\ The Lymphatic System and Immunity ‘The environment in which we live i filled with microbes that have the ability to cause disease if given the right opportunity. we did Not resist these microbes, we would be ill constantly or even die. Fortunately, we have a number of defenses that either keep ‘microbes from entering our bodies or combat them if they do gain, ‘entrance. The lymphatic (lymphoid) system is one of the principal body systems that helps to defend us against disease-producing microbes. In this chapter you will earn about the organization and components of the lymphatic system and its role in keeping us healthy, Looking Back to Move Ahez + Circulatory (Section 16.3) + Cancer (chapter 3, Common Disorders) + Epidermis of Skin (Section .1) + Mucous Membranes (Section 44) + Phagocytosis (Section 33) Maintaining homeostasis in the body requires continual combat against harmful agentsinourinteraland extemal environments Despite constant ‘exposure to a varity of pathogens (PATH é-ens)— bative action should begin. Buta T cell becomes activated only if its antigen receptor binds tothe foreign antigen (antigen recognition) while atthe same time it receives a second simulating signa, 2 pro- ‘ess known as costimulation (Figure 17). common costimulator |sinterleukin-2 (2). The need fortwo signals isa litle ke starting and arvingacar. When you insertthe correct key (antigen inthe ign- tion (eel receptor) and tur it the car starts (recognition of specfc antigen), butitcanact move forwarduntilyou move the gear shi into drive (costimulation) The need for costimulation probably helps prevent immune responses from occurring accidentally. Once aT ell has been activated, it undergoes clonal selection. Recall that clonal selections the process by which alymphocytepro- Iierates (divides several times) and differentiates (forms more highly specialized cells) in response toa specific antigen. The result of clonal selection isthe formation of aclone of cellsthatcanrecognzethesame antigen a the original ymphocyte (see Figure 17.6). Some ofthe cells ‘of aT cell clone become effector cells, while other cells ofthe lone become memory cells The effector calls ofa T call lone cary out immune responses that ultimately resuttin elimination ofthe intruder ‘As you have already leamed there are two major types of mature Tells helper Tcellsand cytotoxic Tells Activation of ahelper Tell, resultsin the formation ofa clone of active helper T cells and memory helper T cells (Figure 17.9). The active helper Tcellshelp other cells of the adaptive immune system combat intruders. Fo instance, helper FF cells release the protein interieukin2, which acts as acostimulator ‘resting helper Tcellsor cytotoxic T cells, anditenhances activation ‘nd proliferation of cls, B cells, and natural kiler cls. The memory telperT cells of a helper T cell clone ate not activ cells. However if the same antigen enters the body again in the future, memory helper cellscan quickly proliferate and diferentiate into more active helper cells and more memory helper T cells. Clinical Connection ‘Organ Transplantation ‘Przan transplantation involves the replacement ofan injured or diseased ‘Ban, such a5 the heart, tver, kidney, lngs, or pancreas, with an oan ‘onated by anather individual. To reduce the rik freecion recipients of ‘gan transplants receive immunosuppressv drugs One such dugis lo- orig, derived from a fungus, which inhibits secretion of ieleuki-2 by #Haer Tells but has ony a minimal effect on B cel. Thus, thers of ee: tis diminished while resistance to some diseases smaieained TIEMITETEY Activation endclonatsteton ota helper Tee ‘Once a eipr Yen sce Aforms wane facie Piper T | andmamonytiger Teal Toot antigen teeepior ‘tonal selection (Goterion and terectiaon) ze o, ‘Ace helper calls Memory helper Tees (cecrte 2). (ongived) Q What are some of the functions of an active helper T Cell? Activation of cytotoxic T cell results inthe formation ofa clone of cftotore T cll that consists of active cytotoxic T ces and memory ‘ytotoric Tells (Fre 17.10). Active ototoxic Tees attackotherbody ‘eels that have been infected with the antigen. Memory toto Tells do not atack infected body cel. Instead, they can quickly proliferate and diferentite into more active cytotoxic T cells and more memory ‘ytotorcT cells ifthe same antigen enters the