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M. Sompayrac

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Table of Contents

Cover

DedicationPage

TitlePage

CopyrightPage

Acknowledgments

HowtoUseThisBook

AbouttheCompanionWebsite

LECTURE1:AnOverview

INTRODUCTION

PHYSICALBARRIERS

THEINNATEIMMUNESYSTEM

THEADAPTIVEIMMUNESYSTEM

ACOMPARISONOFTHEINNATEANDADAPTIVEIMMUNESYSTEMS

THEINNATESYSTEMRULES!

EPILOGUE

LECTURE2:TheInnateImmuneSystem

INTRODUCTION

THECOMPLEMENTSYSTEM

THEPROFESSIONALPHAGOCYTES

HOWIMMUNESYSTEMSENTINELSRECOGNIZEINVADERS

HOWTHEINNATEIMMUNESYSTEMDEALSWITHVIRUSES

THEINNATEIMMUNESYSTEM–ACOOPERATIVEEFFORT

APROPORTIONALRESPONSE

SUMMARYFIGURE

LECTURE3:BCellsandAntibodies

INTRODUCTION

THEBCELLRECEPTOR

HOWTHEBCRSIGNALS

HOWBCELLSAREACTIVATED

CLASSSWITCHING

ANTIBODYCLASSESANDTHEIRFUNCTIONS

SOMATICHYPERMUTATION

BCELLSMAKEACAREERCHOICE

SUMMARYFIGURE

LECTURE4:TheMagicofAntigenPresentation

INTRODUCTION

CLASSIMHCMOLECULES

CLASSIIMHCMOLECULES

ANTIGENPRESENTATIONBYCLASSIMHCMOLECULES

ANTIGENPRESENTATIONBYCLASSIIMHCMOLECULES

ANTIGENPRESENTINGCELLS

THELOGICOFCLASSIMHCPRESENTATION

THELOGICOFCLASSIIMHCPRESENTATION

CROSS-PRESENTATION

NON-CLASSICALMHCMOLECULESANDLIPIDPRESENTATION

MHCPROTEINSANDORGANTRANSPLANTS

SUMMARYFIGURE

LECTURE5:TCellActivation

INTRODUCTION

TCELLRECEPTORS

HOWATCELL’SRECEPTORSSIGNAL

CD4ANDCD8CO-RECEPTORS

CO-STIMULATION

ATIME-LAPSEPHOTOOFHELPERTCELLACTIVATION

HOWKILLERTCELLSAREACTIVATED

LECTURE6:TCellsatWork

INTRODUCTION

HELPERTCELLSASCYTOKINEFACTORIES

THEDENDRITICCELLAS“COACH”OFTHEIMMUNESYSTEMTEAM

Th1HELPERTCELLS

Th2HELPERTCELLS

Th17HELPERTCELLS

Th0HELPERTCELLS

LOCKINGINTHEHELPERTCELLPROFILE

DELAYED-TYPEHYPERSENSITIVITY

HOWCTLsKILL

SUMMARYFIGURE

LECTURE7:SecondaryLymphoidOrgansandLymphocyteTrafficking

INTRODUCTION

LYMPHOIDFOLLICLES

HIGHENDOTHELIALVENULES

LYMPHNODES

PEYER’SPATCHES

THESPLEEN

THELOGICOFSECONDARYLYMPHOIDORGANS

LYMPHOCYTETRAFFICKING

WHYMOTHERSKISSTHEIRBABIES

LECTURE8:RestrainingtheImmuneSystem

INTRODUCTION

ATTENUATINGTHEIMMUNERESPONSE

DEACTIVATINGTHESYSTEM

LIFEISSHORT

EXHAUSTION

LECTURE9:SelfToleranceandMHCRestriction

INTRODUCTION

THETHYMUS

MHCRESTRICTION

THELOGICOFMHCRESTRICTION

THYMICTESTINGFORTOLERANCEOFSELF

GRADUATION

THERIDDLEOFMHCRESTRICTIONANDTOLERANCEINDUCTION

TOLERANCEBYIGNORANCE

TOLERANCEINDUCTIONINSECONDARYLYMPHOIDORGANS

PERIPHERALTOLERANCEINDUCTION

TOLERANCEDUETOACTIVATION-INDUCEDCELLDEATH

BCELLTOLERANCE

