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Chapter 17
Immunology
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What is Immunology?
Immunology: The study of the human immune system
___________: A practitioner who specializes in the field
of immunology
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Answers
Immunology: The study of the human immune system
Immunologist: A practitioner who specializes in the field
of immunology
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Overview of the Immune System
– The body has built-in protections from:
• The skin which serves as an outer barrier
• Mucous linings which trap bacteria to be expelled
by ______________
• Stomach ________ which kills swallowed bacteria
• Helpful ________ in the bowel which stop other
bacteria from growing
• Urine flow which flushes bacteria out of the body
• ___________ blood cells which find and kill
foreign cells
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Answers
– The body has built-in protections from:
• The skin which serves as an outer barrier
• Mucous linings which trap bacteria to be expelled
by coughing
• Stomach acid which kills swallowed bacteria
• Helpful bacteria in the bowel which stop other
bacteria from growing
• Urine flow which flushes bacteria out of the body
• White blood cells which find and kill foreign cells
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• These protections can be breached by:
– ___________ the skin barrier
– Damage to _________ linings or hairs that help
remove bacteria
– A catheter inserted in the body
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Answers
– Breaking the skin barrier
– Damage to mucous linings or hairs that help remove
bacteria
– A catheter inserted in the body
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• The body has a several-layer system of defense:
– ____________: skin and mucous membranes
– Second layer: ___________________
– _____________: adaptive immune system
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Answers
– First layer: skin and mucous membranes
– Second layer: innate immune system
– Third layer: adaptive immune system
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Self and nonself: the body's own cells (self) and foreign
cells (nonself)
___________: foreign (nonself) cells such as bacteria,
fungi, etc.
___________ response: reaction of the immune system
against the foreign substance
______________: microorganisms that cause disease
and initiate an immune response
____________ immunity: early exposure, immune
protection throughout life
_____________ immunity: provided from other sources
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Answers
Self and nonself: the body's own cells (self) and foreign
cells (nonself)
Antigens: foreign (nonself) cells such as bacteria, fungi,
etc.
Immune response: reaction of the immune system
against the foreign substance
Pathogens: microorganisms that cause disease and
initiate an immune response
Active immunity: early exposure, immune protection
throughout life
Passive immunity: provided from other sources
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Anatomy of the Immune System
– Immune system is also referred to as __________
system
– Lymphatic structures are also called
___________organs because they involve the
growth, development, and deployment of leukocytes
– __________: Key to the function of the immune
system
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Answers
– Immune system is also referred to as lymphatic
system
– Lymphatic structures are also called lymphoid
organs because they involve the growth,
development, and deployment of leukocytes
– Leukocytes: Key to the function of the immune
system
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Components of the Lymphatic System
• Lymphatic vessels
– Circulating system of vessels
– Carry ________ to bathe tissues throughout the
body
– Foreign matter is carried to __________ for disposal
• Lymph nodes
– Found along the __________ vessels, which act as
filters
– Destroy foreign invaders collected by the lymph
– Filtered lymph enters the lymphatic blood vessels
again
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Answers
• Lymphatic vessels
– Circulating system of vessels
– Carry lymph to bathe tissues throughout the body
– Foreign matter is carried to lymph nodes for disposal
• Lymph nodes
– Found along the lymphatic vessels, which act as
filters
– Destroy foreign invaders collected by the lymph
– Filtered lymph enters the lymphatic blood vessels
again
