* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Lesson 12.2 PPT - Freeman Public Schools
DNA vaccination wikipedia , lookup
Duffy antigen system wikipedia , lookup
Sjögren syndrome wikipedia , lookup
Immune system wikipedia , lookup
Lymphopoiesis wikipedia , lookup
Psychoneuroimmunology wikipedia , lookup
Molecular mimicry wikipedia , lookup
Innate immune system wikipedia , lookup
Monoclonal antibody wikipedia , lookup
X-linked severe combined immunodeficiency wikipedia , lookup
Adaptive immune system wikipedia , lookup
Adoptive cell transfer wikipedia , lookup
Cancer immunotherapy wikipedia , lookup
PowerPoint® Lecture Slide Presentation by Patty Bostwick-Taylor, Florence-Darlington Technical College The Lymphatic System and Body Defenses 12 PART B Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Immune response is the immune system’s response to a threat  Immunology is the study of immunity  Antibodies are proteins that protect from pathogens Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Three aspects of adaptive defense  Antigen specific—recognizes and acts against particular foreign substances  Systemic—not restricted to the initial infection site  Memory—recognizes and mounts a stronger attack on previously encountered pathogens Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Types of Immunity  Humoral immunity = antibody-mediated immunity  Provided by antibodies present in body fluids  Provided by B lymphocytes  Cellular immunity = cell-mediated immunity  Targets virus-infected cells, cancer cells, and cells of foreign grafts  Provided by T lymphocytes Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Antigens (nonself)  Any substance capable of exciting the immune system and provoking an immune response  Examples of common antigens  Foreign proteins (strongest)  Nucleic acids  Large carbohydrates  Some lipids  Pollen grains  Microorganisms Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Self-antigens  Human cells have many surface proteins  Our immune cells do not attack our own proteins  Our cells in another person’s body can trigger an immune response because they are foreign  Restricts donors for transplants Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Allergies  Many small molecules (called haptens or incomplete antigens) are not antigenic, but link up with our own proteins  The immune system may recognize and respond to a protein-hapten combination  The immune response is harmful rather than protective because it attacks our own cells Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Cells of the adaptive defense system  Lymphocytes respond to specific antigens  B lymphocytes (B cells)  Produce antibodies and oversees humoral immunity  T lymphocytes (T cells)  Cell-mediated immunity  Macrophages help lymphocytes Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Immunocompetent—cell becomes capable of responding to a specific antigen by binding to it  Cells of the adaptive defense system  Lymphocytes  Originate from hemocytoblasts in the red bone marrow  B lymphocytes become immunocompetent in the bone marrow (remember B for Bone marrow)  T lymphocytes become immunocompetent in the thymus (remember T for Thymus) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Lymphocyte Differentiation and Activation Lymphocytes destined to become T cells migrate from bone marrow to the thymus and develop immunocompetence there. B cells develop immuno-competence in the bone marrow. Bone marrow Circulation in blood Immature lymphocytes Thymus Immunocompetent, but still naive, lymphocytes migrate via blood Mature immunocompetent B and T cells recirculate in blood and lymph After leaving the thymus or bone marrow as naive immunocompetent cells, lymphocytes “seed” the infected connective tissues (especially lymphoid tissue in the lymph nodes), where the antigen challenge occurs and the lymphocytes become fully activated. Bone marrow Activated (mature) lymphocytes circulate continuously in the bloodstream and lymph, and throughout the lymphoid organs of the body. Lymph nodes and other lymphoid tissues KEY: Site of lymphocyte origin and Sites of development of immunocompetence as B or T cells; primary lymphoid organs Site of antigen challenge and final differentiation to mature B and T cells Figure 12.11 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Lymphocyte Differentiation and Activation Lymphocytes destined to become T cells migrate from bone marrow to the thymus and develop immunocompetence there. Bone marrow Circulation in blood Immature lymphocytes Thymus KEY: Site of lymphocyte origin and Sites of development of immunocompetence as B or T cells; primary lymphoid organs Site of antigen challenge and final differentiation to mature B and T cells Figure 12.11, step 1a Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Lymphocyte Differentiation and Activation Lymphocytes destined to become T cells migrate from bone