MAINTENANCEOFBCELLTOLERANCEINGERMINALCENTERS

THEEDUCATIONOFNATURALKILLERCELLS

LECTURE10:ImmunologicalMemory

INTRODUCTION

INNATEMEMORY

ADAPTIVEMEMORY

PROPERTIESOFADAPTIVEMEMORYCELLS

COMPARINGBANDTCELLMEMORIES

INNATEVERSUSADAPTIVEMEMORY

LECTURE11:TheIntestinalImmuneSystem

INTRODUCTION

INTESTINALARCHITECTURE

CHALLENGESFACEDBYTHEINTESTINALIMMUNESYSTEM RESPONDINGGENTLYTOLIMITEDTHREATS

THEINTESTINALIMMUNESYSTEM’SRESPONSETOPATHOGENS HOWTORESPOND?

LECTURE12:TheImmuneSystemGoneWrong INTRODUCTION

DISEASESCAUSEDBYDEFECTSINIMMUNEREGULATION AUTOIMMUNEDISEASE

LECTURE13:Immunodeficiency INTRODUCTION

GENETICDEFECTSLEADINGTOIMMUNODEFICIENCY

AIDS

LECTURE14:Vaccines INTRODUCTION

GENERATINGMEMORYHELPERTANDBCELLS

GENERATINGMEMORYKILLERTCELLS STRATEGIESFORVACCINEDEVELOPMENT WILLTHEREBEANAIDSVACCINE?

VACCINATIONTOPREVENTVIRUS-ASSOCIATEDCANCER VACCINEADJUVANTS

LECTURE15:CancerandtheImmuneSystem INTRODUCTION

CANCERISACONTROLSYSTEMPROBLEM CLASSIFICATIONOFCANCERCELLS

IMMUNESURVEILLANCEAGAINSTCANCER

IMMUNESURVEILLANCEBYMACROPHAGESANDNKCELLS

LECTURE16:Immunotherapy INTRODUCTION

IMMUNOTHERAPYUSINGMONOCLONALANTIBODIES

IMMUNOTHERAPYUSINGTCELLS

LECTURE17:COVID-19andtheImmuneSystem INTRODUCTION

THERESPIRATORYSYSTEM

SARS-CoV-2

THEIMMUNERESPONSETORESPIRATORYVIRUSES

THEPATHOLOGYOFASARS-CoV-2INFECTION THEmRNAVACCINEPLATFORM

mRNAVACCINATIONVERSUSNATURALINFECTION

CORRELATESOFPROTECTION

REINFECTION

VIRALVARIANTS

Glossary

AcronymsandAbbreviations

Index

EndUserLicenseAgreement

Idedicatethisbooktomysweetheart,mybestfriend,andmywife:VickiSompayrac.

How the Immune System Works

SEVENTHEDITION

LaurenSompayrac

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Acknowledgments

Iamindebtedtomyfirsteditor,ChrisDavis,whorecognizedthatstudentsdidnotneed anotherfact-filledimmunologytextbook.Theyneededabookthatwouldhelpthem understandhowthepiecesofthiscomplexsystemallfittogetherThatthisbookisinits seventheditionisatributetoChris’swisdom.IalsowouldliketothankmyfriendDr.Jim Cookforhismanyinsightfulcomments,especiallyontheCOVID-19lecture.Ithankthe followingpeople,whosecriticalcommentsonearliereditionsweremosthelpful:Drs.Mark Dubin,LindaClayton,DanTenen,TomMitchell,LannyRosenwasser,andEricMartz.Diane Lorenzillustratedthefirstandsecondeditions,andherwonderfulartworkcanstillbe foundinthisbook.Finally,IwishtothankVickiSompayrac,whosewisesuggestionshelped makethisbookmorereadable,andwhoseeditingwasinvaluableinpreparingthefinal manuscript.

