Davorin Lukman, Ruth Klein
LABOKLIN GmbH&Co.KG; Bad Kissingen, Njemačka
Izlaganje sa Znanstveno-stručnog skupa
Izvor: Zbornik radova Veterinarski dani, Primošten, 2019.
U veterinarskoj medicini, broj pacijenata s autoimunim bolestima, kreće se od 0,5-3%, no treba naglasiti, da je taj podatak vjerojatno daleko ispod stvarnog broja. Razlog je, nedovoljna informiranost te nekorištenje dijagnostičkih mogućnosti, koje pruža današnja klinička laboratorijska dijagnostika.
Osim hematopoetskog sustava, štitnjače, kože, autoimune bolesti mogu zahvatiti i muskulaturu, neurološki sustav, zglobove, odnosno svaki organ u tijelu. Imunosni sustav dijelimo na središnji, kojim dominira prsna žlijezda, zatim koštana srž, odnosno Fabricijeva burza u ptica, a periferni dio čine limfni čvorovi, slezena i limfno tkivo.
Treba istaknuti, da već u embrionalnom razdoblju T-limfociti imaju mogućnost programiranog samoprepoznavanja, a slijedeća zaštita od autoimunih poremećaja su kriptični epitopi, koji stimuliraju sustav otklanjanja potencijalno autodestruktivnih i autoreaktivnih T-limfocita.
Molekularnim patološkim restrukturiranjem, dolazi do poremećaja imunosne regulacije, čime nastaje imunološki odgovor stvaranjem antitijela protiv vlastitih, endogenih tvari u organizmu. Takav poremećaj može nastati prikrivenom infekcijom, što se u literaturi naziva mimikrijom, zatim zbog genetske dispozicije, kao i zbog disbioze intestinalnih mikrobiota. Smatra se čak, da je navedena disbioza, glavni „okidač“ autoimunih bolesti.
Naime, probavni trakt je najveći organ imunosnog sustava. U intestinalnoj mukozi locirano je čak 70-80% svih stanica koje proizvode antitijela, a crijeva sadrže najveću količinu limfoidnog tkiva u tijelu.
Današnja laboratorijska dijagnostika može objektivno dijagnosticirati autoimune bolesti.
Svrha predavanja „Dijagnostika odabranih imunološki uvjetovanih bolesti“, prezentacija je najznačajnih bolesti koje ne spadaju u grupu dermatoloških. Prve dvije prezenitrane, pripadaju imunološki uvjetovanim bolestima hematopoetskog sustava.
Destrukciju eritrocita autoantitijelima te ekstravazalnu fagocitozu makrofagima nazivamo „imunološki uvjetovanom hemolitičkm anemijom.“
Stvaranje antitrombocitnih antitijela dovodi do trombocitopenije uslijed preosjetljivosti tipa II. Klinički je moguć najširi dijapazon manifestacija krvarenja od petehija pa sve do masivnih krvarenja. Autoimuno inducirani tireoiditis, jedna je od autoimuno uvjetovanih endokrinopatija, opisana kao najčešći razlog Hipotireoidizma u pasa.
Miozitis žvačne muskulature M2, imunološki je uvjetovana miopatija. Predominantno može biti zahvaćena temporalna muskulatura, maseter, pterigoidni mišić te digastricus rostralis. Prosječna dob pojavnosti je tri godine, ali su opisani su i slučajevi u ranijoj dobi. Mogu oboljeti sve pasmine, no u praksi najčešće susrećemo u njemačkih ovčara, labrador retrivera, zlatnog retrivera i dobermanovog pinča.
Mijastenija gravis se može pojaviti u dva oblika. Kongenitalni mijastenični sindrom, urođen je oblik u pasa, mačaka i ljudi. Autoimuni oblik, nastaje zbog stvaranja autoantitijela protiv acetilkolinskih receptora. Bolest se pojavljuje u fokalnom ili difuznom obliku.
U imunološki uvjetovane neurološke bolesti ubrajamo na steroide osjetljiv meningitis-arteritis. To je sustavan imunološki poremećaj s općom upalnom reakcijom.
Etiopatogeneza je nepoznata, a može biti akutnog ili kroničnog oblika. Osim upale leptomeningealnih krvnih žila, također mogu biti involvirane i krvne žile srca, medijastinuma i tiroidne žlijezde.
Reumatoidni artritis spada u grupu bolesti pod nazivom imunouvjetovani poliartritisi.
Erozivni poliartritisi dijagnosticirani su u 16% pacijenata, a neerozivni u preostalih 84%. Dijagnostiku reumatoidnih bolesti provodimo Waaler Rose testom.