body at future time. Elimination of Invaders cytotoxic T cells are the soldiers that march forth to do battle with foreign invaders in cell-mediated immune responses. The name cytotoxic reflects their function— Kalin cells. They leave secondary lymphatic organs and tissues and Scanned with CamScanner173 haven mmanty 19 DRRIEERT scion snd cnt secioetecymie es cen cept. her eng at opp anerplinrdoreinn Pol thease sniper, “rotons hl rapes recy by secreting EaeN WNC Uuezer ap0pt0, and perlorin, whch Eggers ahs of ineced W Feces geere a Clonal anecton ‘crear a3 F Stoves Bit cotergen recep (e oponecotaasrcen ct Sty Formation of ote Tel lone: Satenunapiponemenea = conser @ Isebes a rsope by apne a @ @ Besides cells infected by microbes, whatother types of ae @O_ cells do eytotoxie T cell attack? a” @° ‘on their surface. The cytotoxic T cell then releases granzymes, wy brotenigesting enzymes that vigae’ apoptosis, the fragmenta score eytoxe Tela Memory evetole Tels tion af ear contents (Figure 1-11). Once the infected el is feast teed tey "fone dertroyed the related microbes are kil by phagocytes. ea A.Atematively, cjotove T eels bind to infected body cells and What is the function of a memary eytotonieT cl? release two proteins from their granules: perforin and gronu- Iysin. Perforn inserts into the plasma membrane of the target, mig to seck out and destroy infected tage calls, cancer cels, ell and creates channel nthe membrane (Figure 17-120) nd ransplanted cel igure 17.41). Cytotove Tcellsrecognize and AS a result extracellular fluid flows into the target cell and atioch otargetcels Then te cjtotoe Tees deliver 2“lthathie Toss (cll bursting) occurs. Other granules in cyttore onion Teall release granulysin, which enters though the channels and Gytotowe Tels il nfected target body cells much ke natural destroys the microbes by creating holes in thei plasma mem- bileccatisdo: the mojor ierence is thateytotoiTcelishaverecep- anes. CytotorcT cell may also destroy target cellsby releasing a tors specif for a particular microbe and thus kil only target body 1024 molecule called iymphetaxio which activates enzymesin the cells infected with one paricular typeof microbe; natural kilercells__'"GEt cell. These enzymes cause the target cells DNA to fragment, [sn dostcy a wide vonety of mecrobeinfected body cls, Cytotoxic 24 the cell dies. In addition, ctoto T cells secrete gamma Tells have two principal mechanisms for kling infected targtcals: ‘interferon, which attracts and activates phagocytic cells, and mac. rophage migration inhibition factor, which prevents migration of ytotorc Teel, using receptors on ther surfaces, recognize and phagocytes from the infection ste. Ater detaching from a target. » bind to infected targetelsthat have microbial antigens displayed call, acyttoxic Teel can seek out and destroy another target cel Scanned with CamScanner420. CHAPTER 17 Tetymphac Sytem an erty Checkpoint “7. wnatis tbe normal function f major histocompatbiy complet protein etantges)? 1. Hom do antigens ave at ymphate sues? 9. How do anger presenting els process angers? 130, vnataetneunconsot nee eto, and meron Tet? 21, How do notices htt? B Cells and Antibody-mediated Immunity ‘The body contains not only millions of eilferent T cells ut aso mil lions of ciferentB cells, each capable of responding ta specific ant- ‘8. Cytotorc Tells leave lymphatic tissues to seek out and destroy ‘foreign antigen, but cells stay put. Inthe presence of afreignati- en, aspeciicBcellinalymph node, the spleen, ormucosa-associated Iymphatic tissue becomes activated. Then it undergoes clonal selec tion, forming a clone of plasma ces and memory els. Plasma cells ‘are the effector cells ofa 8 cell clone they secrete specific antibodies, ‘hich in tum circulate in the lymph and blood to reach the site of During activation of a8 cellantigen receptors onthe ellsurface ‘of 2B cal bind to an antigen (Figure 17.12).B cell antigen receptors {are chemically similar tothe antibodies that eventually are secreted by the plasma cells. Although B cells can respond to an unprocessed _ntigen present in lymph or interstitial Mud, their response is much ‘more intense when they process the antigen. Antigen processing ina ‘8 cell ocursin the following way: the antigen i taken into the 8 cll, broken down into fragments and combined with MHC