How to Use This Book

Iwrote How the Immune System Works becauseIcouldn’tfindabookthatwouldgivemy studentsanoverallviewoftheimmunesystem.Sure,thereareasmanygood,thick textbooksasapersonmighthavemoneytobuy,butthesearecrammedwithevery possibledetail.Therearealsolotsof“reviewbooks”thataregreatifyouwantasummary ofwhatyou’vealreadylearned–buttheywon’tteachyouimmunology.Whatwasmissing wasashortbookthattells,insimplelanguage,howtheimmunesystemfitstogether–a bookthatpresentsthebigpictureoftheimmunesystem,withoutthejargonandthe details

How the Immune System Works iswrittenintheformof“lectures,”becauseIwanttotalkto youdirectly,justasifweweretogetherinaclassroom.AlthoughLecture1isalightheartedoverview,meanttogiveyouarunningstartatthesubject,you’llsoondiscoverthat thisisnot“babyimmunology.” How the Immune System Works isaconcept-drivenanalysis ofhowtheimmunesystemplayersworktogethertoprotectusfromdisease–and,most importantly,whytheydoitthisway.

InLectures2through10,Ifocusmorecloselyontheindividualplayersandtheirroles. Theselecturesareshort,soyouprobablycanreadthemallinacoupleofafternoons.In fact,IstronglysuggestthatyoubeginbyreadingquicklythroughLectures1–10.The wholeideaistogetanoverallviewofthesubject,andifyoureadonelectureaweek,that won’thappenDon’t“study”thesetenlecturesthefirsttimeyoureadthemJustripthrough them.Then,onceyouhaveafeelfortheimmunesystem,gobackandspendabitmoretime withthesesametenlecturestogetaclearerunderstandingofthe“howsandwhys.”

InLectures11–17,Idiscusstheintestinalimmunesystem,vaccines,allergies,autoimmune disease,HIV-1,cancer,immunotherapy,andCOVID-19.Theselectureswillletyoureview whatyouhavelearnedintheearlierlecturesbyexaminingreal-worldexamplesofthe immunesystematworkAndwhenyoureadthesefinallectures,Ithinkyou’llbeamazed byhowmuchyounowunderstandabouttheimmunesystem.

Asyouread,youwillencounterpassageshighlightedingreen,andwordsthatare highlightedinredThesehighlightsaretoalertyoutoimportantconceptsandtermsThey alsowillhelpyoureviewalecturequickly,onceyouhavereaditthrough.

Finally,becausemostimmunologytextbookscontainsomanyfacts,it’seasytogetthe impressionthatalltheimportantquestionsabouttheimmunesystemhavealreadybeen answered.That’snottrue.Toemphasizethispoint,attheendofmostlectures,Iwillpoint outsomeofthe“knownunknowns”–importantquestionswhichimmunologistsstillaren’t abletoanswer

Insomesettings, How the Immune System Works willserveasthemaintextforthe immunologysectionofalargercourse.Forasemester-longundergraduateorgraduate immunologycourse,yourprofessormayusethisbookasacompaniontoacomprehensive textbook.Asyourcourseproceeds,reviewingtheappropriatelecturesin How the Immune System Works willhelpyoukeepthebigpictureinfocusasthedetailsarefilledin.It’sreally easytogetlostinthedetails.

Nomatterhowyourprofessormaychoosetousethisbook,youshouldkeeponeimportant pointinmind:Ididn’twrite How the Immune System Works foryourprofessorThisbookis foryou!

About the Companion Website

Thisbookisaccompaniedbyacompanionwebsite www.wiley.com/go/sompayrac/immune7e

Thiswebsiteincludes: Figuresfrombook

LECTURE 1

An Overview

HEADS UP!

