Professional Documents
Culture Documents
1. Variolation
2. Who introduced vaccination?
3. Who is the father of microbiology?
4. Who introduced antiseptic techniques for surgery?
5. When were antibiotics developed?
6. When were antibiotics commercialized?
1. Injection of crusted material from smallpox blisters used to “immunize” in ~16th century
2. Jenner – for smallpox in England, late 1700s
§ Inoculated cowpox (“vaca” Latin for cow)
3. Pasteur (1860s)
§ Showed bacteria could be killed by heat
§ Developed chicken cholera, anthrax, and rabies vaccines
4. Lister
5. 1920s
6. 1940s
1. Antigen
2. Immunogen
3. Hapten
4. Tolerogen
5. Epitope
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1. Defensins
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Acquired (adaptive/specific) immunity
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Diseases and abnormalities that predispose to infections
1. Diabetes
§ Often have S aureus infections, perhaps b/c:
o Extensive atherosclerosis (causes tissue anoxia)
o Defect in neutrophil function
2. Sickle cell anemia
§ Often have Salmonella osteomyelitis
3. Pts w/certain congenital cardiac defects
· Predisposed to endocarditis caused by streptococci
· Neutrophils have difficulty penetrating vegetations formed on valves in endocarditis
4. Pts w/an anortic aneurysm
§ Prone to vascular infections by Salmonella species
1. Cell-mediated immunity
§ Consists primarily of killer T cells
§ Utilizes lymphocytes, cytokines, phagocytes
§ Inhibits organisms (fungi, parasites, and certain intracellular bacteria)
§ Kills virus-infected cells and tumor cells
2. Antibody-mediated (humoral) immunity
§ Consists primarily of B cells (and plasma cells)
§ Utilizes antibodies and complement
§ Neutralizes toxins and viruses
§ Opsonizes bacteria (makes them easier to phagocytize)
What bridges the two arms (cell-mediated and humoral immunity) of acquired immunity?
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RAG
Antigen recognition
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Steps in antibody-mediated immunity
1. They recognize antigens w/their surface IgM that acts as an antigen receptor
2. They present epitopes to TH cells in association w/class II MHC proteins
3. Note:
· IgM antigen receptor on B cell can recognize foreign proteins, carbs, lipids, DNA, RNA, etc.
· Class II MHC proteins of B cell can only present peptide fragments to TH cells
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Clonal Selection
1. Antigen “selects” a B cell endowed w/the preexisting capacity to make the specific antibody
for that antigen
2. Each person has a large pool of B cells
3. Each B cell bears specific receptor (either IgM or IgD) that can react with 1 antigen (or closely
related group of Ags)
4. An antigen interacts w/B cell w/best “fit” Ig surface receptor
· Stimulates B cells to proliferate and form clone of cells
· Selected B cells à plasma cells à Ig specific for Ag
5. Clonal selection also occurs with T cells
· Antigen interacts w/specific receptor on a Th or Tc cell
· This “selects” cell à expands into clone of cells with the same specificity
1. Inflammation
· Innate immunity, influx of factors and cells, PMNs
2. Phagocytosis
· Ingestion of particles by macrophages and neutrophils
3. Neutralization
· Ab combines w/antigen and inactivates it
4. Cytotoxic reaction
· Killer cells interact w/target cell and kill it
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Thymic education
MHC proteins
GALT
Sepsis
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Hematopoiesis
1. Blood cells are short lived and are thus continuously renewed from pluripotent stem cells in
bone marrow
· Pluripotent à under influence of cytokines, stem cells become a variety of other cells
· Exception: memory cells, progeny of which last for yrs
2. Process is controlled by cytokines
· IL-7 à imp for B cell development
· IL-3 à acts on early bone marrow progenitor cells
3. GM-CSF - stimulates cells of granulocytic & macrophage
4. M-CSF (macrophage colony stimulating factor)
5. G-CSF (granulocyte colony stimulating factor)
· Used clinically _ speeds up bone marrow recovery
· Subtypes:
o TCR a/b or g/d
o Th-1 – T helper cell
o Th-2 – T helper cell
o Tc – T cytotoxic cell
o Ts – T suppressor cell
o NK – natural killer (large granular lymphocyte)
· Surface markers (CD = cluster designation)
o All T cells à TCR, CD3 (TCR complex)
o Th cells à CD4
o Tc cells à CD8
o NK cells à receptors for class I MHC, CD16
TCR complex
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1. Th cells
2. Tc cells
3. Ts cells
4. NK cells
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What enzymes are involved in the signal transduced by CD3, CD4, and CD8?