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• Bone marrow
– The tissue in __________ of long bones that
produces blood cells for the immune system
– __________ cells are immature cells that grow
into different types of cells
– ____________ are white blood cells that help the
body fight infection
• __ cells and ___ cells are two major classes of
lymphocytes
• B cells mature in the bone marrow
• T cells migrate to the thymus to mature
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Answers
– The tissue in hollow shafts of long bones that
produces blood cells for the immune system
– Stem cells are immature cells that grow into
different types of cells
– Lymphocytes are white blood cells that help the
body fight infection
• B cells and T cells are two major classes of
lymphocytes
• B cells mature in the bone marrow
• T cells migrate to the thymus to mature
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• Thymus
– A __________ found in the thorax and under the
breastbone
– Releases mature T cells
– Process occurs for several months after birth, then
thymus atrophies
• Spleen
– Located in the upper left portion of the abdomen
cavity
– Largest of the ____________ organs
– Stores lymphocytes that fight infection
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Answers
– A gland found in the thorax and under the
breastbone
– Releases mature T cells
– Process occurs for several months after birth, then
thymus atrophies
• Spleen
– Located in the upper left portion of the abdomen
cavity
– Largest of the lymphoid organs
– Stores lymphocytes that fight infection
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• Lymphoid Tissues
Clumps of tissue found in the body to help fight infection
– Tonsils
– Adenoids
–
____________ Patches
– Appendix
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Answers
Clumps of tissue found in the body to help fight infection
– Tonsils
– Adenoids
– Peyer Patches
– Appendix
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Cells and Their Products
B cells: make antibodies (immunoglobins)
• Types:
– _____: body's basic active immunity
– _____: largest, kills bacteria
– _____: in secretions respiratory and digestive tracts
– ____: protects against parasitic infections and
causes allergic response
– _____: helps initiate early response to an antigen
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Answers
B cells: make antibodies (immunoglobins)
• Types:
– IgG: body's basic active immunity
– IgM: largest, kills bacteria
– IgA: in secretions respiratory and digestive tracts
– IgE: protects against parasitic infections and causes
allergic response
– IgD: helps initiate early response to an antigen
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• T Cells
– Travel through the body patrolling for foreign
_________
– Receptors __________ signals from antigens
– T cells stimulate ___ cells to secrete antibodies and
call other T cells to destroy antigen
– Types:
• Helper T cells
• __________ T cells
• Killer T cells
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Answers
• T Cells
– Travel through the body patrolling for foreign
invaders
– Receptors receive signals from antigens
– T cells stimulate B cells to secrete antibodies and call
other T cells to destroy antigen
– Types:
• Helper T cells
• Memory T cells
• Killer T cells
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Common Immunologic Diseases and
Treatments
• __________: Abnormal reactions to a specific
environmental antigen (allergen)
– _________ trigger immune response in the body
– Body releases ___________ that cause allergic
symptoms
– Cause: Environmental factors; some are hereditary
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Answers
• Allergies: Abnormal reactions to a specific
environmental antigen (allergen)
– Allergens trigger immune response in the body
– Body releases histamine that cause allergic
symptoms
– Cause: Environmental factors; some are hereditary
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– Treatments:
• ___________: Block histamine receptors
(Clarinex, Allegra, Zyrtec)
• ___________: Relieve congestion (Claritin-D,
Allegra-D, Zyrtec-D)
• ___________: Reduce inflammation (Rhinocort,
Nasonex, Flonase, Flovent, Serevent)
• ____________: Inhaled to control asthma
symptoms (albuterol)
• __________: For nasal allergy symptoms
(Accolate, Singulair)
• Injections which help the immune system build
tolerance to allergen
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Answers
– Treatments:
• Antihistamines: Block histamine receptors
(Clarinex, Allegra, Zyrtec)