Theimmunesystemisa“teameffort,”involvingmanydifferentplayers.Theseplayers canbedividedroughlyintotwogroups:thosethataremembersoftheinnateimmune systemteamandthosethatarepartoftheadaptiveimmunesystem.Importantly, thesetwogroupsworktogethertoprovideapowerfuldefenseagainstinvaders

INTRODUCTION

Immunologyisadifficultsubjectforseveralreasons.First,therearelotsofdetails,and sometimesthesedetailsgetinthewayofunderstandingtheconceptsTogetaroundthis problem,we’regoingtoconcentrateonthebigpicture.Itwillbeeasyforyoutofindthe detailssomewhereelse.Anotherdifficultyinlearningimmunologyisthatthereisan exceptiontoeveryrule.Immunologistslovetheseexceptions,becausetheygivecluesasto howtheimmunesystemfunctions.Butfornow,we’rejustgoingtolearntherules.Ohsure, we’llcomeuponexceptionsfromtimetotime,butwewon’tdwellonthemOurgoalisto examinetheimmunesystem,strippedtoitsessence.

Athirddifficultyinstudyingimmunologyisthatourknowledgeoftheimmunesystemis stillevolvingAsyou’llsee,therearemanyunansweredquestions,andsomeofthethings thatseemtruetodaywillbeprovenfalsetomorrow.I’lltrytogiveyouafeelingfortheway thingsstandnow,andfromtimetotimeI’lldiscusswhatimmunologistsspeculatemaybe true.ButkeepinmindthatalthoughI’lltrytobestraightwithyou,someofthethingsI’ll tellyouwillchangeinthefuture–maybeevenbythetimeyoureadthis!

Althoughthesethreefeaturesmakestudyingimmunologydifficult,Ithinkthemainreason immunologyissuchatoughsubjectisthattheimmunesystemisa“teameffort”which involvesmanydifferentplayersinteractingwitheachother.Imagineyou’rewatchinga footballgameonTV,andthecameraisisolatedononeplayer,say,thetightendYousee himrunatfullspeeddownthefield,andthenstop.Itdoesn’tseemtomakeanysense. Later,however,youseethesameplayonthebigscreen,andnowyouunderstand.That tightendtooktwodefenderswithhimdownthefield,leavingtherunningbackuncovered tocatchthepassandrunforatouchdown.Theimmunesystemisalotlikeafootballteam. It’sanetworkofplayerswhocooperatetogetthingsdone,andfocusingonasingleplayer doesn’tmakemuchsense.Youneedanoverallview.That’sthepurposeofthisfirstlecture, whichyoumightcall“turboimmunology.”Here,I’mgoingtotakeyouonaquicktourofthe immunesystem,soyoucangetafeelingforhowitallfitstogether.Theninthenext lectures,we’llgobackandtakeacloserlookattheindividualplayersandtheirinteractions.

PHYSICAL BARRIERS

Ourfirstlineofdefenseagainstinvadersconsistsofphysicalbarriers,andtocausereal trouble,viruses,bacteria,parasites,andfungimustpenetratetheseshieldsAlthoughwe tendtothinkofourskinasthemainbarrier,theareacoveredbyourskinisonlyabouttwo squaremeters.Incontrast,theareacoveredbythemucousmembranesthatlineour digestive,respiratory,andreproductivetractsmeasuresabout400squaremeters–anarea aboutasbigastwotenniscourts.Themainpointhereisthatthereisalargeperimeter whichmustbedefended

THE INNATE IMMUNE SYSTEM

Anyinvaderthatbreachesthephysicalbarrierofskinormucosaisgreetedbytheinnate immunesystem–oursecondlineofdefenseImmunologistscallthissystem“innate” becauseitisadefensethatallanimalsjustnaturallyseemtohave.Indeed,someofthe weaponsoftheinnateimmunesystemhavebeenaroundformorethan500millionyears. Letmegiveyouanexampleofhowthisamazinginnatesystemworks.

