From Big Medical Encyclopedia

IMMUNOMORPHOLOGY (immunology + morphology) — the section of immunology studying morphological manifestations of immunological processes in an organism. The morphology of an immunogenesis in broad understanding covers the morfofunktsionalny characteristic of the central and peripheral bodies of immune system, synthesis of antibodies of various classes and types, immunol, memory and immunol, tolerance. Immunol, the reactions which are made in a sensibilized organism are presented by various types of hypersensitivity (a fabric allergy), and also manifestations of transplant immunity. And. studies immunopatol. the processes proceeding in cells and fabrics solves problems not only immunology, but also immunopathologies (see), being a component patol, anatomy.

Ancestor I. it is possible to consider I. I. Mechnikov who established in 1901 participation of leukocytes and macrophages in immunol, reactions of an organism. For a long time in immunology the theory of antibody formation in reticuloendothelial (macrophagic) system based on observations of V. K. Vysokovich who found accumulation of antigenic substances at their intravenous administration in cells of reticuloendothelial system dominated (a liver, a spleen, marrow, limf. nodes). Numerous observations over features of antibody formation at various experimental impacts on reticuloendothelial system received contradictory interpretation. Observations over morfol, shifts in an adenoid tissue at an antigen challenge allowed to put forward the concept of antibody formation lymphocytes. It was shown that after hypodermic administration of antigen in the blood flowing from regional limf, nodes the quantity of lymphocytes, and in a lymph — the maintenance of antibodies sharply increases. However experiments with various impacts on an adenoid tissue and parallel studying of antibody formation as producers of antibodies did not confirm a role of lymphocytes. At the same time participation was proved plasmocytes (see) to antibody formation. A. Fagraeus in 1948 one of the first showed that there is a feedforward of proliferation of plasmocytes in a spleen and limf, nodes with a hyperglobulinemia and increase in an antiserum capacity, and the maximum antiserum capacity matched the maximum plasmatization of a pulp of a spleen and accumulation in plasmocytes of ribonucleoproteins. Further antibody formation cells plazmotsitarny a row found confirmation in numerous researches with use of methods of an electrophoresis and sedimentation, a histochemistry, autoradiografiya and submicroscopy.

Success of immunology, in particular And., the proof of existence at the person of the central and peripheral bodies of adenoid (immunocompetent) tissue and the related T - and V-systems of immunity was (see. Adenoid tissue ), and also opening of the predecessor immunocompetent cells (see) — a stem hemopoietic cell of marrow. It is established that thymus (see) it is responsible for development and functioning of T-system, and limfoepitelialny formations of intestines and, perhaps, marrow — for development and functioning of V-system of immunity. Under the influence of the central bodies of immune system the stem cell of marrow is differentiated in T - or the V-lymphocytes having in peripheral bodies of an adenoid tissue (limf, nodes, a spleen) characteristic zones of distribution. Carry a paracortical layer and a peripheral zone of follicles to T-dependent zones limf, nodes, and also a paraarterial zone of follicles of a spleen. V-dependent zones are the cortical layer, the light centers of follicles and a medulla limf, nodes, and also a peripheral zone of follicles of a spleen. At an antigen challenge of T - and the B-lymphocytes having characteristic structurally functional distinctions are differentiated in cells effectors (the activated lymphocyte, a plasmocyte) which are carrying out reactions immunity (see). With T lymphocytes reactions of cellular immunity — reaction of hypersensitivity of the slowed-down type, transplant, atrepsy, some reactions of antimicrobic immunity, are connected with B-lymphocytes — - reactions of humoral immunity (reaction of immediate hypersensitivity, antimicrobic immunity with products of antibodies).

The great value in immunol, reactions is given to macrophages (see) which source the stem cell of marrow is. Participation of macrophages in an afferent link of an immune response at development of humoral antibodys is proved. Macrophages regional limf, nodes take the antigen which got to an organism, «digest» it by means of lysosomic enzymes that leads to release of antigenic determinants, and then transfer information on antigen to a T-lymphocyte-helperu (English helper the assistant).

If the macrophage completely digests antigen, then the immune response does not develop. After antibody formation the macrophage joins in an efferent link of an immune response: on its surface cytophilic antibodies by means of which specific interaction of a macrophage with antigen, i.e. immune phagocytosis as a component of cellular immunity is carried out are adsorbed. Believe that transport of cytophilic antibodies and transfer to their macrophages are carried out by lymphocytes. Along with cytophilic antibodies the complement also participates in immune phagocytosis, and macrophages are capable to synthesize its fractions. Thus a macrophage and T-limfotsit-helper can be considered as morfol. substrate binding reaction of humoral and cellular immunity.