• Decongestants: Relieve congestion (Claritin-D,
Allegra-D, Zyrtec-D)
• Corticosteroids: Reduce inflammation (Rhinocort,
Nasonex, Flonase, Flovent, Serevent)
• Bronchodilators: Inhaled to control asthma
symptoms (albuterol)
• Leukotriene modifiers: For nasal allergy symptoms
(Accolate, Singulair)
• Injections which help the immune system build
tolerance to allergen
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Immunodeficiency Diseases
• Immunodeficiency
– _________ system fails to respond effective to a
foreign invader, or is absent entirely
– ___________ immunodeficiency: a genetic
abnormality
• Acquired immunodeficiency syndrome (AIDS): caused by
a disease that affects the immune system
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Answers
• Immunodeficiency
– Immune system fails to respond effective to a foreign
invader, or is absent entirely
– Inherited immunodeficiency: a genetic abnormality
• Acquired immunodeficiency syndrome (AIDS): caused by
a disease that affects the immune system
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Treatments for AIDS
– ______________: Interrupts the ability of the HIV
virus to make copies of itself in the early stages of
infection (AZT, 3TC, Epivir, Sustiva)
– ______________: Interrupts the ability of the HIV
virus to make copies of itself in later stages of
infection (Norvir, Invirase, Crixivan, Kaletra,
Reyataz)
– _____________: Blocks merging of the HIV virus
with cell membranes (Fuzeon)
– _________________ (HAART): A combination of
drugs used to suppress the HIV virus
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Answers
Treatments for AIDS
– Nucleoside reverse transcriptase inhibitors:
Interrupts the ability of the HIV virus to make copies
of itself in the early stages of infection (AZT, 3TC,
Epivir, Sustiva)
– Protease inhibitors: Interrupts the ability of the HIV
virus to make copies of itself in later stages of
infection (Norvir, Invirase, Crixivan, Kaletra,
Reyataz)
– Fusion inhibitors: Blocks merging of the HIV virus
with cell membranes (Fuzeon)
– Highly-active antiretroviral therapy (HAART): A
combination of drugs used to suppress the HIV virus
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Autoimmune Diseases
___________: An abnormal condition in which the
immune system attacks the body
___________: Confused antibodies produced to attack
the body's own tissues
• Causes
– __________ may resemble healthy self-tissue
– An error in genetic code may play a role
– A ___________, such as an infection or a virus
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Answers
Autoimmunity: An abnormal condition in which the
immune system attacks the body
Autoantibodies: Confused antibodies produced to attack
the body's own tissues
• Causes
– Antigen may resemble healthy self-tissue
– An error in genetic code may play a role
– A trigger, such as an infection or a virus
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• Systemic Lupus Erythematosus (SLE or lupus)
– A multisystem disease
– Comes from Latin word “__________”
– ________________: reacts with a cell's nucleus
– Can affect any organ or tissue in the body
– ____________: periods of acute disease activity
– SLE Disease Activity Index (SLEDAI) measures this
activity during a flare
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Answers
• Systemic Lupus Erythematosus (SLE or lupus)
– A multisystem disease
– Comes from Latin word “wolf”
– Antinuclear antibody (ANA): reacts with a cell's
nucleus
– Can affect any organ or tissue in the body
– Lupus flare: periods of acute disease activity
– SLE Disease Activity Index (SLEDAI) measures this
activity during a flare
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•
_____________: Immune system attacks joints and
surrounding tissues of the body
–
_________: joints only
–
Extra-_________: joints as well as nerves, lungs,
muscles, heart, and blood vessel walls
–
Treatments:
•
Medications to diminish anti-inflammatory
symptoms
•
___________: Joint repair
•
____________: Intact tendon is attached to a
damaged one helping to restore hand function
•
___________: Removal of inflamed synovial
tissue
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Answers
•
Rheumatoid arthritis (RA): Immune system attacks
joints and surrounding tissues of the body
–
Articular: joints only
–
Extra-articular: joints as well as nerves, lungs,
muscles, heart, and blood vessel walls
–
Treatments:
•
Medications to diminish anti-inflammatory
symptoms
•
Arthroplasty: Joint repair
•
Tendon reconstruction: Intact tendon is attached
