.falciparum more resistant
toP. falciparum infectionOvalocytocis
Disorder of band3
protein, more resistant to P.vivax, P. malariae andP.falciparum
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Erythrocyte disorder
G-6-PD deficiency : patients moreresistant to P. falciparum
Haemoglobinopathy: condition of RBC
influence the life of Plasmodium: Sickle cell anemia
Thalasemia
Hb -F; Hb- C; Hb-D; Hb-E
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non genetic
Hormone: pregnant woman easier to have
complicated malaria
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Immunity to Plasmodium
The Plasmodium exists in humans in :
extracellular forms: sporozoites and
merozoites,
intracellular stages in hepatocytes anderythrocytes.
Its stimulates CD4 and CD8 T cells,
gamma-delta T cells, macrophages,natural killer (NK) cells, and B cells
make antibodies against epitopes on the
surface of the sporozoite,
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Ab helping macrophage tophagocyte Trypanosome
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In toxoplasmosis
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Response to Intestinal protozoa
Gut Associated Lymphoid tissue(GALT)
Mucosal lymphoid follicles
Immunological active cell in thelamina propria
The protozoa stimulate
inflammation: Proliferation, crypt >>, atrophy of thevillous
Malabsorption syndrome
Hypermotility
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Response to intestinal protozoa
infection
Activation of Intraepithelial
lymphocyte, especially CD8+ T
cell Function:
To produce cytokine ( IFN and IL-
10) Cytotoxicity process
Apoptosis and cell regeneration
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Immune response:
Not always protected
Reinfection in Plasmodium, Ascaris infection
Not always beneficiary: Immunopathology Response
Allergic reaction:
anaphylactic shock in hydatidosis
Syndroma Loeffler
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Ag-Ab immune
complex in malaria :
glomerulonephritis
P.falciparuminfection: parasitizedred blood cells
adhere to thecerebral capillary
(Cerebral malaria)
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Immune response (contd)
Chronic Amebiasis : formation ofgranuloma surrounding the amebic
ulcer (ameboma / amebic
granuloma)
Cardiomyopathy in Chagas
disease ( Trypanosoma cruziinfection) : autoimmune reaction to
the nerve ganglion
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Onchocercosis :
Auto immune response to
microfilaria of Onchocerva
volvulusproduce blindness
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The Advantage of Immune
response :
I. Immuno-diagnosis (sero-diagnosis)
Based on antigen-antibody
reaction
Antibody / antigen detection
When do we need ??
Parasite difficult to find Pre-patent and chronic phase
Light infection (number of parasite
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II. Make vaccines
An ideal malaria vaccine : safe,cheap, easy to manufacture, easy
to administer and confer life-long
immunity against the disease
Three main types of vaccines, are
being developed:
1. A pre-erythrocytic / antisporozoite :
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1. A pre-erythrocytic /
antisporozoite :
would prevent invasion of
hepatocytes by sporozoites
and/or prevent liver-stage
parasites from developing tomaturity, e.g.:
oCSP ( circum sporozoite
protein)
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2.Againts asexual blood stage
:
to induce Ab that neutralize/
destroy the merozoites and
infected RBC, and block
cytoadherence,
Proteins identified :
MSP 1 (merozoit surfaceprotein), MSP 3
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Vaccines against asexual
blood (contd)
o apical merozoite surface
antigen 1 (AMA-1),
o the 175 kDa erythrocyte binding
antigen (EBA175)
o and rhoptry- associated protein
1 (RAP-1), RAP-2
o RESA (ring infected
erythrocyte surface antigen)
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3. Blocking transmission
inducing Ab that inactivate
gametocytes and interfere with
fertilization would prevent
transmission of the disease.
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