marrow to the thymus and develop immunocompetence there. B cells develop immuno-competence in the bone marrow. Bone marrow Circulation in blood Thymus Immature lymphocytes Bone marrow KEY: Site of lymphocyte origin and Sites of development of immunocompetence as B or T cells; primary lymphoid organs Site of antigen challenge and final differentiation to mature B and T cells Figure 12.11, step 1b Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Lymphocyte Differentiation and Activation Lymphocytes destined to become T cells migrate from bone marrow to the thymus and develop immunocompetence there. B cells develop immuno-competence in the bone marrow. Bone marrow Circulation in blood Immature lymphocytes Thymus Immunocompetent, but still naive, lymphocytes migrate via blood After leaving the thymus or bone marrow as naive immunocompetent cells, lymphocytes “seed” the infected connective tissues (especially lymphoid tissue in the lymph nodes), where the antigen challenge occurs and the lymphocytes become fully activated. Bone marrow Lymph nodes and other lymphoid tissues KEY: Site of lymphocyte origin and Sites of development of immunocompetence as B or T cells; primary lymphoid organs Site of antigen challenge and final differentiation to mature B and T cells Figure 12.11, step 2 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Lymphocyte Differentiation and Activation Lymphocytes destined to become T cells migrate from bone marrow to the thymus and develop immunocompetence there. B cells develop immuno-competence in the bone marrow. Bone marrow Circulation in blood Immature lymphocytes Thymus Immunocompetent, but still naive, lymphocytes migrate via blood Mature immunocompetent B and T cells recirculate in blood and lymph After leaving the thymus or bone marrow as naive immunocompetent cells, lymphocytes “seed” the infected connective tissues (especially lymphoid tissue in the lymph nodes), where the antigen challenge occurs and the lymphocytes become fully activated. Bone marrow Activated (mature) lymphocytes circulate continuously in the bloodstream and lymph, and throughout the lymphoid organs of the body. Lymph nodes and other lymphoid tissues KEY: Site of lymphocyte origin and Sites of development of immunocompetence as B or T cells; primary lymphoid organs Site of antigen challenge and final differentiation to mature B and T cells Figure 12.11, step 3 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Adaptive Defense System: Third Line of Defense  Cells of the adaptive defense system (continued)  Macrophages  Arise from monocytes  Become widely distributed in lymphoid organs  Secrete cytokines (proteins important in the immune response)  Tend to remain fixed in the lymphoid organs Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Functions of Cells and Molecules Involved in Immunity Table 12.3 (2 of 2) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral (Antibody-Mediated) Immune Response  Stage One of B cell development  Inactive B cells are released from bone marrow and circulate to lymph nodes, spleen and other lymphatic structures  Stage Two is when B cell becomes activated  B lymphocytes with specific receptors bind to a specific antigen  One the antigen is an epitope  Epitope is protein molecule that has a sequence that determines its shape Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral (Antibody-Mediated) Immune Response  The binding event activates the lymphocyte to undergo clonal selection  Family of identical B cells are produced  A large number of clones are produced (primary humoral response) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response  Most B cells become plasma cells  Produce antibodies to destroy antigens  Activity lasts for 4 or 5 days  Some B cells become long-lived memory cells (secondary humoral response)  A Second exposure causes a rapid response  Secondary response is stronger and lasts longer Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Primary Response (initial encounter with antigen) B lymphoblasts Proliferation to form a clone Antigen Antigen binding to a receptor on a specific B cell (lymphocyte) (B cells with non-complementary receptors remain inactive) Plasma cells Memory B cell Secreted antibody molecules Secondary Response (can be years later) Subsequent challenge by same antigen Clone of cells identical to ancestral cells Plasma cells Secreted antibody molecules Memory B cells Figure 12.12 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Primary Response (initial encounter with antigen) Antigen Antigen binding to a receptor on a specific B cell (lymphocyte) (B cells with non-complementary receptors remain inactive) Figure 12.12, step 1 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Primary Response (initial encounter with antigen) B lymphoblasts Proliferation to form a clone Antigen Antigen binding to a receptor on a specific B cell (lymphocyte) (B cells with