to a damaged one helping to restore hand function
•
Synovectomy: Removal of inflamed synovial
tissue Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Autoimmune ___________: Thyroid function is
impaired
• __________ disease: overactivity of the thyroid gland
(hyperthyroidism)
– Symptoms
• _________ (enlarged, inflamed thyroid gland)
• ___________ (bulging eyes from water retention)
– Treatments:
• Medications to block production of thyroid
hormone (levothyroxine, or Levophed)
• Radioactive iodine
• ___________: Removal of the thyroid
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Answers
• Autoimmune thyroid disease: Thyroid function is
impaired
• Graves disease: overactivity of the thyroid gland
(hyperthyroidism)
– Symptoms
• Goiter (enlarged, inflamed thyroid gland)
• Exophthalmos (bulging eyes from water retention)
– Treatments:
• Medications to block production of thyroid
hormone (levothyroxine, or Levophed)
• Radioactive iodine
• Thyroidectomy: Removal of the thyroid
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• _______________: underactivity of the thyroid
(hypothyroidism)
– Antibodies attack the thyroid gland directly, leading
to insufficient production of thyroid hormone
– Treatment:
• Medication to bring thyroid levels back to normal
(thyroxine, or Synthroid)
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Answers
• Hashimoto thyroiditis: underactivity of the thyroid
(hypothyroidism)
– Antibodies attack the thyroid gland directly, leading
to insufficient production of thyroid hormone
– Treatment:
• Medication to bring thyroid levels back to normal
(thyroxine, or Synthroid)
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• __________: An inflammation of blood vessels
– Effects of Disorder:
• _________: Bulge in blood vessel wall
• __________: Restricted blood flow
• ___________: Blockage of vessel
• ___________: Death of blood vessel
– Forms of Vasculitis:
• ___________: Inflammation of arteries that
supply the head
• ___________ granulomatosis: Lungs, kidneys,
and upper respiratory tract
• __________ arteritis: Affects the aorta
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Answers
• Vasculitis: An inflammation of blood vessels
– Effects of Disorder:
• Aneurysm: Bulge in blood vessel wall
• Ischemia: Restricted blood flow
• Occlusion: Blockage of vessel
• Infarction: Death of blood vessel
– Forms of Vasculitis:
• Giant-cell arteritis: Inflammation of arteries that
supply the head
• Wegener granulomatosis: Lungs, kidneys, and
upper respiratory tract
• Takayashu arteritis: Affects the aorta
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• Vasculitis (Continued)
– Treatments: Goal is to decrease immune system’s
production of antibodies
• Corticosteroids: Help slow progression of disease
• Angioplasty: Arteries are widened using balloontipped catheter
• Vessel bypass procedures
• Aortic valve replacement
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• ________ Syndrome: attacks the exocrine glands
(tears
and saliva), causing mucous membranes to dry up
– Second most common autoimmune rheumatic
disease after rheumatoid arthritis
– No known cure
– Treatments: Symptomatic and supportive only
• Moist-replacement medications to help ease
symptoms of dryness (Refresh Tears, Pred Forte
for eyes)
• Medications to stimulate saliva production
(Salagen, Evoxac)
• NSAIDs for musculoskeletal pain
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Answers
• Sjögren Syndrome: attacks the exocrine glands (tears
and saliva), causing mucous membranes to dry up
– Second most common autoimmune rheumatic
disease after rheumatoid arthritis
– No known cure
– Treatments: Symptomatic and supportive only
• Moist-replacement medications to help ease
symptoms of dryness (Refresh Tears, Pred Forte
for eyes)
• Medications to stimulate saliva production
(Salagen, Evoxac)
• NSAIDs for musculoskeletal pain
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• ___________: Immune system attacks collagen in
tissues, causing skin to harden and scar (fibrosis)
– Derives from Greek words sklero- (hard) and derma
(skin)
– _________ scleroderma: Affects only the skin
– __________ scleroderma: Affects many areas of the
body, including body organs
– Results of disease:
• ___________ phenomenon: Sensitivity to cold
• ____________: Fingers cannot be bent due to
skin becoming hard and tight
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Answers
• Scleroderma: Immune system attacks collagen in
tissues, causing skin to harden and scar (fibrosis)
– Derives from Greek words sklero- (hard) and derma
