Læknablaðið : fylgirit - 01.10.1980, Blaðsíða 23

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identical to different types of pathogene-
tic mechanism. The specifically altered
reactivity depends either on antigen inter-
action with specific extracellular immuno-
globulin, which is present in the blood or
other body fluids, or it depends upon anti-
gen interaction with specifically reacting
T-effector lymphocytes with consequent re-
lease of lymphokines, biologically active
substances that can cause inflammatory
changes and tissue damage.
Table I.
Immunological tissue damage. Illustration of
etiology and pathogenesis.
1. Identification of antigen
self not self
cell component microbial
cell product other macromolecular not-self
hapten
2. Identification of antibody and/or specifically
reactive T-effector lymphocytes
Specific ensured
Ig class
type of lymphocyte
3. Location of antigen
on external/internal surface
cell membrane bound
in circulation
in AgAb complexes
in tissue target
4. Location of antibody
on mast cell membrane
on macrophage/monocyte
in circulation
in complexes
in tissue target
5. Location of specifically reactive T-effector
lymphocytes
in circulation
in tissue target
in lymphoid organs
All these points and questions should be enlightened
as far as possible.
The immunological specificity must always be
ensuded.
To illustrate, classify and pathogeneti-
cally describe a disease process associated
with inflammation, it is therefore necessary
to find the answers to a series of questions,
represented in table I. Firstly, are immuno-
logical factors involved at all in the in-
flammatory reaction? Can an association
be demonstrated between the inflamma-
tory reaction and an anti'gen and/or a
specific antibody or specifically reactive
lymphocytes? In a elinical disease process:
Can a similar association be found in other
cases of the same disorder? Investigations
should endeavour to detect antigen in the
surroundings to trace the route by which
the antigen has penetrated the body sur-
face into the tissues, to trace where anti-
gen is located in relation to the inflamma-
tory process. The antigen could be of pro-
tein or of polysaccaride nature, or perhaps
cojugated to a large molecule. The chemi-
cal nature of the antigen/hapten should be
defined as far as possible. The antigen may
also be totally or in part a component be-
longing to the organism itself, an autoanti-
gen, either belonging to tissue structures
and cell structures or be a non structural
self product. If the antigen has been de-
fined along these line as far as possible,
the antibody or the specifically reactive
lymphocytes should be traced with equal
thoroughness: Class and subclass of immu-
noglobulin, class and subclass of lympho-
cytes and location and concentration of
these immunologically active products in
TYPE I
4
4
*
MEDIATOREFFECT
Figure 1.