Task and contents immunomorfol. researches are immunol. reaction, its components, the involved fabric and cellular structures, the characteristic of the arising damage. During the performance of this task comparison of data morfol, and immunol is obligatory. (functional) researches: morfol, changes in the center of an immune response, i.e. localization of its components (antigen, an antibody, a complement), are estimated in parallel with immunol, (level of antibodies and antigens in blood, urine, a lymph) and morfol. indicators of a condition of an adenoid tissue.

V I. apply methods of an immunohistochemistry in various modifications with use of combinations of the luminescing antibodies or antigens with radioactive labels and the so-called contrasting markers, with attraction of quantitative assessment of a specific luminescence (mikroflyuorimetriya); light, polarizing, a submicroscopy in combination with gistokhy, reactions; immunol. a method of identification of antigens, antibodies, a complement in fabrics and liquids of an organism. Among them takes the leading place immunogistokhy. a method, the employee not only for detection of cell-bound immune complexes, but also for their «interpretation» — identification of antigen, an antibody, a complement. With the help immunomorfo l. methods are studied: an immunogenesis, the changes of a thymus gland arising at disturbances of an immunogenesis, local allergic reactions.

The immunogenesis, i.e. the mechanism of formation and development of immune responses, has characteristic morfol, expression. In a humoral immune response distinguish afferent, central and efferent links. The afferent link includes all stages from hit in an organism of antigen before information transfer about it an adenoid tissue. The antigen which got to an organism is exposed to phagocytosis by blood cells and reticuloendothelial system.

However the main role in immune phagocytosis belongs to macrophages. Only after a passage of antigen through a macrophage his determinants which are identified T-limfotsitami-helperami are released, information on antigen is transferred to cells of marrow, and then an adenoid tissue. The central link of a humoral immune response carries out transfer by a recirculating lymphocyte of information on antigen to a thymus gland, «storing» by a thymus gland of this information and the message on it to B-lymphocytes of an adenoid tissue. A lot of things in this link of an immunogenesis gipotetichno, however are established that an intermediary between antigen and a B-lymphocyte is the same recirculating lymphocyte. The efferent link — a link of proliferation of immunocompetent cells of a B-dependent adenoid tissue in which there is a hyperplasia of a granular cytoplasmic reticulum in this connection they become is raised pironinofilny (pironinofilny cells). These cells turn into immunoblasts (ancestors of the cells capable to products of immunoglobulins), and then plasmablasts and plasmocytes; there is plasmatization of an adenoid tissue. At height of plasmatization of an adenoid tissue the highest content of antibodies in blood serum is noted. The listed processes are directed to formation of the specific antibodies capable to connect antigen and to form cell-bound immune complexes which eliminirutsya.

At an antigen challenge of an antibody and cell-bound immune complexes circulate a lot of antigen and connect a complement. Such cell-bound immune complexes have the damaging effect on cells and fabrics, arises inflammation (see) on an immune basis.

The cellular immune response also consists of three phases. In the first phase the contact of lymphocytes with antigen which is localized in skin, mucous membranes, internals conducts to a sensitization of T lymphocytes — there are so-called sensibilized lymphocytes which transfer information on antigen of an adenoid tissue. In the second phase there is a proliferation and blast transformation of cells of T-dependent zones of an adenoid tissue. The cellular forms which are formed at the same time differ from plasmablasts ultrastrukturno and gistoenzimatichesk, they are not capable to develop antibodies. The third phase — reaction of a sensibilized lymphocyte with antigen. In this reaction the T-lymphocyte-helper carries out the cytopathic (gistopatichesky) effect on antigen — a so-called target cell. The macrophages who are carrying out immune phagocytosis and between lymphocytes also participate in reaction with antigen, in addition to a lymphocyte, and close contacts arise macrophages, cytoplasmatic bridges appear. The cellular immune response is directed to destruction of antigen by a sensibilized lymphocyte by means of a macrophage. At an antigen challenge this reaction comes to the end with damage of cells and fabrics, development of an inflammation on an immune basis.

The changes of a peripheral adenoid tissue arising in response to an antigen challenge are presented by macrophagic reaction, a hyperplasia of reticular macrophages and lymphocytes with the subsequent their plazmotsitarny transformation. These changes are supplemented with increase in permeability of microvessels, hypostasis of an interstitium and accumulation in it proteinaceous polisakharidnykh PAS positive substances (fabric disproteinoz). Degree macrophagic plazmotsitarnoy transformations of an adenoid tissue reflects tension of an immunogenesis and first of all level of development of antibodies — immunoglobulins — cells plazmotsitarny a row.