1. CD3
· One of its transmembrane proteins – the zeta chain – is linked to a tyrosine kinase called fyn
2. CD4 and CD8
· May signal via tyrosine kinase lck
1. Th-2 cells
· Help B cells develop into Ab-producing plasma cells by producing IL-4 and IL-5 (influence
humoral immunity)
2. Th-1 cells
· Help CD8 T cells to become activated cytotoxic T cells by producing IL-2, activate NK cells
· Help macrophages effect delayed hypersensitivity (eg, limit infection by M tuberculosis) by
producing primarily IL-2 and gamma IFN (i.e. activate macrophages)
· Also activate NK cells
· Thus influence CMI
What is the main thing that regulates the balance between Th-1 and Th-2 cells?
· IL-2 levels
o Produced by macrophages
o Increases the number of Th-1 cells
o Thus enhances:
§ Host defenses against organisms controlled by delayed hypersens response
§ Cell-mediated immunity
· Gamma IFN
o Inhibits production of Th-2 cells
1. Class I
a. Viral peptides associate w/class I MHC protein
b. Complex is transported to surface, where viral antigen is presented to receptor on CD8+ cell
2. Class II
a. Foreign protein is cleaved into peptides that associate w/class II MHC proteins
b. Complex is transported to surface of APC, where antigen, in association w/class II MHC
protein, is presented to receptor on CD4+ helper cell
Remember the rule of eight:
CD4 cells interact w/class II, CD8 cells interact w/class I
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Activation of T cells
1. Requires that they recognize a complex on surface of APCs consisting of both the antigen and
a class II MHC protein
2. 1st step à antigen interacts w/TCR specific for that antigen
· CD4 on Th cell also interacts w/class II MHC protein
· Other proteins also help stabilize contact between T cell & APC (LFA-1 on T cell binds to
ICAM-1 on APCs)
3. For full activation of Th cells, costimulator is required à B7 protein on APC must interact
w/CD28 protein on Th cell
· If costimulatory signal occurs: IL-2 is made by Th cell à Th cell capable of performing all of its
functions
· If costimulatory signal does not occur: state of unresponsiveness called anergy ensues
CTLA-4
· Protein that appears on the T cell surface after the T cell has been activated
· Binds to B7 by displacing CD28
· Interaction of B7 with CTLA-4 inhibits T cell activation by blocking IL-2 synthesis
o This restores activated T cell to a quiescent state and thus plays an imp role in T cell
homeostasis
· Mutant T cells that lack CTLA-4 participate w/increased frequency in autoimmune rxns
· Administration of CTLA-4 reduces the rejection of organ transplants in experimental animals
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What to T cells recognize?
1. Present the antigens of extracellular microorganisms that have been phagocytized (eg.
Bacterial proteins)
· Extracellularly acquired proteins are cleaved to peptide fragments within an endosome, where
the fragment associates w/class II MHC proteins
· This complex then migrates to the cell surface
2. An “invariant chain” is attached to the class II MHC proteins when they are outside of the
endosome
· Chain degraded by proteases w/in endosome, allowing peptide to attach to class II MHC w/in
compartment
· Prevents endogenously synthesized proteins from associating w/class II MHC proteins
· Unlike T cells, they interact directly with antigens via their surface antigen receptors (IgM and
IgD)
o Antigens do NOT have to be presented to B cells in association w/class II MHC proteins
· IgM and IgD recognize many different types of molecules, such as peptides, polysaccharides,
nucleic acids, small chemicals (penicillin)
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Describe the events that occur when the antigen-MHC complex on the APC interacts with the
TCR.