non-complementary receptors remain inactive) Figure 12.12, step 2 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Primary Response (initial encounter with antigen) B lymphoblasts Proliferation to form a clone Antigen Antigen binding to a receptor on a specific B cell (lymphocyte) (B cells with non-complementary receptors remain inactive) Plasma cells Memory B cell Secreted antibody molecules Figure 12.12, step 3 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Primary Response (initial encounter with antigen) B lymphoblasts Proliferation to form a clone Antigen Antigen binding to a receptor on a specific B cell (lymphocyte) (B cells with non-complementary receptors remain inactive) Plasma cells Memory B cell Secreted antibody molecules Secondary Response (can be years later) Subsequent challenge by same antigen Clone of cells identical to ancestral cells Figure 12.12, step 4 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Primary Response (initial encounter with antigen) B lymphoblasts Proliferation to form a clone Antigen Antigen binding to a receptor on a specific B cell (lymphocyte) (B cells with non-complementary receptors remain inactive) Plasma cells Memory B cell Secreted antibody molecules Secondary Response (can be years later) Subsequent challenge by same antigen Clone of cells identical to ancestral cells Plasma cells Secreted antibody molecules Memory B cells Figure 12.12, step 5 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Humoral Immune Response Figure 12.13 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Active Immunity  Occurs when B cells encounter antigens and produce antibodies  Active immunity can be  Naturally acquired during bacterial and viral infections  Artificially acquired from vaccines  Amount of antibodies produced in response to a vaccination is called an antibody titer  Booster shots may intensify the immune response at a later meeting with the same antigen Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Passive Immunity  Occurs when antibodies are obtained from someone else  Conferred naturally from a mother to her fetus (naturally acquired)  Conferred artificially from immune serum or gamma globulin (artificially acquired)  Immunological memory does not occur  Protection provided by “borrowed antibodies” Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Passive Immunity  Monoclonal antibodies  Antibodies prepared for clinical testing or diagnostic services  Produced from descendents of a single cell line  Examples of uses for monoclonal antibodies  Diagnosis of pregnancy  Treatment after exposure to hepatitis and rabies  Inherited Immunity- immunity you are born with Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Types of Acquired Immunity Figure 12.14 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies (Immunoglobulins or Igs)  Soluble proteins secreted by B cells (plasma cells)  Carried in blood plasma  Capable of binding specifically to an antigen Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies (Immunoglobulins or Igs) Figure 12.15a Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies  Antibody structure  Four amino acid chains linked by disulfide bonds  Two identical amino acid chains are linked to form a heavy chain- 400 amino acids  The other two identical chains are light chains  Specific antigen-binding sites are present Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibody Structure Figure 12.15b Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies  It is Y shaped and the ends have variable regions  Variable region is region where the sequence varies in different antibodies (epitope)  Also has a complement binding site Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies  Antibody classes  Antibodies of each class have slightly different roles  Five major immunoglobulin classes (MADGE)  IgM—can fix complement  IgA—found mainly in mucus, saliva, tears  IgD—important in activation of B cell  IgG—can cross the placental barrier and fix complement and is most abundant  IgE—involved in allergies Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Immunoglobin Classes Table 12.2 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies  Antibody function  Antibodies inactivate antigens in a number of ways  Neutralization-antibodies bind to specific sites on bacteria and viruses and turns them into harmless cells  Agglutination- clumping so easy for phagocytosis; happens in blood mixing Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibodies  Antibody function  Complement fixation- alters shape of antibody to expose previously hidden complement site  Binding to these sites causes a hole in the middle of the enemy cell and water runs in and cell bursts  cytolosis  Precipitation Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Antibody Function Figure 12.16 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Cellular (Cell-Mediated) Immune Response  Antigens