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Chapter 17 Immunology Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins What is Immunology? Immunology: The study of the human immune system ___________: A practitioner who specializes in the field of immunology Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answers Immunology: The study of the human immune system Immunologist: A practitioner who specializes in the field of immunology Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • These protections can be breached by: – ___________ the skin barrier – Damage to _________ linings or hairs that help remove bacteria – A catheter inserted in the body Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answers – Breaking the skin barrier – Damage to mucous linings or hairs that help remove bacteria – A catheter inserted in the body Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • The body has a several-layer system of defense: – ____________: skin and mucous membranes – Second layer: ___________________ – _____________: adaptive immune system Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answers – First layer: skin and mucous membranes – Second layer: innate immune system – Third layer: adaptive immune system Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • Lymphoid Tissues Clumps of tissue found in the body to help fight infection – Tonsils – Adenoids – ____________ Patches – Appendix Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answers Clumps of tissue found in the body to help fight infection – Tonsils – Adenoids – Peyer Patches – Appendix Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins – 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • _____________: 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • _______________: 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) Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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) Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • __________: 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • ________ 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • ___________: 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • Types of Blood Tests (Continued) – Erythrocyte sedimentation rate (ESR) – Antiphospholipid antibodies (APLs) – Venereal Disease Research Laboratory (VDRL) test – Complement levels – SCL-70 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins • Imaging Studies – X-rays: look for signs of bone loss and joint destruction caused by inflammation – CT scan – MRI/MRA – PET scans – Ultrasound Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Insight Feeling Good is Good for You Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins