Section I Essential Immunobiological Concepts

in Clinical Immunology 1

1. An Introduction: The Immune System 2

Objectives 2

The Immune System 3

General Features 3

Innate Immune Responses 4

Adaptive Immune Responses 6

Cells That Function in Innate Immune Responses 8

Cells That Function in Adaptive Immune Responses 11

Tissues of the Immune System: General Features 12

Tissues of the Immune System: Primary Lymphoid Organs 12

Tissues of the Immune System: Secondary Lymphoid Tissues 14

Soluble Mediators of the Immune System 20

Molecules That Activate Lymphocytes 22

Molecules That Activate Lymphocytes: Monoclonal Activators 22

Molecules That Activate Lymphocytes: Oligoclonal Activators 24

Molecules That Activate Lymphocytes: Polyclonal Activators 24

Summary 25

Clinical Cases and Discussion 26

Test Yourself 29

2. Innate Immune Responses to Pathogens 31

Objectives 31

Innate Immune Responses to Pathogens 32

General Features 32

Role of Complement 32

Phagocytosis 32

Genetic Defects in NADPH Oxidase: Chronic Granulomatous Disease.. 42

Natural Killer Cells 42

Eosinophils 45

Summary 45

Clinical Cases and Discussion 46

Test Yourself 49

3. Antigen Presenting Cells 51

Objectives 51

Antigen Presenting Cells 51

Antigen Presenting Molecule: General Features 55

Antigen Presenting Molecule: Class I MHC Molecules 56

Antigen Presenting Molecules: Class II MHC Molecules 61

Antigen Presenting Molecules: CD1 Molecules 64

Summary 64

Clinical Cases and Discussion 65

Test Yourself 67

4. Soluble Mediators of Immunity I: Antibodies 69

Objectives 69

Antibodies 69

General Features of Antibodies 69

Structure Function Relationship of Antibodies 71

Properties of Immunoglobulin Isotypes 72

Monoclonal Antibodies 77

Monoclonal Antibodies as Therapeutic Agents 78

Clinical Trials 79

Summary 80

Clinical Cases and Discussion 81

Test Yourself 84

5. Soluble Mediators of Immunity II: Complement 85

Objectives 85

Complement 86

Complement Pathways: General Features 86

Complement Biological Activities 93

Complement Regulation 95

Complement and Coagulation Pathways Are Linked via Kallikrein 99

Complement Genetic Deficiencies 99

Role of Complement in Medicine 103

Xenotransplantation: Complement Is Deleterious 103

Summary 104

Clinical Cases and Discussion 105

Test Yourself 108

6. Soluble Mediators of Immunity III: Cytokines 110

Objectives 110

Cytokines 111

General Features 111

Cytokine Receptors That Engage the JAK/STAT Pathway 111

Cytokine Receptors That Engage SMADs 117

Biological Activities of Cytokines That Signal via the JAK/STAT Pathway 117

Clinical Relevance of Cytokines 120

Chemokines 124

Summary 125

Clinical Cases and Discussion 125

Test Yourself 128

7. Cells of Adaptive Immunity 130

Objectives 130

B-lymphocyte Antigen-specific Receptor 130

Constructing an Immunoglobulin 131

B-cell Differentiation: Bone Marrow 134

Clinical Significance: B-cell Neoplasms 137

Summary 137

T-lymphocyte Antigen-specific Receptor 137

Differentiation of Lymphoid Progenitor Cells in the Thymus 140

Transport of Lymphocytes from Primary to Secondary Lymphoid Tissues 146

Summary 146

Clinical Cases and Discussion 147

Test Yourself 152

8. Antigen Dependent B-cell Differentiation 153

Objectives 153

Antigen Dependent B-cell Differentiation 153

Fate of Activated B Cells in Germinal Centers 155

Primary versus Secondary Immune Responses 159

Clinical Significance 159

Models of Signal Transduction in B-cell Activation 160

Negative Signaling in B Cells 161

B-cell Responses to T-independent Antigens 163

Summary 164

Clinical Cases and Discussion 164

Test Yourself 166

9. T Lymphocytes 168

Objectives 168

CD4+ T cells: Antigen Induced Differentiation 168

Memory CD4+ T Cells 174

Clinical Relevance of Type 1 versus Type 2 Cytokines 175

CD8+ T Cells: Antigen Induced Differentiation 177

Memory CD8+ T Cells 179

Clinical Relevance CD8+ T Cells 179

Model of Signal Transduction in T-cell Activation 180

Negative Regulation of T-cell Signaling 182

Memory Lymphocytes in Immunosurveillance 182

Gamma/Delta T Cells 184

Summary 185

Clinical Cases and Discussion 186

Test Yourself 189

10. Inflammation 190

Objectives 190

Inflammation 191

General Features 191

Vasodilatation, Increased Vascular Permeability and Edema 191

Recruitment of Neutrophils and Monocytes to the Site of Inflammation 195