Fig. 1. Microdrug of a lymph node at measles: plazmotsitarny transformation (it is specified by shooters) fabrics of marrow; Brashe's reaction.
Fig. 2. Microdrug of a lymph node at chicken pox: plazmotsitarny transformation (it is specified by shooters) and accumulations of macrophages in a follicle; Brashe's reaction.
Fig. 3. Microdrug of a lymph node at measles: proliferation and desquamation of cells of a sine (in the center of drug), a macrophage (it is specified by an arrow) in his gleam; coloring hematoxylin-eosine.
Fig. 4. Microdrug of a spleen of a rabbit at hyper immunization: plasmatization of a follicle (it is specified by shooters); Brashe's reaction.
Fig. 5. Microdrug of a spleen at measles: accumulation of proteinaceous polisakharidny substances in the center of a follicle (it is specified by shooters); PAS reaction.

Morfol, the changes arising at an antigen challenge are substantially expressed in limf, the nodes which are especially in close proximity to the place of intake of antigen, and a spleen. In limf, nodes which increase, become plethoric and edematous, in a cortical zone in the light centers of follicles and a medulla there is a large number of the plasmablasts and plasmocytes which are forcing out lymphocytes. Proliferation and desquamation of cells of sine, formation of a large number of macrophages and proteinaceous polisakharidnykh substances in a stroma is noted (tsvetn. fig. 1 — 3). The spleen increases, looks plethoric and juicy, its big follicles are well visible on a section. The reticular hyperplasia and plasmatization of a red pulp and especially follicles of a spleen which peripheral zone entirely consists of plasmablasts and plasmocytes is noted. In a red pulp along with plasmablasts there are a lot of macrophages (tsvetn. fig. 4 and 5). If in response to an antigen challenge preferential cellular immune responses, then in limf develop, nodes and a spleen proliferate generally sensibilized lymphocytes, but not plasmablasts and plasmocytes. At the same time there is an expansion of T-dependent zones.

Fig. 6. Microdrug of a lung at scarlet fever: pironinofilny cells (are specified by shooters) in interalveolar partitions, peribronchial and perivascular fabric; Brashe's reaction.

The same changes in a type of a reticular hyperplasia and macrophagic plazmotsitarnoy transformations, and in some cases and a myeloid metaplasia are found in marrow, portal paths and sinusoids of a liver, in alveolar partitions, perivascular and peribronchial tissue of lungs, in an interstitium of kidneys, a pancreas, intestines, in intermuscular layers, fatty tissue (tsvetn. fig. 6).

The changes of a thymus arising at disturbances of an immunogenesis in one cases are a consequence, in others — a cause of infringement immunol. homeostasis. At aktsidentalny involution of the thymus which is found at children at many diseases there is a bystry reduction of its weight and volume in connection with the progressing disintegration of lymphocytes and phagocytosis by their macrophages. Death of lymphocytes is led to a collapse by a retikuloepiteliya of gland. In far come cases there comes the atrophy of a thymus. About a role of aktsidentalny involution in disturbances immunol, a homeostasis there is no consensus. Most likely injury of a thymus comes for the second time in connection with a massive and long antigen challenge. The is longer and heavier the disease flows, the aktsidentalny involution of a thymus is expressed more. Its hyperplasia is quite often combined with a hyperplasia of an adenoid tissue, a hypoplasia of adrenal glands and polova: glands, obesity, reduction of diameter of an aorta and arteries that characterizes status thymicolym phaticus (see). At this disturbance processes of an immunogenesis in connection with dysfunction of a thymus, and extreme sensitivity of people considerably has a talk with status thymicolymphaticus to an antigen challenge (immunization, an infectious disease), surgical interventions, an anesthesia, medicamentous drugs, sudden death as a result of insignificant influences it. Due to the hypoplasia of a thymus at children a number of hereditary immunodeficient diseases and syndromes develops, and the hypoplasia of a thymus is quite often combined with a hypoplasia of a peripheral adenoid tissue, with pathology of nervous, endocrine and vascular systems, and also mesenchymal malignant tumors.

Fig. 7. Microdrug of a lung at tuberculosis: exudative fabric reaction with a secondary tyromatosis (it is specified by shooters); coloring hematoxylin - eosine.
Fig. 8. Microdrug of connecting fabric at rheumatism: fibrinoid swelling (in the center of drug); coloring by azocarmine on Geydengayna.
Fig. 9. Microdrug of connecting fabric at a nodular periarteritis: a fibrinoid necrosis (an upper part of drug) with perifocal cellular reaction; coloring hematoxylin - eosine.
Fig. 10. Microdrug of an artery at a nodular periarteritis: a fibrinoid necrosis of internal and average covers of a vascular wall (it is specified by shooters), cellular reaction in an adventitia and surrounding connecting fabric; coloring hematoxylin-eosine.