protein, and ‘moved to the 8 cell surface. Helper T calls recognize the processed antigen-MHC protein complex and deliver the costimulation needed for B cell division and diferentiation. The helper T cell releases Jnterleukin-2 ond other proteins that function as costimulators to activate B cells Once activated, 2 B cell undergoes clonal selection Figure 17.12). The results the formation ofa cione of 8 cells that Consists of plasma cells and memory B cells. Plasma cells secrete intibodies. A few days ater exposure to an antigen, a plasma cell .2cretes hundreds of millions of antibodies each day for about 4or ‘days, until the plasma cell dies. Most antibodies travel in lymph 1 Blood to the invasion site. Memory 8 cells do not secrete anti- ‘dies. instead, they can quichly proliferate and differentiate into ‘re plasma cells and more memory B cells should the same ant- ‘reappear ata future tim ‘Although the functions of the five classes of antibodies differ “sewhat, all attack antigens in several ways: Yeutralize antigen. The binding of an antibody to its antigen leutralizes some bacterial toxins and prevents attachment of tome viruses to body cells. mobilize bacteria. Some antibodies cause bacteria to lose «tie motility, which limits the spread of bacteria into nearby sues. Acton and clonal selection of cls. Plasma ces re acuay much lrgerthan Beas A Plume celesscte abode Beet agen rece Dpeteron? shdeter pans cot isplaying processed repens copes ByreperTect: wien ‘leases cosimalaor: 99 Memery Beals (eestearbosies) ongaves) @ How many diferent kinds of antibodies willbe secreted by ‘te plasma cells in the clone shown here? ‘3. Agglutinate antigen. Binding of antiboges to antigens may co- rect pathogens to one another, causing agglutination, the clump: ing together of particles. Phagocytic cells ingest agglutinated m- robes more readily. 4.Activate complement. Antigen-antibody complexes activate complement proteins, which then work to remove microbes ‘through opsonization and cytolysis 5. Enhance phagocytosis. Once antigens have bound to an antibody’ ‘arable region the antibody actsasa “fog that attracts phagocytes ‘Antibodies enhance the activity of phagocytes by causing agalutina tion, byactvating complement, and by coating microbes otha they ‘are more susceptible to phagocytosis opsonization). ‘Table 17.3 summarizes the functions of cells that participate in adaptive immune responses. | Scanned with CamScanner273 Aawptva menty 22 ‘Summary of Cell Functions ln Adaptive Immune Responses Antigen presenting Cell (APC) Processes and presen foreign artgen oT els incldes macrophages, 8 ces, and enc cals Helper ¥ cat ‘eps cite els of mrnane sytem eb rude by reaaang striae een Peiecn? (2, wich enhances acvaton and @vsion of ais cher prota aac phagocyes and ease ‘hago abity of macrophages: aa stimulates Gevelogmert of 8 els Int artbady Posen plasma eels and eveopmert of atra Klee fotone Teall ‘ls ost target cls by leasing ganzymes tat induce apoptass, perfor tat forms Canoes to cause fois, ranulysn that Gestroys micobes nphotoun ak Sess a ce OMA, {Eamma-neferon that tracts macophoges and incesses the pragacyc avy, and maCoeNagE Innbtion factor that prevents macrophage migration rom eo fection Memory T call ‘Remains in phat tsue ard recognizes orignal nvacingaign, ven yeas ae sk cat Dierenttes nto antibody preducng plasma call Plasma elt Descendant of Bclthat produces and secretes artbodies Memory Ball Remains ead to produce amore rapid and foreul secondary response should the same age eter the body nthe future TT clinical Connection ‘ytotoxc T cells or plasma cll within hours the next time the same Monoclonal Antibodies ‘An anibody mediated response typically produces many diferent ent bodies that recogniaeciferen.pasf an arin or ferent artigensof2 foreign cll By contrast, amonoconal antibody (MAB) is2 pure antibedy produced from a single clone of identical els gown in the laboratory, CUrical uses Abs include he diagnosis of pregnancy alles, andi eases such a strep throat, hepatitis abies, and some sewvaly transmited ‘iseases. MAbs hve also been used to detect cancer at an etl sage and todetermine the estentof metastasis Theymayalsabe weulin preparing ‘vaccines to counteract the rejection associated with transplants to est ‘autoimmune dzeaes and perhaps to teat ADS. antigen appears. ‘One