must be presented by macrophages to an immunocompetent T cell (antigen presentation)  T cells must recognize nonself and self (double recognition)  After antigen binding, clones form as with B cells, but different classes of cells are produced Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Cellular (Cell-Mediated) Immune Response Figure 12.17 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Cellular (Cell-Mediated) Immune Response  T cell clones  Cytotoxic (killer) T cells  Specialize in killing infected cells  Insert a toxic chemical (perforin)  Helper T cells  Recruit other cells to fight the invaders  Interact directly with B cells to differentiate into plasma cells Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Cellular (Cell-Mediated) Immune Response Figure 12.18 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Cellular (Cell-Mediated) Immune Response  T cell clones (continued)  Regulatory T cells  Formerly called suppressor T cells  Release chemicals to suppress the activity of T and B cells  Stop the immune response to prevent uncontrolled activity  A few members of each clone are memory cells Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Functions of Cells and Molecules Involved in Immunity Table 12.3 (1 of 2) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Functions of Cells and Molecules Involved in Immunity Table 12.3 (2 of 2) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Summary of Adaptive Immune Response Figure 12.19 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Summary of Adaptive Immune Response Figure 12.19 (1 of 2) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Summary of Adaptive Immune Response Figure 12.19 (2 of 2) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Organ Transplants and Rejection  Major types of grafts  Autografts—tissue transplanted from one site to another on the same person  Isografts—tissue grafts from an identical person (identical twin)  Allografts—tissue taken from an unrelated person  Xenografts—tissue taken from a different animal species Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Organ Transplants and Rejection  Autografts and isografts are ideal donors  Xenografts are never successful  Allografts are more successful with a closer tissue match  Immunosuppressive therapy needed to prevent rejection  Includes drugs, radiation, and controlling inflammation  May have side effects Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Organ Transplants and Rejection  Host vs. Graft rejection- destroys donated tissue  Graft vs. Host rejection- destroys tissue in hosts body and may lead to death Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Disorders of Immunity: Allergies (Hypersensitivity)  Abnormal, vigorous immune responses  Types of allergies  Immediate hypersensitivity  Triggered by release of histamine from IgE binding to mast cells  Reactions begin within seconds of contact with allergen  Runny nose, watery eyes, itching, hives, constricted airways, irregular heart beat  Antihistimines may help  When allergen inhaled- asthma Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Disorders of Immunity: Allergies (Hypersensitivity)  Anaphylactic shock—dangerous, systemic response  Occurs when allergen enters the blood and rapidly circulates through body  Bee stings and spider bites  Can happen with penicillin in some people Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Disorders of Immunity: Allergies (Hypersensitivity)  Types of allergies (continued)  Delayed hypersensitivity  Triggered by the release of lymphokines from activated helper T cells  Symptoms usually appear 1–3 days after contact with antigen  Use corticosteroid drugs  Contact dermatitis (poison ivy), cosmetics, detergents Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Allergy Mechanisms Sensitization stage Antigen (allergen) invades body Plasma cells produce large amounts of class IgE antibodies against allergen IgE antibodies attach to mast cells in body tissues (and to circulating basophils) Mast cell with fixed IgE antibodies IgE Granules containing histamine Subsequent (secondary) responses More of same allergen invades body Allergen binding to IgE on mast cells triggers release of histamine (and other chemicals) Antigen Mast cell granules release contents after antigen binds with IgE antibodies Histamine Histamine causes blood vessels to dilate and become leaky, which promotes edema; stimulates release of large amounts of mucus; and causes smooth muscles to contract Outpouring of fluid from capillaries Release of mucus Constriction of bronchioles Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 12.20 Allergy Mechanisms Sensitization stage Antigen (allergen) invades body Figure 12.20, step 1 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Allergy Mechanisms Sensitization stage Antigen (allergen) invades body Plasma cells produce large amounts of class IgE antibodies