Imagineyouaregettingoutofyourhottub,andasyoustepontothedeck,yougetalarge splinterinyourbigtoe.Onthatsplinteraremanybacteria,andwithinafewhoursyou’ll notice(unlessyouhadalottodrinkinthathottub!)thattheareaaroundwherethe splinterenteredisredandswollen.Theseareindicationsthatyourinnateimmunesystem haskickedinYourtissuesarehometorovingbandsofwhitebloodcellsthatdefendyou againstattack.Tous,tissuelooksprettysolid,butthat’sbecausewe’resobig.Toacell, tissuelookssomewhatlikeaspongewithholesthroughwhichindividualcellscanmove ratherfreely.Oneofthedefendercellsthatisstationedinyourtissuesisthemostfamous innateimmunesystemplayerofthemall:themacrophage.Ifyou’reabacterium,a macrophageisthelastcellyouwanttomeetafteryourrideonthatsplinter!Hereisan electronmicrographshowingamacrophageabouttodevourabacterium.

Credit:LennartNilsson/BoehringerIngelheim/TT/SciencePhotoLibrary

Youwillnoticethatthismacrophageisn’tjustwaitinguntilitbumpsintothebacterium purelybychance.No,thismacrophagehasactuallysensedthepresenceofthebacterium andisreachingouta“foot”tograbitButhowdoesamacrophageknowthatabacteriumis outthere?Theansweristhatmacrophageshaveantennae(receptors)ontheirsurface whicharetunedtorecognize“dangermolecules”characteristicofcommonmicrobial invaders.Forexample,themembranesthatsurroundbacteriaaremadeupofcertainfats andcarbohydratesthatarenotnormallyfoundinthehumanbody.Someoftheseforeign moleculesrepresent“findmeandeatme”signalsformacrophages.Andwhen macrophagesdetectdangermolecules,theybegintocrawltowardthemicrobewhichis emittingthesemolecules

Whenitencountersabacterium,amacrophagefirstengulfsitinapouch(vesicle)calleda phagosome.Thevesiclecontainingthebacteriumisthentakeninsidethemacrophage, whereitfuseswithanothervesicletermedalysosome Lysosomescontainpowerful chemicalsandenzymeswhichcandestroybacteria.Infact,theseagentsaresodestructive

thattheywouldkillthemacrophageitselfiftheywerereleasedinsideit.That’swhythey areconfinedwithinvesiclesUsingthiscleverstrategy,themacrophagecandestroyan invaderwithoutcommittingsuicide.Thiswholeprocessiscalledphagocytosis,andthis seriesofsnapshotsshowshowithappens.

Macrophageshavebeenaroundforaverylongtime.Infact,theingestiontechnique macrophagesemployisarefinementofthestrategythatamoebasusetofeedthemselves–andamoebashaveroamedtheEarthforabout2.5billionyears.Sowhyisthiscreature calledamacrophage?“Macro,”ofcourse,meanslarge–andamacrophageisalargecell PhagecomesfromaGreekwordmeaning“toeat.”Soamacrophageisabigeater.Infact,in additiontodefendingagainstinvaders,themacrophagealsofunctionsasagarbage collector.Itwilleatalmostanything.Immunologistscantakeadvantageofthisappetiteby feedingmacrophagesironfilings.Then,usingasmallmagnet,theycanseparate macrophagesfromothercellsinacellmixtureReally!