1. Signal is transmitted by CD3 complex thru several pathways that lead to a large influx of Ca+
into the cell
2. Ca+ activates calcineurin, a serine phosphatase
3. Calcineurin activates genes for IL-2 and the IL-2 receptor
4. IL-2 (T cell growth factor) stimulates:
· Th to multiply into a clone of antigen-specific Th cells
à Most cells of this clone perform effector and regulatory functions, some become “memory”
cells
· Tc cells to produce gamma interferon
à IFN gamma _ expression of class II MHC proteins on APCs à enhances ability of APCs to
present antigen to T cells & upregulates immune response
Memory T cells
· Endow host defenses w/ability to respond rapidly and vigorously for many years after initial
exposure antigen
· This memory response to a specific antigen is due to:
o Many memory cells are produced, so that sec-ondary exposure is greater than primary response
o Memory cells live for many years or have the capacity to reproduce themselves
o Memory cells are activated by smaller amounts of antigen and require less costimulation
o Activated memory cells produce greater amounts of interluekins than do naïve T cells when
they are first activated
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Effector functions of T cells
1. Delayed hypersensitivity
· Produced against antigens of intracellular microorganism
· Mediated by macrophages and CD4 cells (esp Th-1)
2. Cytotoxicity
· Concerned w/destroying virus-infected & tumor cells
· To kill virus-infected cell, Tc cell must recognize both viral antigens and class I molecules on
surface of infected cell AND receive a cytokine stimulus from a Th cell
· Note: Infected cell can also be killed by antibody-dependent cellular cytotoxicity (ADCC)
1. Combination of IgG and phagocytic cells that can destroy virus-infected cells
2. Ab bound to the surface of the infected cell is recognized by IgG receptors on the surface of
phagocytic cells (eg, macrophages or NK cells)
3. Infected cell is killed
4. This process can also kill helminths (worms)
· In this case, IgE is the Ab involved and eosinophils are the effector cells
1. Antibody production
· Most Ab production requires Th cells (T cell-depen)
2. Cell-mediated immunity
· Ag is processed by macrophages, is fragmented, and is presented w/class II MHC molecules on
the surface
· These interact w/receptor on Th cell à stimulated to produce lymphokines (IL-2 = T cell growth
factor) à stimulates specific Th and Tc cells to grow
3. Suppression of certain immune responses
· Certain T cells can suppress Ab production
· Failure of such regulation may result in unrestrained Ab production to self antigens
(autoimmune disease)
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T cell-dependent response
T cell-independent response
B cell functions
B cell origin
1. B cell precursosrs first in fetal liver, then migrate to bone marrow where they remain during
adult life
2. Maturation of B cells has 2 phases:
· Antigen-independent phase
à Consists of stem cells, pre-B cells, and B cells
· Antigen-dependent phase
à Cells that arise subsequent to interaction with antigen (eg, activated B cells and plasma cells)
3. B cells display surface IgM, the antigen receptor
· Surface IgM = monomer (circulating IgM = pentamer)
4. Located in germinal centers of lymph n, white pulp of spleen, GALT
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B cell surface markers
Activation of B cell
Recognition phase:
1. Antigen binds to B cell IgM or IgD, endocytosis of antigen
Activation phase:
1. Antigen epitopes appear on surface w/class II MHC proteins
2. Complex is recognized by Th cell w/a receptor for antigen
3. T cell produces IL-2, IL-4, IL-5 à growth & differentiation of B cell, isotype switching to IgG,
affinity maturation
4. Costimulatory interactions must occur for full activation:
· CD28 on T cell must interact w/B7 on B cell
à Required for activation of T cell to produce IL-2
· CD40L on T cell must interact w/CD40 on B cell
à Required for class switching to IgG & other classes
Effector phase:
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Macrophages (mononuclear phagocytes/monocytes)
1. Kidney shaped nucleus, large (10-20mm), granules w/lots of enzymes (ex. peroxidase, lipase,
protease, elastase, etc.)