Adaptive Immune Responses in Inflammation 202

Role of Innate and Adaptive Immunity in Inflammation 203

Clinical Relevance 204

Summary 204

Clinical Cases and Discussion 205

Test Yourself 209

11. Immunological Responses to Microbes 211

Objectives 211

Immunity to Microbes 212

General Features 212

Host Defenses to Extracellular Bacteria 212

Resistance to Immunity: Extracellular Bacteria 217

Host Defenses to Viruses 217

Resistance to Immunity: HIV 222

Host Defenses to Intracellular Bacteria 224

Resistance to Immunity: Intracellular Bacteria 226

Host Defenses to Fungi 227

Resistance to Immunity: Fungi 229

Summary 230

Clinical Cases and Discussion 232

Test Yourself 236

Section II: Clinical Immunology in Practice 239

12. Immunization 240

Objectives 240

Immunization 241

Passive Immunization 242

Active Immunization or "Vaccination" 244

Forms of Vaccines 247

Vaccine Efficacy and Safety 254

Successful Application of Vaccine Technology 255

Limited Use Vaccines and Experimental Vaccines 256

Uses of Vaccines (for Other than Control of Infection) 258

Summary 258

Clinical Cases and Discussion 259

Test Yourself 264

13. Hypersensitivity Reactions 266

Objectives 266

Hypersensitivity Reactions 267

General Features 267

Type I: Immediate Hypersensitivity Reactions 267

Type II: Antibody-mediated Hypersensitivity Reactions 272

Type III: Immune-complex Mediated Hypersensitivity 276

Type IV: Cell-mediated Hypersensitivity 278

Summary 282

Clinical Cases and Discussion 283

Test Yourself 287

14. Autoimmunity 289

Objectives 289

Autoimmunity 290

General Features 290

Tolerance Induction 290

Loss of Self Tolerance 293

Immunopathology of Autoimmune Disorders:

Autoreactive Antibodies 296

Immunopathology of Autoimmune Disorders:

Cell Mediated Immunity 299

Immunotherapy of Autoimmune Disease: Suppression 301

Immunotherapy of Autoimmune Disorders: Cytokine Modulation 306

Summary 307

Clinical Cases and Discussion 308

Test Yourself 312

15. Immunodeficiency Disorders 314

Objectives 314

Immunodeficiency Disorders 315

General Features 315

Primary Immunodeficiency Disorders 315

Primary Immunodeficiency Disorders: Progenitor Cells 315

Primary Immunodeficiency Disorders: T Cells 319

Primary Immunodeficiency Disorders: B Cells 320

Primary Immunodefieciency Disorders: Phagocytic 323

Primary Immunodeficiency Disorders: Other Leukocytes 323

Primary Immunodeficiency Disorders: Complement System 323

Secondary Immunodeficiency Disorders 327

Secondary Immunodeficiency Disorders: Acquired 329

Secondary Immunodeficiency Disorders: Abnormal Production of Immune Components 330

Summary 330

Clinical Cases and Discussion 331

Test Yourself 335

16. Tumor Immunology 337

Objectives 337

Tumor Immunology 338

General Features 338

The Concept of Immunosurveillance 338

Tumor Antigens 340

Tumor Immunosurveillance 344

Effector Mechanisms for Elimination of Tumors 345

Evasion of Immune Surveillance 349

Immunology in Diagnosis or in Monitoring Prognosis 354

Novel Therapies: Enhancing Antigen Presentation by Dendritic Cells 355

Novel Therapies: Cytokines and other Molecules Transfected into Tumor Cells Themselves 357

Novel Therapies: Modification of CTL as a Strategy for Enhancing Tumor Immunity 359

Novel Therapies: Monoclonal Antibodies and Immunotherapy 359

Summary 360

Clinical Cases and Discussion 361

Test Yourself 366

17. Transplantation 367

Objectives 367

Transplantation 368

General Features 368

Classification of Grafts According to Their Source 368

Classification of Graft Rejection 371

Genetics of Transplantation 373

Immunology of Graft Rejection 379

Tissue Differences in Clinical Transplantation 387

Graft Versus Host Disease 389

Immunosuppression in Transplantation 389

Summary 391

Clinical Cases and Discussion 392

Test Yourself 396

Index 398

How To Bolster Your Immune System

How To Bolster Your Immune System

All Natural Immune Boosters Proven To Fight Infection, Disease And More. Discover A Natural, Safe Effective Way To Boost Your Immune System Using Ingredients From Your Kitchen Cupboard. The only common sense, no holds barred guide to hit the market today no gimmicks, no pills, just old fashioned common sense remedies to cure colds, influenza, viral infections and more.

Get My Free Audio Book


Post a comment