Explain how mycobacteria avoid immune recognition by T cells during infection.
After the bone marrow transplant, the patient’s entire immune system, including T cells
and dendritic cells, will become reconstituted from hematopoietic stem cells in the donor
bone marrow. Donor-derived T cells developing in the recipient’s thymus will, however, be
positively selected on the recipient’s HLA molecules, and will only recognize antigen in
that context. If the donor and recipient do not share any HLA molecules, these T cells will
not be able to recognize antigen presented by the donor-derived dendritic cells or
macrophages and will not be activated in response to pathogens. Because T-cell activation
is central to all adaptive immune responses, the recipient will remain severely
immunodeficient and unable to make adaptive immune responses to pathogens. In
addition, HLA matching reduces the severity of graft-versus-host disease (GVHD), in
which mature T cells in the donor graft respond to the allogeneic MHC class I and II
molecules of the recipient and attack host tissue.