2. Three main functions (1st – CMI, 2nd – humoral function):
· Phagocytosis – surface Fc receptors interact w/Fc portion of Igs, enhancing uptake of opsonized
organism
· Antigen presentation – present antigen fragments in association w/class II MHC for interaction
w/the TCR
· Cytokine production – IL-1 and TNF
à IL-1 – activates Th cells
à TNF – imp inflammatory mediator
3. Derived from bone marrow histiocytes
4. Markers: MHC class II, Fc receptors, complement receptors
Granulocytes
Eosinophils
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Basophils and mast cells
1. Basophils
· WBCs w/blue granules
· Circulate in blood stream
2. Mast cells
· Fixed in tissue (esp under skin and in mucosa of respiratory and GI tracts)
3. Both:
· Have receptors for Fc portion of heavy chain of IgE
· When adjacent IgE molecules are cross-linked by antigen, histamine and enzymes (eg,
peroxidases, hydrolases) are released à inflammation and, in large amounts, cause severe
immediate hypersensitivity rxns
1. IL-1
2. IL-2
1. IL-4
2. IL-5
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1. IL-6
2. IL-3
1. Produced by Th cells
· Stimulates B cells to differentiate
· Induces fever
· Induces production of acute-phase proteins in liver
1. IL-13
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Interferons
1. Lymphotoxin/TNF-b
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CD Leukocyte Markers
Are both composed of lymphocytes, accessory cells (eg, APCs) and epithelial cells
· Epithelial cells can secrete factors that help in maturation and development of immune response
o Ex. thymic epithelial cells secrete thymosin, which promotes T cell maturation
Thymus
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Bone marrow
1. Contains all the cells and cytokines necessary for B cell development
2. preB à immature B à mature B
Spleen
Lymph nodes
1. Protein complexes and particulate antigens are better than non-complexed proteins or soluble
antigens (i.e. they engage APCs better à better immune response)
2. Route
· Subcutaneous injection give best immune response
· Intradermal (I.D.) also good
3. Dose
· Too little or too much can be inhibitory
4. Adjuvants
· Substances that mix w/antigen thus engaging APCs
· Vaccines are given w/adjuvant (eg, Freund’s adjuvants)
5. Immune response potential (immune responses are variable)
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Rank order for antigen potency
Lipopolysaccharides
1. Are endotoxins
2. T-independent antigens (induce T-indep immune responses)
· Very limited immune response
3. Contain 3 functional groups:
· Lipid A group – stimulates B cells
à Combines w/a serum protein
à This complex then binds to CD14 on B cells
· Core polysaccharide
· O antigen polysaccharide – binds to B cell receptors (if that receptor is a clone w/affinity to O
antigen)
1. Isotypes
2. Allotypes
3. Idiotypes
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· B/c individuals have different alleles for L and H chains
3. Antigenic determinants formed by specific amino acids in hypervariable region, thus specific
to each Ig molecule
· Each is unique for the Ig produced by a specific clone of Ab producing cells
· Anti-idiotype Ab reacts only w/hypervariable region of Ig that induced it
Immunoglobulin classes
How many domains do the H chains have in each of the 5 classes of immunoglobulin?
Unique sequences in the H domains allow for isotypic variation (common to all members of the
species), allotypic variation (variation between members of the species), complement binding, Fc
binding, and disulfide bond formation.
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Domain positions in IgG
1. Fab
· Portion of IgG that binds the antigen
· Composed of entire light chain and the variable and 1st constant domain of heavy chain (VL,
CL, VH, and CH1)
2. Fc
· Terminal end of heavy chain (carboxy end)
· Controls the biological activity
· Contain amino acid regions that confer function such as complement activation and binding to
Fc receptors
· Ex. amino acid sequence Glu-Lys-Lys in Cg2 domain of IgG is needed for C1q of complement
to bind to IgG
Hypervariable regions
1. Amino acid sequences in the variable domains of H and L that are unique from one Ig to the
next
2. Called “complementarity determining regions” (CDRs)
3. There are 3 CDRs in each H and L chain
4. Where the antibody makes actual contact with the antigen
5. Amino acid residues of antigen epitope form noncovalent bonds w/amino acids lining the
binding site on the Ab
· These weak noncovalent forces become stronger as the fit between Ag epitope and combining
site _
6. These variations are called idiotypic variations b/c they vary w/in a single member of a species
7. Every human serum contains Igs of many different idiotypes
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CDRs and affinity and specificity