Zaključno, autoimune bolesti mogu zahvatiti svaki organski sustav. Primjena pojedinih dijagnostičkih postupaka ovisi o sustavu koji je zahvaćen patološkim procesom. Dakle, uniformni testovi ne postoje.
Diagnostic of selected immunologically conditioned diseases
Davorin Lukman, Ruth Klein
T oday, there are about forty diseases in humans, which are qualified as diseases of autoimmune origin. About 5-7% of the world population suffers from them, and in “western” countries this number is up to 8% of the total population. The causes of autoimmune diseases have not been yet fully elucidated, but they are thought to be “new age” or “abundant” diseases. This implies the consequences of technological and cultural advancement and the departure of man from his natural environment and way of life. According to current researches, women are significantly more prone to autoimmune diseases. Women are 79% of the total number of patients in the United States.In veterinary medicine, the number of patients with autoimmune diseases ranges from 0.5-3%, but it should be emphasized, that this figures are probably far below the actual number. The reason is the lack of information and the lack of use of diagnostic capabilities provided by today’s clinical laboratory diagnostics.
In addition to the hematopoietic system, the thyroid, skin, autoimmune diseases can also affect the musculature, the neurological system, the joints, or any organ in the body. The immune system is divided into the central one, which is dominated by the breast gland, then the bone marrow, or the bursa of Fabricius in birds, and the peripheral part consists of lymph nodes, spleen and lymphatic tissue. It should be noted, that already in the embryonic period, T-lymphocytes have the possibility of programmed self-recognition, and the next protection against autoimmune disorders are cryptic epitopes, which stimulate the system of elimination of potentially autodestructive and autoreactive T-lymphocytes. Molecular pathological restructuring disrupts the immune regulation, resulting in an immune response by producing antibodies against its own, endogenous substances in the body.
Such a disorder can be caused by a covert infection, which is called mimicry in the literature, then due to genetic disposition, as well as due to dysbiosis of the intestinal microbiota. It is even thought that dysbiosis is a major “trigger” for autoimmune diseases. Specifically, the digestive tract is the largest organ of the immune system.
As many as 70-80% of all antibody-producing cells are located in the intestinal mucosa, and the gut contains the largest amount of lymphoid tissue in the body.Today’s laboratory diagnostics can objectively diagnose autoimmune diseases.
The purpose of the lecture “Diagnosis of selected immune conditioned diseases”, is the presentation of the most important diseases that do not belong to the group of dermatological diseases. The first two presented, belong to the immune conditioned diseases of the hematopoietic system.
Erythrocyte destruction by autoantibodies and extravasal phagocytosis by macrophages, are called “Immunologically conditioned hemolytic anemia.” The production of antiplatelet antibodies leads to thrombocytopenia due to type II hypersensitivity. Clinically, the widest possible range of bleeding manifestations are possible, from petechiae to massive haemorrhage.
Autoimmune Induced Thyroiditis is one of the autoimmune conditioned endocrinopathies, described as the most common cause of hypothyroidism in dogs.
M2 chewing muscle myositis, is an immune conditioned myopathy. The temporalis muscle, masseter, pterigoid muscle and Digastricus rostralis can predominantly be affected. The average age of occurrence is three years, but earlier cases have also been described. This pathology can be presented in all breeds, but in practice, they are most commonly encountered in German Shepherds, Labrador Retrievers, Golden Retrievers and Doberman Pinscher.Myasthenia gravis can occur in two forms. Congenital myasthenic syndrome, as innate form in dogs, cats and humans and autoimmune form, due to the formation of autoantibodies against acetylcholine receptors. The disease occurs in focal or diffuse form.
Immune conditioned neurological diseases include steroids-sensitive meningitis-arteritis. It is a systemic immune disorder, with a general inflammatory response.
Ethiopathogenesis is unknown and may be acute or chronic. In addition to inflammation of the leptomeningeal blood vessels, the blood vessels of the heart, mediastinum and thyroid can also be involved.Rheumatoid arthritis belongs to a group of diseases called Immunostained Polyarthritis. Erosive polyarthritis was diagnosed in 16% of patients, and non-erosive 84%. Diagnosis of rheumatoid diseases is performed by the Waaler Rose Test.
In conclusion, autoimmune diseases can affect any organ system. The application of individual diagnostic procedures depends on the system involved in the pathological process. So uniform tests do not exist.
Key words:
- Suočavanje s petljom nasljednih i stečenih imunosno posredovanih bolesti u pasa – putevi i stranputice
- Koloplet najčešćih imunosno posredovanih bolesti u pasa
- Primjene CRISPR/Cas9: pregledni članak
- Pridjev imun i njegove tvorenice
- Epidemiologija, imunost, dijagnostika i mjere kontrole kod zaraznog ektima ovaca i koza – pregledni rad