منبع : janeway immunology 8th ed
Tissue grafts placed in some sites in the body do not elicit immune responses.
For instance, the brain and the anterior chamber of the eye are sites in which
tissues can be grafed without inducing rejection. Such locations are termed
immunologically privileged sites (Fig. 15.7). It was originally believed that
immunological privilege arose from the failure of antigens to leave privileged
sites and induce immune responses. Subsequent studies have shown that
antigens do leave these sites and that they do interact with T cells. Instead of
eliciting a destructive immune response, however, they induce tolerance or a
response that is not destructive to the tissue.
Immunologically privileged sites are: brain - eye -testis -uterus -hamster cheek pouch
Immunologically privileged sites seem to be unusual in three ways. First, the
communication between the privileged site and the body is atypical in that
extracellular fluid in these sites does not pass through conventional lym
phatics, although proteins placed in these sites do leave them and can have
immunological efects. Privileged sites are generally surrounded by tissue
barriers that exclude naive lymphocytes. The brain, for example, is guarded
by the blood-brain barrier. Second, soluble factors, presumably cytokines,
that affect the course of an immune response are produced in privileged sites
and leave them together with antigens. The anti-inflammatory transforming
growth factor (TGF)-� seems to be particularly important in this regard.
in homeostatic conditions (that is, in the absence of infection and thus of pro
infammatory signals), antigens recognized in concert with TGF-� tend to
induce regulatory T-cell responses that do not damage tissues, rather than
pro-infammatory TH17 responses, which are induced by TGF-� in the pres
ence of IL-6 co-signaling . Third, the expression of Fas ligand
by the tissues of immunologically privileged sites may provide a futher level
of protection by inducing the apoptosis of Fas-bearing efector lymphocytes
that enter these sites.
Paradoxically, the antigens sequestered in immunologically privileged sites
are ofen the targets of autoimmune attack; for example, brain autoantigens
such as myelin basic protein are targeted in the autoimmune disease mul
tiple sclerosis, a chronic inflammatory demyelinating disease of the central
nervous system . It is therefore clear that the tolerance normally
shown to this antigen cannot be due to previous deletion of the self-reactive T
cells. In the condition experimental autoimmune encephalomyelitis (E),
a mouse model for multiple sclerosis, mice become diseased only when they
are deliberately immunized with myelin basic protein, which causes substan
tial infltration of the brain with antigen-specifcTH17 and THl cells that coop
erate to induce a local inflammatory response that damages nerve tissue.
This shows that at least some antigens expressed in immunologically privi
leged sites induce neither tolerance nor lymphocyte activation in normal cir
cumstances, but if autoreactive lymphocytes are activated elsewhere, these
autoantigens can become targets for autoimmune attack. It seems plausible
that T cells specifc for antigens sequestered in immunologically privileged
sites are most likely to be in a state of immunological ignorance. Further evi
dence comes from the eye disease sympathetic ophthalmia (Fig. 15.8). If
one eye is ruptured by a blow or other trauma, an autoimmune response to
eye proteins can occur, although this happens only rarely. Once the response
is induced, it often attacks both eyes. Immunosuppression-and, rarely,
removal of the damaged eye, the source of antigen-is required to preserve
.vision in the undamaged eye
It is not surprising that efector T cells can enter immunologically privileged
sites: such sites can become infected, and effector cells must be able to enter
these sites during infection. Effector T cells enter most or all tissues after
activation but accumulation of cells is seen only when anti
gen is recognized in the site, triggering the production of cytokines that alter
tissue barriers.
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