· The better the antigenic epitope fits into Ab binding cleft (i.e. high specificity), the # and
strengths of the bonds _
· _ association = _ affinity constant (K) = _ binding strength
· Specificity is relative in that binding clefts can accommodate cross-reacting antigenic epitopes
· Inject multivalent antigen into an animal à antiserum containing Abs of multiple specificities &
affinities
· Affinity and specificity mature w/time after immunization
1. Allotypic markers
2. Immune clearance
1. Additional antigenic features of Igs that vary among individuals (their biological function is
unknown)
· Are found in the:
à Fc portion of the H chain
à Constant portion of the L chain
IgM Structure
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IgG
IgA
1. Main immunoglobulin in secretions (colostrum, saliva, tears, respiratory, intestinal and genital
tract secretions)
2. Prevents attachment of bacteria and viruses to mucous membranes
3. Each molecule consists of two H2L2 units + J chain and secretory component
· Secretory component – polypeptide made by epithelium
à Provides for IgA passage to mucosal surface
à Also protects IgA from being degraded in intestinal tract
4. Neutralizes toxin or virus upon binding to them
IgM
IgD
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IgE
Fc Receptors
1. 2 gene segments (V + J)
· V codes for first 95 residues
· J codes for 13 residues
2. 3 gene segments (V + D + J)
3. a) Multiple gene segments for Variable regions
b) their rearrangement into different sequences
c) combining different L and H chains in assembly of Igs
d) mutations (responsible for affinity maturation)
4. Mu (m) and delta (d) (IgM and IgD H chains)
· Delta lacks a switch region, thus “comes along for the ride” with mu
· Two H chains produced will either have mu or delta
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Class Switching
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Functions of the complement system
- cytolysis – complement binds to Ag-Ab complex and directs lysis of certain cell types; only
certain bacteria are susceptible to lysis, also happens to some body cells (RBCs)
- opsonization – certain phagocytic cells that have complement receptors will recognize the
complement-Ab complex and opsonize the antigen
- inflammation – in the cascade, there are products of the complement system being produced
called anaphylatoxins. These products have two roles:
- recruit inflammatory cells to the area
- activate these cells to produce mediators that will lead to additional inflammation. This will
help in Ag clearance
- similarities
- both consist of inactive proteins -- zymogens
- both are highly regulated – there are regulatory proteins at every step in the process
- both involve enzymatic cascades
- both end with the membrane attack complex (MAC)
- difference is in how they are initiated
- the classical system starts with antigen-antibody complex
- the alternative system doesn’t need antibody to start
- alternative system used by Gram- and Gram+ bacteria, fungal & yeast cell walls, tumors,
parasites, etc.
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Alternate pathway
1. Spontaneous activation (autolysis) of C3 into C3a and C3b – this process is called “tickover”
2. C3b then binds to the cell membrane by itself
· When C3b binds to self cells _ inactivated
· When C3b binds to foreign cells _ it sticks
3. Binding of C3b leads to activation of other components
4. Factor B interacts w/C3b _ proteolyzed by factor D to form C3bBb (C3 convertase) (different
from classical path)
5. C3 convertase then activates another C3 to form C3b
6. C3b combines with C3 convertase to form C3bBb3b (C5 convertase) (also different from one
in classical path)
7. C5 convertase then interacts w/C6, 7, 8 and 9 to form MAC
1. Time – complement components need to be under fine control, don’t want too much firing
leading to constant inflammation (unbound components active for nanosec)
2. Receptors – different CRs on different cells
· CR1 – B cells, PMNs, monocytes, macrophages
· CR2 – B cells, dendritic cells
· CR3 – monocytes, macrophages, PMNs, NK cells
· CR4 – PMNs, monocytes, macrophages
3. Specific factors – regulatory factors that have very specific actions in limiting the complement
system
· Ex: CCP and DAF inhibit C3 convertase
· MCP degrades C4b
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Examples of lab tests that are based on:
1. Primary unions/interactions
2. Secondary unions/interactions
3. Tertiary unions/interactions
1. Depends on cellular and humoral elements of inflammation; does not involve T cells directly
· Sets up stage for adaptive immunity
· Includes chemotaxis, phagocytosis, acute phase proteins, and inflammatory mediators
(histamine, serotonin, PAF, IL-8, C3a, C5a, bradykinin, PGs, leukotrienes, etc.)