Wheredomacrophagescomefrom?Macrophagesandalltheotherbloodcellsinyourbody arethedescendantsofself-renewingbloodstemcells–thecellsfromwhichalltheblood cells“stem.”Byself-renewing,Imeanthatwhenastemcellgrowsanddividesintotwo daughtercells,itdoesa“oneforme,oneforyou”thinginwhichsomeofthedaughtercells gobacktobeingstemcells,andsomeofthedaughtersgoontobecomematurebloodcells Thisstrategyofcontinualself-renewalinsuresthattherewillalwaysbebloodstemcellsin reservetocarryontheprocessofmakingmaturebloodcells

Macrophagesaresoimportanttoourdefensethattheyactuallytakeuptheirsentinel positionsinthetissueswellbeforeweareborn.Afterbirth,bloodstemcells,whichreside inthebonemarrow,canreplenishthesupplyofmacrophagesandalltheotherbloodcells astheyareneeded.Asthedaughtersofbloodstemcellsmature,theymustmakechoices thatdeterminewhichtypeofbloodcelltheywillbecomewhentheygrowup.Asyoucan imagine,thesechoicesarenotrandom,butarecarefullycontrolledtomakesureyouhave enoughofeachkindofbloodcell.Forexample,somedaughtercellsbecomeredbloodcells, whichcaptureoxygeninthelungs,andtransportittoallpartsofthebodyOurstemcell “factories”mustturnoutmorethantwomillionnewredbloodcellseachsecondtoreplace thoselostduetonormalwearandtear.Otherdescendantsofabloodstemcellmaybecome macrophages,neutrophils,orothertypesof“white”bloodcells.Andjustaswhitewineisn’t reallywhite,thesecellsaren’twhiteeither.Theyarecolorless,butbiologistsusetheterm “white”toindicatethattheylackhemoglobin,andthereforearenotredWhitebloodcells alsoarecalledleukocytes.Hereisafigureshowingsomeofthemanydifferentkindsof bloodcellsastemcellcanbecome

Whenthecellsthatcanmatureintomacrophagesfirstexitthebonemarrowandenterthe bloodstream,theyarecalledmonocytes Allinall,youhaveabouttwobillionofthesecells circulatinginyourbloodatanyonetime.Thismayseemalittlecreepy,butyoucanbevery gladtheyarethereWithoutthem,you’dbeindeeptroubleMonocytesremainintheblood foranaverageofaboutthreedays.Duringthistimetheytraveltothecapillaries–which representthe“endoftheline”forbloodvessels–lookingforacrackbetweenthe endothelialcellsthatlinetheinsideofthecapillaries.Theseendothelialcellsareshaped likeshingles,andbystickingafootbetweenthem,amonocytecanleavetheblood,enter thetissues,andmatureintoamacrophage.Inthetissues,mostmacrophagesjusthangout,

dotheirgarbagecollectingthing,andwaitforyoutogetthatsplintersotheycandosome realwork

Whenmacrophageseatthebacteriaonthatsplinterinyourfoot,theygiveoffchemicals whichincreasetheflowofbloodtothevicinityofthewound.Thebuildupofbloodinthis areaiswhatmakesyourtoewiththesplinterred.Someofthesechemicalsalsocausethe cellsthatlinethebloodvesselstocontract,leavingspacesbetweenthemsothatfluidfrom thecapillariescanleakoutintothetissues.Itisthisfluidwhichcausestheswelling.In addition,chemicalsreleasedbymacrophagescanstimulatenervesinthetissuesthat surroundthesplinter,sendingpainsignalstoyourbraintoalertyouthatsomethingisn’t quiterightintheareaofyourbigtoe.

Duringtheirbattlewithbacteria,macrophagesproduceandgiveoff(secrete)proteins calledcytokines.Thesearehormone-likemessengerswhichfacilitatecommunication betweencellsoftheimmunesystem.Someofthesecytokinesalertmonocytesandother immunesystemcellstravelinginnearbycapillariesthatthebattleison,andencourage thesecellstoexitthebloodtohelpfighttherapidlymultiplyingbacteria.Prettysoon,you haveavigorousinflammatoryresponsegoingoninyourtoe,astheinnateimmune systembattlestoeliminatetheinvaders.

Sohere’sthestrategy:Youhavealargeperimetertodefend,soyoustationsentinels (macrophages)tocheckforinvaders.Whenthesesentinelsencountertheenemy,theysend outsignals(cytokines)thatrecruitmoredefenderstothesiteofthebattle.The macrophagesthendotheirbesttoholdofftheinvadersuntilreinforcementsarrive.