measure of immunological memory is the amount of anti body in blood plasma. After an intial contact with an antigen, no antibodies are present fora few days. Then, the levels of antibodies slowly rise, fist lgM and then IgG, followed by a gradual decline (Figure 17.13). Thisisthe primary response. Memory cells may lve for decades. Every new encounter withthe same antigen causes a secretion of antibodies. The primary response aker Ftstepesre) mer than the secondary response ake seondor subsequent exposure toa ven antigen Immunological Memory [Ahallmark of adaptive immune responsesis memory for specific ant- ‘gens that have triggered immune responses inthe past. mmunolog- ‘cal memory due to the presence oflonglasting antibodies and very long:tved lymphocytes that arise during division and diferentiation of antigen stimulated B cells and T cells. Primary and SecondaryResponses _Adapveimmune responses, whether ellmedated or anibody-medlate, are much ‘quicker and more Intense aera second or subsequent exposure to an antigen than ater the frst exposure. italy, ony afew cls have the correct antigen receptors to respond, and the immune response may tahe several days to buld to maximum intensity. Because thousands of memory ells exist aker an inital encounter tnth an antigen they can divide and diferente into helper Tels, ‘immunological memory i the bass for sucesfl mmurizaton by vcinton. @ Which type of antibody responds most strongly during the secondary response? Scanned with CamScanner422. CHAPTER 1T TetymphateSystemanéinnanty ‘rapid division of memory cells The antibody level ater subsequent ‘encounters is fa greater than during a primary response and con- sists mainly of IgG antibodies. This accelerated, more intense re- sponse is called the secondary response. Antibodies produced dut- ing a secondary response are even more effective than those produced duringa primary response. Thus, they are more successful In disposing ofthe invaders Primary and secondary responses occur during microbial infec tion. When yourecoverfrom an infection without taking antimicrobial, ‘drugs, itis usualy becouse ofthe primary respons. Ifthe same mi- ‘robe infects you later, the secondary response could be so swt that ‘the microbes are destroyed before you eaibit any sins or symptoms of infection, Naturally Acquired Immunity and Artificially Acquired Immunity immunological memory provides the bass for immunization by vecination agaist certain diseases, for instance, polo. When you receive the vccne, which may contain weakened or killed wiole mizrobes or parts of microbes, your 8 Calls and calls are actnate, Should you subsequently encounter the Uving pathogen a an infecting microbe, your body inates 3 secondary response. However, booster dotes of zme immunising agents must be ven periodically to mainsin adequate protection against the pathogen, Table 17.4 summarize the various types of antigen encounters that provide nturaly and atl acquired munity. TABLE 17.4 Types of Adaptive Immunity Naturally acquired Following exposure toa microbe antigen setive immunity recognition by Bclls and Tels and ‘ontimolton leno antbody secreting plasma ls, enotonT el and Band Timemory cls Waturally equired Trlr ogg antibodies from mother tus ‘atsivelmmonity across the placenta, of pA antibodies rom other to baby nmi during rest feeding “anigensieguced dung vaccination ‘Simulte celtmedated and antibody mediated immune response, indingto production of ‘memory cls The antigens are pereated tobe Immunogens but not pathogen; hat they ails a immune response but not cause Senifeareiiness ‘iat acqlred Active Immnity ‘ariiclaly acquire passive immunity Tnravenons jection af mmunoglobullns (amiboces) Checkpoint 12, How ore cel mediated and antibody mated rune esorses ‘ima? How cosh er? 12, whaticnederence between the secondary tesponse 18" antigen andthe primar response? 