against allergen Figure 12.20, step 2 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Allergy Mechanisms Sensitization stage Antigen (allergen) invades body Plasma cells produce large amounts of class IgE antibodies against allergen IgE antibodies attach to mast cells in body tissues (and to circulating basophils) Mast cell with fixed IgE antibodies IgE Granules containing histamine Figure 12.20, step 3 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Allergy Mechanisms Subsequent (secondary) responses More of same allergen invades body Antigen Figure 12.20, step 4 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Allergy Mechanisms Subsequent (secondary) responses More of same allergen invades body Allergen binding to IgE on mast cells triggers release of histamine (and other chemicals) Antigen Mast cell granules release contents after antigen binds with IgE antibodies Histamine Figure 12.20, step 5 Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Allergy Mechanisms Subsequent (secondary) responses Antigen More of same allergen invades body Allergen binding to IgE on mast cells triggers release of histamine (and other chemicals) Mast cell granules release contents after antigen binds with IgE antibodies Histamine Histamine causes blood vessels to dilate and become leaky, which promotes edema; stimulates release of large amounts of mucus; and causes smooth muscles to contract Outpouring of fluid from capillaries Release of mucus Constriction of bronchioles Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 12.20, step 6 Allergy Mechanisms Sensitization stage Antigen (allergen) invades body Plasma cells produce large amounts of class IgE antibodies against allergen IgE antibodies attach to mast cells in body tissues (and to circulating basophils) Mast cell with fixed IgE antibodies IgE Granules containing histamine Subsequent (secondary) responses More of same allergen invades body Allergen binding to IgE on mast cells triggers release of histamine (and other chemicals) Antigen Mast cell granules release contents after antigen binds with IgE antibodies Histamine Histamine causes blood vessels to dilate and become leaky, which promotes edema; stimulates release of large amounts of mucus; and causes smooth muscles to contract Outpouring of fluid from capillaries Release of mucus Constriction of bronchioles Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Figure 12.20, step 7 Disorders of Immunity: Immunodeficiencies  Production or function of immune cells or complement is abnormal  May be congenital or acquired  Includes AIDS (Acquired Immune Deficiency Syndrome) and Severe Combined Immunodeficiency Disease (SCID) Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Disorders of Immunity: Autoimmune Diseases  The immune system does not distinguish between self and nonself  The body produces antibodies and sensitized T lymphocytes that attack its own tissues Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Disorders of Immunity: Autoimmune Diseases  Examples of autoimmune diseases  Multiple sclerosis—white matter of brain and spinal cord are destroyed  Myasthenia gravis—impairs communication between nerves and skeletal muscles  Type I diabetes mellitus—destroys pancreatic beta cells that produce insulin Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Disorders of Immunity: Autoimmune Diseases  Examples of autoimmune diseases  Rheumatoid arthritis—destroys joints  Systemic lupus erythematosus (SLE)  Affects kidney, heart, lung and skin  Glomerulonephritis—impairment of renal function  Reynaud’s Disease Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Self Tolerance Breakdown  Inefficient lymphocyte programming  Appearance of self-proteins in the circulation that have not been exposed to the immune system  Eggs  Sperm  Eye lens  Proteins in the thyroid gland Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Self Tolerance Breakdown  Cross-reaction of antibodies produced against foreign antigens with self-antigens  Rheumatic fever Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings Developmental Aspects of the Lymphatic System and Body Defenses  Except for thymus and spleen, the lymphoid organs are poorly developed before birth  A newborn has no functioning lymphocytes at birth, only passive immunity from the mother  If lymphatics are removed or lost, severe edema results, but vessels grow back in time Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings
 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
									 
                                             
                                             
                                             
                                             
                                             
                                             
                                             
                                             
                                            