Becausetheinnateresponseinvolveswarriorssuchasmacrophages,whichare programmedtorecognizemanycommoninvaders,yourinnateimmunesystemusually respondssoquicklythatthebattleisoverinjustafewdays

ThereareotherplayersontheinnateteamForexample,inadditiontotheprofessional phagocytessuchasmacrophages,whichmakeittheirbusinesstoeatinvaders,theinnate systemalsoincludesthecomplementproteinsthatcanpunchholesinbacteria,andnatural killercellswhichareabletodestroybacteria,parasites,virus-infectedcells,andsome cancercells.Wewilltalkmoreaboutthemacrophage’sinnatesystemteammatesinthe nextlecture

THE ADAPTIVE IMMUNE SYSTEM

About99%ofallanimalsgetalongjustfinewithonlynaturalbarriersandtheinnate immunesystemtoprotectthemHowever,vertebrateslikeushaveathirdlevelofdefense: theadaptiveimmunesystem.Thisisadefensesystemwhichactuallycanadapttoprotect usagainstalmostanyinvader.Oneofthefirstcluesthattheadaptiveimmunesystem existedcamebackinthe1790swhenEdwardJennerbeganvaccinatingtheEnglishagainst smallpoxvirus.Inthosedays,smallpoxwasamajorhealthproblem.Hundredsof thousandsofpeoplediedfromthisdisease,andmanymorewerehorriblydisfiguredWhat Jennerobservedwasthatmilkmaidsfrequentlycontractedadiseasecalledcowpox,which causedlesionsontheirhandsthatlookedsimilartothesorescausedbythesmallpoxvirus Jenneralsonotedthatmilkmaidswhohadcontractedcowpoxalmostnevergotsmallpox (which,itturnsout,iscausedbyacloserelativeofthecowpoxvirus).

SoJennerdecidedtoconductadaringexperiment.Hecollectedpusfromthesoresofa milkmaidwhohadcowpox,andusedittoinoculatealittleboynamedJamesPhipps.Later, whenPhippswasre-inoculatedwithpusfromthesoresofapersoninfectedwithsmallpox, hedidnotcontractthatdiseaseInLatin,thewordforcowis vacca –whichexplainswhere wegetthewordvaccine.HistorymakesouttheherointhisaffairtobeEdwardJenner,but Ithinktherealherothatdaywastheyoungboy.Imaginehavingthisbigmanapproachyou withalargeneedleandatubefullofpus!Althoughthisisn’tthesortofthingthatcouldbe donetoday,wecanbethankfulthatJenner’sexperimentwasasuccess,becauseitpaved thewayforvaccinationsthathavesavedcountlesslives.

Smallpoxviruswasnotsomethinghumansencounteredregularly.SoJenner’sexperiment showedthatifthehumanimmunesystemwasgiventimetoprepare,itcouldproduce weaponsthatcouldprovideprotectionagainstanintruderithadneverseenbefore Importantly,thesmallpoxvaccinationonlyprotectedagainstsmallpoxorcloselyrelated virusessuchascowpox.Phippswasstillabletogetmumps,measles,andtherest.Thisis oneofthehallmarksoftheadaptiveimmunesystem:Itadaptstodefendagainstspecific invaders.

Antibodies and B cells

Eventually,immunologistsdeterminedthatimmunitytosmallpoxwasconferredbyspecial proteinsthatcirculatedinthebloodofimmunizedindividuals.Theseproteinswerenamed antibodies,andtheagentthatcausedtheantibodiestobemadewascalledanantigen–in thiscase,thecowpoxvirus.Here’sasketchthatshowstheprototypeantibody, immunoglobulinG(IgG).