174 Aging and the Immune System ‘OBJECTIVE + Deteribe the effet of aging on the immune system With advancing age, most people become more susceptible tal ‘types of infections and malignancies. Their response to vaccines is ‘decreased, and they tend to produce more autoantibodies (antibod- les against ther bodys onn molecules). In addition, the immunesys- tem exhibits lowered levels of function. Fr example, Tcelis become less responsive to antigen, and fewer T cals respond to infections. ‘This may recut from age elated atrophy ofthe thymus o decreased production of thymic hormones. Because the cell population decreases with age, 8 cals are also less responsive. Consequently, antibody levels donot increase as rapidly in response toa challenge by an antigen, resulting in increased susceptibit to various infec- tions es for this key eason tha elderly individual ae encouraged to get influenza fu) vacinations each yea. ‘Checkpoint 14, What arethe consequences decreasesin the numberof cls and Beelswin advancing ge? To appreciate the many ways thatthe lymphatic system and immu- nity contribute to homeostasis of other body systems, examine Focus on Homeostasis: The Lymphatic System and Immunity. Next, in Chapter 18, we wil explore the steuctur and function of the es: piratory system and see how is operation's regulated by thenervous system. Most importantly, the respiratory system provides for gas ‘exchange=taking in oxygen and blowing of carbon dioxide. The cardiovascular system aids gas exchange by transporting blood containing the gases between the lungs ad tissue cls. Scanned with CamScanner424, CHAPTER 17 TheLymphale System andimmunity Common Disorders AIDS: Acquired Immunodeficiency Syndrome ‘Acquired immunodeficiency syndrome (A105) sa condition in which ‘2 person experiences 2 teltale assortment of infections due to the progressive destruction of immune system cells by the human immu- Iodefciency virus (HI). AIDS represents the end stage of infection by HIV.A person who is infected with HIV may be symptomtee for ‘many year, even while the virus is actively attacking the immune sys- tem. nthe wo decades after the ist fivecases were reportedin 1981, 22 milion people died of AIDS. Worldwide, about 3 milion people are currently infected with HV. HIV Transmission secause HiVispresentin the blood and ‘some body fluid, it ie most effectively transmitted (spread from ‘one person to another) by practices that involve the exchange of blood or body fluids, HI i transmitted in semen or vaginal id during unprotected (without @ condom) anal, vaginal, or oral sex. HIV also is transmitted by direct blood-to-blood contact, such as ‘occurs in intravenous drug users who share hypodermic needles or health-care professionals who may be accidentally stuck by Hiv-contaminated hypodermic needles. In addition, HIV can be transmitted from an Hivinfected mother to her baby at birth or during breast feeding “The chances of transmitting or of beinginfected by HIV during vaginal or anal intercourse can be greatly reducedalthough not climinated—by the use of latex condoms. Public health programs aimed at encouraging drug users notto share needles have proved effective at checking the Increase in new HIV infections in this population. Also, giving certain drugs to pregnant HiVinfected ‘women greatly reduces the risk of transmission of the virus to their babies. HIVis a very fragile virus; it cannot survive forlong outside the human body. The virus is not transmitted by insect bites. A person ‘cannot become infected by casual physical contact with an HIV: infected person, such as by hugging or sharing household items. The vius can be eliminated from personal care items and medical equipment by exposing them to heat (135°F for 10 minutes) or by ‘leaning them with common disinfectants such as hydrogen pe ‘oxide, rubbing alcohol, household bleach, or germicidal cleansers such as Betadine* or Hbiclens. Standard dishwashing and clothes washing also kil HIV HIV: Structure and Infection Hiv consists of an inner core of ribonucleic acid (RNA) covered by a protein coat (capsid) surrounded by an outer layer (envelope), composed of a lipid ilayer penetrated by proteins. Outside a living host cel, virus is sunable to replicate, However, when the virus infects and enters a hhost cell Its RNA uses the host cell's resources to make thousands va rage tee nent any eminent ieee eee Signs, Symptoms, and Diagnosis of HIV Infection Soon afer being infected with MW, most people experience a brief ft illness, Common signs and symptoms ae fever, fatigue rash, headache, joint pain, sore throat, and swollen lymph nodes. About 50% of infected people have night sweats. As early as three to four weeks ater HIV infection, plasma cells begin secreting antibodies ‘against HIV These antibodies