Local allergic reactions, i.e. local damages of bodies and fabrics where it is played immunopatol. process, can be presented by reactions of hypersensitivity of the immediate and slowed-down type (see. Allergy ). Reaction of the immediate hypersensitivity (IH) is connected with mechanisms of humoral immunity and arises at impact on fabric of the cell-bound immune complexes connecting a complement or reagins (the reaginic mechanism of damage). Manifestations of a giperergichesky inflammation on an immune basis are characteristic of it morfol, speed of development, dominance of alterativny and vascular and exudative changes, drift of proliferative and reparative processes are inherent to Krom. Most typically dynamics morfol, changes at GNT is presented at Artyus's phenomenon (see. Artyusa phenomenon ). In pathology of the person of GNT makes essence of many allergic diseases and processes, proceeding with dominance of alterativny or vascular and exudative changes. Manifestations of GNT with dominance of alteration are continuous at tuberculosis (a caseous necrosis), syphilis, they are the cornerstone of vascular changes (a fibrinoid necrosis) at a system lupus erythematosus, a glomerulonephritis, a nodular periarteritis, etc. (tsvetn. fig. 7 — 10). Vascular and exudative manifestations of GNT are brightly presented at bronchial asthma, a serum disease, a small tortoiseshell, a Quincke's edema, hay fever, a lung fever; vasculites, polyserosites, arthritises at rheumatism, tuberculosis, a brucellosis shall be carried to them, etc.

Reaction of the hypersensitivity of the slowed-down type (HSDT) is connected with mechanisms of cellular immunity. It can be induced by a bacterial or not bacterial antigen, auto-or the homologous cell-bound immune complex containing structural antigen of fabric. Two types of cells — sensibilized lymphocytes and macrophages therefore limfogistiotsitarny and Macrophagic infiltration in the center of the immune conflict are the basic morfol, expression of GZT participate in this reaction. The proof of a role of T lymphocytes in GZT is the fact that at timektomirovanny in the period of a neonatality of animal GZT does not develop, and the transplant is not torn away. By means of sensibilized lymphocytes transfer of GZT is possible.

Fig. 11. Microdrug of a kidney at reaction of rejection (allotransplantation): 1 — a sharp plethora; 2 — infiltration of fabric limfogistiotsitarny elements; 3 — a necrosis of an epithelium of tubules; coloring hematoxylin - eosine.
Fig. 12. Microdrug of a lung at tuberculosis: granulomas from lymphoid, epithelial and colossal cells of Pirogov — Langkhansa with focuses of a tyromatosis (are specified by shooters); coloring hematoxylin - eosine.

The mechanism of action T-limfotsitov-helperov on a target cell (antigen) considerably gipotetichen. Most likely it is connected with activation of lizosomalny enzymes of a lymphocyte, and it is possible, and target cells. Macrophages enter specific reaction with antigen by means of mediators of cellular immunity and cytophilic antibodies. At the same time between lymphocytes and macrophages there are contacts in the form of cytoplasmatic bridges which, probably, serve for exchange of information about antigen between cells. Perhaps, the lymphocyte stimulates immune phagocytosis of a macrophage. It is not excluded that the macrophage transfers information to a lymphocyte about antigen. In GZT the role of humoral factors — mediators of GZT is undoubted. To a wedge. - morfol. to manifestations of GZT refer reaction of tuberkulinovy type in skin in response to administration of antigen, contact dermatitis (contact allergy). GZT takes place at autoimmune diseases, reactions of graft rejection, hron, the inflammation especially specific — tuberculosis, a brucellosis, a tularemia (tsvetn. fig. 11 and 12). However the inflammation in the form of limfogistiotsitarny and macrophagic infiltration of fabric in combination with a vascular plazmorragicheskimi and parenchymatous and dystrophic processes can be considered as GZT developing on an immune basis, i.e. reflecting only in the presence of proofs of participation of cells of infiltrate in sensibilized lymphocytes (see. Allergy ).

Reactions of GNT and GZT are quite often combined or replace each other, reflecting dynamics immunopatol. process. Such change of reactions is traced, e.g., at a wound process.

Possibly, local allergic reactions are the cornerstone of many diseases of the infectious, allergic and autoimmune nature. Therefore the immunomorphology of local allergic reactions makes morfol, a basis a wedge, immunopathologies (see).

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B. B. Serov.