(skin)
– Localized scleroderma: Affects only the skin
– Systemic scleroderma: Affects many areas of the
body, including body organs
– Results of disease:
• Raynaud phenomenon: Sensitivity to cold
• Sclerodactyly: Fingers cannot be bent due to skin
becoming hard and tight
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• Scleroderma (Continued)
– Treatments:
• Vasodilators: improve blood flow in vessels
(Procardia, Cardizem, Cozaar, Norvasc)
• Medications involving treatment of lungs, heart, or
kidneys
• High-dose chemotherapy with stem cell rescue:
Harvesting of stem cells, purifying them, freezing
them, destroying patient’s immune system with
high-dose chemotherapy; then reinfusing stem
cells back into patient after treatment to “rescue”
the bone marrow
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Medications that Treat Autoimmune
Disorders
– __________ reduce inflammation
– ___________ control overactivity of the immune
system
– Antimalarials suppress inflammation
– _______ inhibitors block _____ that causes
inflammation
– ________ reduces autoimmune activity
– Immunomodulating drugs suppress system activity
– ___________ help prevent blood clots
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Answers
– NSAIDs reduce inflammation
– Corticosteroids control overactivity of the immune
system
– Antimalarials suppress inflammation
– TNF inhibitors block TNF that causes inflammation
– Cyclosporine reduces autoimmune activity
– Immunomodulating drugs suppress system activity
– Anticoagulants help prevent blood clots
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Cancer of the Immune System
– Lymphoma: A general term for a group of cancers
that originate in the lymphocytes
• Lymphoma cells: Lymphocytes that become
cancerous
• Two categories of lymphoma: Hodgkin lymphoma
and non-Hodgkin lymphoma
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• Hodgkin lymphoma
– Characterized by Reed-Sternberg cells under a
microscope
– Starts in lymph nodes, later involves spleen and
other tissues
• Non-Hodgkin lymphoma
– All other lymphomas that are not Hodgkin's
– Cause is unknown
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• Treatments:
– Combination chemotherapy regimens
– Bone marrow transplant (BMT)
• Autologous BMT: patient's own bone marrow is
used
• Allogeneic BMT: bone marrow is donated by
another person
– Peripheral blood stem cell transplant
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• Treatments (Continued)
– Immunotherapy: Synthetic viruses combined with
the patient's lymphocytes to help destroy tumors
– Monoclonal antibodies: Synthetic chemicals that
react against specific antigens
– Therapeutic cancer vaccines being researched to help
immune system fight off tumors
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Diagnostic Studies and Procedures
• Laboratory Tests
– Allergy skin testing: Identifies substances that are
causing allergy symptoms
– Blood tests: Identify autoantibodies at work in
immune disorders
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• Types of Blood Tests:
– Complete metabolic panel (CMP): Blood chemistry
levels
– Rheumatoid factor (RF): Antibody found in most RA
patients
– Antinuclear antibodies (ANA): Common test for lupus
– Anti-double-stranded DNA: Measures antibodies that
bind to DNA
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• Type of Blood Tests (Continued)
– Anti-Ro, anti-La, and anti-Sm antibodies: Specific
antibodies that help narrow down a diagnosis of a
particular disorder
– Thyroid function tests
– Immunoglobulins: Types and amounts
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• Types of Blood Tests (Continued)
– Erythrocyte sedimentation rate (ESR)
– Antiphospholipid antibodies (APLs)
– Venereal Disease Research Laboratory (VDRL) test
– Complement levels
– SCL-70
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Urine tests: measure abnormal levels of chemicals or
bacteria in the urine
Biopsy: can locate markers of inflammation or degree of
disease present in the body
•
Types of Biopsies:
– Fine needle aspiration (FNA): Fine needle used to
obtain small amount of nodule for examination
– Excisional biopsy: Removal of nodule in its entirety
for examination
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•
Imaging Studies
– X-rays: look for signs of bone loss and joint
destruction caused by inflammation
– CT scan
– MRI/MRA
– PET scans
– Ultrasound
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Insight
Feeling Good is Good for You
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