2. Depends on T helper and cytotoxic cell functions
· Note: cytotoxic effectors include CD8 T cells, NK cells and macrophages
· CD4 cells stimulated by antigen from APCs _ grow and proliferate _ cytokine secreting and
memory cells
Hashimoto’s thyroiditis
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· Pertinent findings: _ T3 and T4, _ TSH, anti-thyroid antibodies _ from first visit
4. Etiology of disease is the production of Abs to thyroid Ags
Immune Regulation
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Immune response to tumors
1. Humoral
· IgG & IgM Abs that fix complement destroy soft tumors
· Abs against tumors impede adhesion some tumors need
· IgG Ab may mediate destruction of tumors via ADCC
2. CMI _ MOST IMPORTANT mechanism (esp Tc cells)
· Macrophages activated by T cell derived IFN gamma kill tumor cells (TNFa, lysozyme, O2
radicals)
· NK cells kill tumors by same mechanism they use to kill virus infected cells (cell w/_MHC _
signals NK)
· Tc kill tumors in Ag specific & MHC restricted way
· CMI is so imp b/c antigens made by tumors are processed by the endogenous pathway
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Cancer immunotherapy
1. Anti-Cancer vaccines
· Immunization against oncogenic viruses
· More difficult to vaccinate against non-viral origins, ex:
à BCG (enhances responses against melanoma)
à Transfection of genes for B7, IL-2, IL-4, IFN gamma, GM-CSF (_ response of T cells)
à Naked DNA constructs (induces Tc cell)
2. In vitro activation of LAK cells & TIL (tumor infiltrating lymphocytes) with IL-2
3. Monoclonal antibodies (Mabs) made w/mice spleens
· Problem: HAMA response (human anti-mouse Ab response); Solution: chimeric Mabs
1. Heteroconjugate Mabs
2. Chimeric Mabs
1. IFN alpha
· Remission in hairy cell leukemia pts
· Possible cytostatic effect on tumor
2. IFN gamma
· Ineffective systemically, remission of ovarian CA
· _ expression of MHC class I, cytostasis
3. IL-2
· Remissions in renal cancer and melanoma
· T cell activation and proliferation, NK cell activation
4. TNF alpha
· Can _ malignant ascites
· Macrophage & lymphocyte activation
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1. Innate immunity to bacteria
2. Adaptive immunity to bacteria
1. Various bacteria contain antigens in their cell envelopes and walls ranging from LPS to
lipoarabino-mannan
· Antigens interact w/serum factors & cells _ inflammat, influx of complement, phagocytes,
cytokines (IL-12)
· Bacteria killed primarily by degradation in phagocytes
· Accomplished by both O2-dep and O2-indep killing
2. Antibodies play imp role in resistance to bacteria
· Bind to bacteria _ prevent attachment to host, activate phagocytosis & complement, prevent
nutrient transport
· Also neutralize toxins released from bacteria
· CMI (T cells and macrophages) important in fighting intracellular bacteria
1. Acute phase proteins bind to CHO moieties on bacterial surface _ alter complement pathway _
C3a, C5a _ vascular permeability, chemotaxis, etc.
2. Formyl peptide, muramyl peptide, peptidoglycan, Lipoproteins, lipoteichoic acid, LPS,
lipoarabinomannan
· Break down products of bacterial cell wall
· Activate NK cells, macrophages and PMNs, 2)interact w/blood clotting, platelet, plasmin
system
· In ALL bacteria
· Specific for gram-positive bacteria
· Specific for gram-negative bacteria
· Specific for acid-fast bacteria
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Innate immunity to viruses
Parasitic infection
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Infectious mononucleosis
1. Presents w/malaise, sore throat, fever, headache, red throat, exudative tonsils, tender lymph
nodes
2. Monospot test positive
3. WBCs show lymphocytosis with atypical cells (T cells)
4. Virus infects epithelium of pharynx, producing sore throat
5. B cells then become infected: Epstein-Barr virus docks to CR2 on B cells, fibroblasts, and
epithelial cells
· Stimulates B cells to make polyclonal Abs (“heterophile Abs”), detected by the monospot test
6. So remember:
· The monospot response is the B cell response
· The atypical lymphocyte is the T cell
1. Passive immunity
2. Active immunity
Types of vaccines
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· ID (intradermal)
2. Oral route _ mainly elicits IgA antibodies due to GALT
1. Birth _ Hep B1
2. 1 – 4 months _ DTaP (diptheria, tetanus, acellular pertussis), Hep B2, and Polio
3. 6 – 18 months _ Hep B3, Hib (H. influenza type B), Polio, MMR (measles, mumps, rubella),
Var (V. zoster), HepA
4. 11-2 years _ tetanus (tetanus should be given every 10 yrs)
Adjuvants
Non-specific immunotherapy
1. Microbial
· Filtered bacterial cultures: Coley’s preparation
· BCG: anti-tumor activity
2. Cytokines
· IFNgamma: leprosy, leishmaniasis
· IL-2: leishmaniasis
· GCSF: bone marrow restoration
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· BCG: anti-tumor activity
3. Cytokine inhibitors
· TNF antagonists: septic shock
What are the active mediators released by mast cells in Type I hypersensitivity?
