Page 972 - Clinical Immunology_ Principles and Practice ( PDFDrive )

CHaPter 69 Inflammation and Atherothrombosis 939

Tolerogenic APC LTB4
Activated APC MPO
TLRs
PMN
IL-10;
IL-1, IL-2, TGF-β Ph-lipase
IL3, IL-12, O2 NADPH-Ox Lipo-Ox
IL-17 MPO
IL-23 MPO
IL-12 TGF-β -
Treg O2
Th0 Th1 H2O2 HOCL
T-cells

MMPs
IFN-γ, TNF-α TF Scavenger
Perforin, granzyme ROS receptor
TLRs
MIF
TNF-α MØ-foam
M-CSF cells
Adhesion IL-1, IL6,
molecules IL12, IL18
TLRs
ECs
Cytokines
PAF Chemokines
Cytokines PAI-1 P-selectin
Chemokines EDRF Collagen
TF ET1 sCD40L

Thrombin Heparin PLT
PAF4 TNF

SMCs Tryptase

Pro Active Mast cells
IL-1, IL-6, TF MMP MMP
TNF-α, IFN-γ
Chymase
Ang I Active
Ang I

FIG 69.3 Histological Features of Fissure-Prone Plaques. Both innate immunity and adaptive
immunity play a key role in the pathogenesis of coronary plaque instability. Multiple types of
inflammatory cells are present in atherosclerotic plaques. Macrophages (MØ) and mast cells
infiltrate the lesion and are particularly abundant in the shoulder region where the atheroma
grows and where the risk of plaque rupture is highest. T-cell infiltrates are always present in
atherosclerotic lesions. Such infiltrates are predominantly CD4 T cells, which recognize protein
antigens processed and presented by activated antigen-presenting cells (APCs). Regulatory T
cells (Tregs) maintain the homeostasis of cell subsets involved in adaptive immunity. In human
atherosclerotic lesions, Treg colocalize with interleukin-10 (IL-10) and transforming growth factor
(TGF)-β expression. TLR, Toll-like receptor; Ang, angiotensin I; EC, endothelial cell; EDRF,
endothelium-derived relaxing factor; ET1, endothelin 1; IFN, interferon; IL12R, IL-12 receptor;
LTB-4, leukotriene B-4; M-CSF, macrophage colony–stimulating factor; MMPs, metalloproteinases;
MØ, macrophage; MPO, myeloperoxidase; TF, tissue factor; PAF, platelet-activating factor; PAI,
plasminogen activator inhibitor; PLT, platelet; PMN, polymorphonuclear cell; ROS, reactive oxygen
species; sCD40L, soluble CD40 ligand; SMC, smooth muscle cell.