are detectable in blood plasma and form the bass for tome ofthe screening tests for HW. When people test “HIV-positive? it usually means they have antibodies to HIV antigensi their bloodstream, Progression to AIDS Mer 2 period of 2 to 10 years, the Virus destroys enough helper Tcels that most infected people begin to experience symptoms of Immunodeficiency. HNinfected people ‘commonly have enlarged lymph nodes and experience persistent fatigue, involuntary weight los, night sweats, skin rashes, iarhea, and various lesions ofthe mouth ané gums. In addition, the virus may begin to infect neuronsin thebrainafecting the person's memory and producing visual disturbances. ‘As the immune system slowly collapses, an Hivinfected person becomes susceptible to a host of opportunistic infections. These are infections caused by microorganisms that are normally held in check ‘but now proliferate because ofthe defective immune system. AIDS is ciagnosed when the helper T cell count drops below 200 cells per mi craliter(= cublemilimeter ofbloodor when opportunistic infections arise, whichever occurs ist atime, opportunistic infections usually are the cause of death. Treatment of HIV Infection atpresent, infection with HN cannotbe cured, Vaccines designed to blocknewHIVinfections and to reduce the viral oad (the numberof copies of HIVRNA in a microliter of blood plasma) in those who are already infected are in clinical tral, Meanwhile, three categories of drugs have proved successful in extending the life of many HiV.nfected people: A. Reverse transcriptase inhibitors interfere with the action of ‘everse transcriptase the enzyme thatthe virus uses to conver its RNA into DNA copy. Among the drugsin this category are zidowu- dine (Z0v, previously called AZT), didanosine (ddl), and stavudine (GAT), Tzivie®, approved in 2000 fr treatment of HIV infection, ‘combines three reverse transcriptase inhibitors in one pill. 2. integrase inhibitors block the enzyme integrase, which inserts the HIV NA copy into host cell ONA. The drug altegraviris an example of an integrase inhibitor, Scanned with CamScanner3. Protease inhibitors interfere with the action of protease, avira en- Zyme that cuts proteins into pieces to assemble te protein coat of newly produced HW particles. Orugs inthis category include neli- Navir,saquinawir rtonavi, and indinavie ‘The recommended treatment for HIV-infected patients it Nghly ctive antiretroviral theropy (HAART)—2 combination of the ‘ore antiretrow inhibitor drug classes. Most HIV-infected individual HAART experience a drastic reduction in vial lo inthe number of helper T cells in their blood, Not only does HAART elay the progression of HIV infection to AIDS, but many individu- als with AIDS have seen the remission or disappearance of oppor- {unisticinfections and an apparent return to heath, Unfortunately, HAART is very costly (exceeding $10,000 per year), the dosing Schedule is grueling, and not all people can tolerate the toc side ‘effects of these drugs. Although HIV may vitually disappear from the biood with drug treatment (and thus a blood test may be “negative” for HIV), the vieus typically stil lurks In various Iym> ‘hati tissues. In such cates, the infected person can still transmit the vius to another person. Allergic Reactions ‘A perton who is overly reactive o a substance that is tolerated by ‘most other people is s3id tobe allergic. Whenever an allergic reaction ‘takes place, some tissue injury occurs. The antigens that induce on ‘allergic reaction are termed ollergens. Common allergens include Certain foods (milk, peanuts, shellfish, eggs), antibiotics (peniclin, tetracycline), vaccines (pertussis, typhoid), venoms (honeybee, SP, snake), coumetics, chemicals in plants such a8 poison ivy, pollens, ust, molds, jodine-containing dyes use in certain tay procedures, ‘and even microbes. Type 1 (anaphylactic) reactions are the most common and typically occur within 2 to 30 minutes after a person who was pre- Vioutly sensitized to an allergen is reexposed toi. In response to ‘certain allergen, some people produce IgE antibodies that bind to the surface of mast cells and batophils The next time the same al- lergen enters the body, it attaches to the Igé antibodies already present. In response, both the mast cells and basophils rele histamine, prostaglandins, and other