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autograft 85 autoimmune cardiac disease
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Infected
subject
Ab 1-2
Fc
Autobody.
Microorganisms
from infected
subject grown in
culture and vaccine
prepared
Autogenous vaccine.
Ab 1-2
autograft
A graft of tissue taken from one area of the body and
placed in a different site on the body of the same individual,
such as grafts of skin transferred from unaffected areas to
burned areas.
autoimmune adrenal failure
Autoimmune destruction of the adrenal gland or idiopathic
adrenal atrophy is the principal cause of primary adrenal
failure in North America. The eponym for this condition
is Addison’s disease. It typically presents in females 20 to
30 years old. It may be part of a polyglandular endocrine
disorder, but in half of the cases it is an isolated autoimmune
endocrine disorder. One study recorded 93 cases per
1,000,000 population, with 40% manifesting autoimmune
disease and 27% remaining unclassified. Autoimmune
adrenal disease is believed to comprise approximately two
thirds of the cases of primary adrenal disease in North
America. The pathologic findings in the adrenal gland
consist of inflammation with lymphocyte and plasma cell
infiltration. By the time of diagnosis, fibrosis is present.
Germinal centers are rare and antibody binding to cortical
cells can be detected by immunohistochemistry. In the
advanced stages of the disease, the adrenal cortex is completely
destroyed. Autoantibodies are present in 60 to 75%
of patients with autoimmune adrenal disease and are more
A
Fc
Killed
vaccine used
to immunize
infected host
common with polyglandular syndrome. These antibodies
are directed against specific cytochrome P-450 enzymes
involved in steroidogenesis. Antibodies to 17 α-hydroxylase
(P-450 C17), 21 α-hydroxylase (P-450 C21), and the side
chain cleavage enzyme (P-450 scc) have all been identified.
The major symptom of acute insufficiency is postural
hypotension.
Autoimmune cardiac disease.
autoimmune cardiac disease
Rheumatic fever is a classic example of microbial-induced
autoimmune heart disease. The immune response against
the M protein of group A streptococci crossreact with
cardiac proteins such as tropomyosin and myosin. The M
protein contains numerous epitopes that participate in these
crossreactions. A second crossreactive protein in the streptococcal
membrane has been purified to a series of four peptides
ranging in molecular weight from 23 to 22kD. Patients
with rheumatic fever may develop antibodies that bind to the
cytoplasm of cells of the caudate nucleus with specificity for
its cells. Autoantibodies against microorganisms crossreact
with cardiac tissue. A monoclonal antibody termed D8/17
identifies all rheumatics. It is not related to the MHC system
and serves as a B cell marker associated with rheumatic
fever, although no specific role for the antigen in the disease
has been demonstrated. Numerous microbes and viruses can
induce acute myocarditis. These cases are characterized by
the presence of lymphocytic infiltrates and increased titers
of heart-reactive antibodies. Important causative agents
include group B coxsackieviruses that cause acute cardiac
inflammation in humans. Rose et al., using an experimental
mouse model, showed that only those mice with heartreactive
antibodies in their sera went on to develop chronic
cardiomyopathy with antibodies primarily against the
cardiac isoform of myosin in their model of acute myocarditis.
Postpericardiotomy syndrome occurs in both adults and
children 10 to 14 days after surgery and is characterized by
fever, chest pain, and pericardial and pleural effusions. This
condition is associated with the presence of high titer, heart
reactive antibodies in the sera. The heart-specific antibodies
are believed to play a role in disease pathogenesis. Since
many microbes share epitopes with human tissues, crossreactions
between antibodies against the microbe and human
tissues may be harmless or may lead to serious autoimmune
consequences in genetically susceptible hosts. Although
much attention has been given to antibodies, cell-mediated
immunity may play a larger role than previously thought in
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