1. Histamine (preformed)
· Cause vasodilation, _ capillary permeability, smooth-muscle contraction
· Causes allergic rhinitis, urticaria, and angioedema
· Contributes to bronchospasms in acute anaphylaxis
2. SRS-A _ leukotrienes (NOT preformed)
· Cause _ vascular permeability, smooth-mus contraction
· Principle mediators in bronchoconstriction of asthma
3. Eosinophil chemotactic factor –A/ECF-A (preformed)
4. Prostaglandins and thromboxanes (NOT preformed)
· Cause dilation, _ vascular perm., bronchoconstriction
· Aggregate platelets
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· Hemolytic disease of newborn (Rh reactions)
· Goodpastures syndrome: IgG Abs to glomerular BM
à Result: nephritis, proteinuria
à Lung also damaged b/c of similarities of BM
· Pemphigus: Abs to desmosome proteins
à Breakdown of cellular adhesions _ blistering
Patterns of infection
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· IgA deficiency
· Common variable immunodeficiency
2. Combined B Cell & T Cell deficiencies
· Severe combined immunodeficiency disease (SCID)
· Ataxia telangiectasia
· Wiskott-Aldrich syndrome
3. T-cell immunodeficiency
· Thymic aplasia (DiGeorge’s syndrome)
· Chronic mucocutaneous candidiasis
4. Neutrophil/granulocyte immunodeficiency (rare)
· Leukocyte adhesion defect
· Chronic granulomatous disease
· Chediak-Higashi syndrome
· Job’s syndrome (Hyper IgE syndrome)
5. Complement deficiency (rare) – early and late deficiencies
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· Seems to be imp for Ig light chain synthesis
5. Diagnosis: serum protein electrophoresis to exclude lymphoid/plasma cell malignancy,
quantitative Ig isotypes, flow cytometry using B cell markers (CD19 or CD20)
6. Treatment: g-globulin replacement (IV every 3-4 weeks)
· Antibiotic therapy of sinopulmonary infections
IgA deficiency
1. Variable autosomal genetic mechanism, but develops in late childhood to early adult life (thus
an “acquired” ID)
2. Hyperplastic lymph nodes w/normal to increased numbers of B-cells but decrease in plasma
cells
3. Increase in lymphoid and GI malignancies as well as autoimmune diseases
4. VERY low IgG, low to NO IgA
5. Same treatment as Bruton’s
SCID
1. Heterogenous group of disorders w/defective development of both B- and T- cells, usually due
to abnormal development of bone marrow cells
2. In some forms, abnormal B-cells is secondary to dysregulation of abnormal T-cells
3. Thymus and peripheral lymph nodes do not develop
4. Affected pts usually die of infections w/in 1st year of life if condition is not recognized
5. Deficiency in IL-2 receptor for gamma chain
6. Can’t respond to IL-2, IL-4, IL-7
7. Treatment: bone marrow transplant (cure if successful)
1. Ataxia telangiectasia
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2. Wiskott-Aldrich
3. Mucocutaneous candidiasis
DiGeorge Syndrome
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Leukocyte adhesion defect
1. Extremely rare
2. Umbilical cords don’t separate, still present @6 months b/c neutrophils can’t go into that area
to lyse collagen to break it off
3. High white count (b/c neutrophils are staying in the blood and can’t find their way out)
4. Measure CD18 adhesion molecule to diagnose
· Absent in these pts
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