chemicals. Collectively, these chemicals cause vatodilation, increased blood capillary p ‘meability, increased smooth muscle contraction inthe airways of the lungs, and increased mucus secretion, As a result, @ person may experience inflammatory responses, difcuty in breathing through the narrowed airways, and 2 runny nose from excess mur us secretion, In anophylactle shock or anaphylaxis, which may ‘occur in a susceptible individual who has ust received a triggering ‘drugor been stung by 8 wasp, wheezing and shortness of breath a airways constrict are usually accompanied by shock due to vasodi- lation and uid loss from blood. Injecting epinephrine to dilate the snd strengthen the heartbeat usually is elfectve in this Ie: threatening emergency. Type (ytotore)reactlons ae caused by antibodies directed against antigens. ona peron’sbloodcelisor tissue calls Typelreations, Scanned with CamScanner which may occur in incompatible blood Uanshusion reactions, damage cela by causing hy, Type il (immune-compler reoctloms invohve antigens. antibod les, and complement. Glomeritonephits and theumatind arthrs (2) aie in his wo. Type WV (cell-mediated) reactions ot delayed hypersensitivity reactions ususlly appear 12-72 hours after exposure to an Allergen. Type 1 reactions occur when allergens are taken up by site of allergen entry into the body, where they produce gamma Interferon, which activates macrophages, and tumor necrosis fe tor, which stimulates an inflammatory response, intrac bacteria such as Mycobacterium tuberculosis wiager this type of cell mediated immune response, as do certain haptens, such as pozon ivy toxin, The shin test for tuberculosis alsa is a delayed hypersensitivity reaction, Autoimmune Diseases In an ovtolmmune dizeose (aw: MON) or autoimmunity, the immune system fails to display selftolerance and attacks the person's own tesues. Autoimmune diseases usually arise in early ‘adulthood and are common, afflicting an estimated 5% of adults in North America and Europe. Females sufer autoimmune diseases ‘more often than males, Sereactive Bclls and T cells normally are Geleted of inactivated during negative selection. Apparently, this process not 100% elective. Under the influence of unknown en onmental triggers and certain genes that make some people more susceptible, self-tolerance breaks down, leading to activation of selereactve clones of T cells and B cells. These cells then gene! cellmediated of antibody-mediated immune responses against seltantigens. ‘variety of mechanisms produce diferent autoimmune dis: ‘eates. Some involve production of autoantibodies, antibodies that bind to and stimulate or block self-antigens. For example, autoan bodies that mimic TSH (thyroid-stimulating hormone) ae present In Graves disease and stimulate secretion of thyroid hormones (thus producing hyperthyroidism); autoantibodies that bind to and block acetylcholine receptors cause the muscle weakness charac- teristic of myasthenia gravis. Other autoimmune diseases involve activation of cytotoxic T eels that destroy certain body cells. Exam ples include type 1 diabetes mellitus, in which T cells attack the Insulin-producing pancreatic beta cells, and multiple sclerosis), Jn which T calls attack myelin sheaths around axons of neurons. Inappropriate activation of helper T cells or excessive production of gamma-interlron also occur in certain autoimmune diseases. Other autoimmune disorders include rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), rheumatic fever, hemolytic ‘and pernicious anemias, Addison's disease, Mashimote's thyroiditis, ‘and ulcerative colts. ‘Therapies for various autoimmune diseases include removal of ‘the thymus gland (thymectomy), injections of bets.interferon immunosuppressive drugs, and plasmapheresis, in which the426 CHAPTER LT The lymphatic Ssem on immanny fitered to remove antibodies and antigen: person's blood plasma antibody complexes Infectious Mononucleosis Infectious mononucleess or “mono" sa contagious disease caused by theEpsten-Borr vis (EBM. occurs manly inchildren and young dls, and more often in ferales than in males. The virus commonly enters the body through intimate oral contact suchas hissing which ‘accounts foritbeing called the “hissing disease” EBY then multiplies in lymphatic issues and spreads ito the blood, where it infects and ‘mkiplesin 8 cells, the primary host cells. Because ofthis infection, the 8 cells become enlarged and abnocmalin appearance so that hey resemble monocytes, the primary reason forthe term mononucleoss, Besides an elevated white blod cll eount with an abnormally high percentage of lymphocytes, signs and symptoms include fatigue, headache, iziness, sore throat, enlarged and tender lymph nodes, and fever. There is no cure for infectious mononucleosis, but the disease usualy uns its coursein afew weeks. Lymphomas Lymphomas (im-F0-mas;ymph- = clear water;-oma = tumor) ae cancers of the lymphatic organ, especialy the lymph nodes. Most hhaverio known cause, The twomaintypesof lymphomas areHodgkin isease and non-Hodgkin lymphoma. ‘Hodgkin dzeate (HO) is characterized by painless, nontender enlargement of one ar more lymph nodes, most commonly in the neck, ches, and axillae (armpits). If the disease has metatasied from these sites, fevers, night sweats, weight os, and bone pain also ‘occur. MO pmariy aflets individuals betwen ages 15 and 35 and ‘those ove ti more common in males éagnosed early, MO has 990-99% cure rate. Non-Heéghia lymphoma (MHI), which & more common than oO, occurs in al age groups. MHL may start the same way a3 HD but ‘may alt include an enlarged spleen, anemia, and genera malaise. Upto half of al individuals with NHL ae cured or survive for alengthy period. Treatment options for both HD and NMI include radiation therapy, chemotherapy, and red bone marrow transplantation. ‘Systemic Lupus Erythematosus Systemic lupus erythematous (SL erethém-+-T0-u),0F pus {pus » wal) sa ehronc autoimmune disease that affects mut ple body systems Most caes of SLE acu in women between the ‘sgesof 15 and 25, more oken in blacks than in whites. Although the aus of SLE i not known, both a genetic predisposition tthe ds fate and environmental factors contibute Females arene ines tore likely than males to suf from SLE. The dsorderohen occurs infemales who exhibit extremely low levels androgens (male sex hormones). Signs and symptoms of SLE include joint pan, sight fever, fatigue, oral ulcers, eight os, enlarged lymph nodes and splen, photosensity, rapid loss of large amounts of scalp ha, and sometimes an eruption across the bridge ofthe nose and cheeks called a "butterfly ash The erosive nature some ofthe SLEskin lesions was thought ta resemble the damoge inflicted by the bi ofa wot-thus the term lupus, Kidney damage occurs a antigen antibody complexesbecometrappedin kidney cpilaies, thereby obstructing blood fering. Renal failure isthe most common couse of death Medical Terminology and Conditions Adenitis (2-25; aden = plan) is = nflammation of) Enlarge, tender, ad lames yh nodes sung from aninfecton ‘Allegra (AL 6-gaalo-= other) Axransplant between genetical d= {erent indviduas ofthe same species. Skin transplants rom otter people ‘and blood tanshsions are allopat. ‘Autograft (at6-ar;outo- = sal A transplant in which ones own tisue is grated to another part the Body suc ssn gras for bur treatment or plastic surgen) ‘Chronic fatigue syndrome CFS) Aciorder, essay occuringin young female aduts, chracterae by (t) extreme fatigue that impairs normal ‘activities for at lassie months and [2 the absence of ether known ds teases (cancer, infection, dive abuse, toy, or psychiatre disorders) ‘that might produce simiar symptoms. Gamma globulin (GLOB.O‘in) Suspension of immunoglobulins fom blood consisting of antibodies that reat witha speciicpathogen.Rispre- pared by injecting the pathogen into armas, removing bleed rom the armas ae antibodies hove Been produced, olating the antibodies, Sndineting them toa human o provide short emmy, Graf dnytsue or ogan sed orvansparation or atransplantofsieh yperspenim (iperSPLENam; hyper: = ve) Abnomalspencac thy dueto splenic enlargement and associated wih an increased rate esruction of ara bode Lymphadenopathy fim fal-eNOP.a th; mph = cer Mui potty = sease) Enlarge, sometimes tender Iymph glands 35a response to Infection alsocalledaneten land. Splenomegalyspl-nO EG, mego:= large) Enlapesplen. ‘Tonsiectomy tor’ sb LEK 6m ectomy = exon Removal of ators enoyat(ZE¥-6-gat:rero-=srangeorforeign)Atansplnt between animals of ciferent species, enogats from porcine (pig) ar bovine (com) sue maybe wsedin people a 2 physiological desing for severe burs. Scanned with CamScanner