Asyoucansee,anIgGantibodymoleculeismadeupoftwopairsoftwodifferentproteins, theheavychain(Hc)andthelightchain(Lc).Becauseofthisstructure,eachmoleculehas twoidentical“hands”(Fabregions)thatcanbindtoantigensProteinsaretheideal moleculestouseforconstructingantibodiesthatcangraspattackers,becausedifferent proteinscanfoldupintoamyriadofcomplexshapes IgGmakesupabout75%oftheantibodiesintheblood,buttherearefourotherclassesof antibodies:IgA,IgD,IgE,andIgM.AlltheseclassesofantibodyareproducedbyBcells–whitebloodcellsthatareborninthebonemarrowandcanmaturetobecomeantibody factoriescalledplasmaBcells.

Inadditiontohavinghandsthatcanbindtoanantigen,anantibodymoleculealsohasa constantregion(Fc)“tail”whichcanbindtoreceptors(Fcreceptors)onthesurfaceof cellssuchasmacrophagesInfact,itisthespecialstructureoftheantibodyFcregionthat determinesitsclass(e.g.,IgGvs.IgA),whichimmunesystemcellsitwillbindto,andhowit willfunction

Thehandsofeachantibodybindtoaspecificantigen(eg,aproteinonthesurfaceofthe smallpoxvirus),soinordertohaveantibodiesavailablethatcanbindtomanydifferent antigens,manydifferentantibodymoleculesarerequired.Now,ifwewantantibodiesto protectusfromeverypossibleinvader(andwedo!),howmanydifferentantibodieswould weneed?Well,immunologistsestimatethatabout100millionshoulddothetrick.Since eachantigen-bindingregionofanantibodyiscomposedofaheavychainandalightchain, wecouldmixandmatchabout10,000differentheavychainswith10,000differentlight chainstogetthe100milliondifferentantibodiesweneed.However,humancellsonlyhave about25,000genesinall,soifeachheavyorlightchainproteinwereencodedbya differentgene,mostofahuman’sgeneticinformationwouldbeusedupjusttomake antibodiesYouseetheproblem

Generating antibody diversity by modular design

TheriddleofhowBcellscouldproducethe100milliondifferentantibodiesrequiredto protectuswassolvedin1977bySusumuTonegawa,whoreceivedtheNobelPrizeforhis discovery.WhenTonegawastartedworkingonthisproblem,thedogmawasthattheDNA ineverycellinthebodywasthesame.Thismadeperfectsense,becauseafteraneggis fertilized,theDNAintheeggiscopied.Thesecopiesarethenpasseddowntothedaughter cells,wheretheyarecopiedagain,andpasseddowntotheirdaughters–andsoon. Therefore,barringerrorsincopying,eachofourcellsshouldendupwiththesameDNAas theoriginal,fertilizedegg.Tonegawa,however,hypothesizedthatalthoughthisisprobably trueingeneral,theremightbeexceptionsHisideawasthatallofourBcellsmightstartout withthesameDNA,butthatasthesecellsmature,theDNAthatmakesuptheantibody genesmightchange–andthesechangesmightbeenoughtogeneratethe100million differentantibodiesweneed.

TonegawadecidedtotestthishypothesisbycomparingtheDNAsequenceofthelightchain fromamatureBcellwiththeDNAsequenceofthelightchainfromanimmatureBcell. Sureenough,hefoundthattheyweredifferent,andthattheyweredifferentinavery interestingway.WhatTonegawaandothersdiscoveredwasthatmatureantibodygenes aremadebymodulardesign.

IneveryBcell,onthechromosomesthatencodetheantibodyheavychain,thereare multiplecopiesoffourtypesofDNAmodules(genesegments)calledV,D,J,andC.Each copyofagivenmoduleisslightlydifferentfromtheothercopiesofthatmodule.For example,inhumansthereareaboutfortydifferentVsegments,abouttwenty-fivedifferent Dsegments,sixdifferentJsegments,andsoon.Toassembleamatureheavychaingene, eachBcellchooses(moreorlessatrandom)oneofeachkindofgenesegment,andpastes themtogetherlikethis.

Youhaveseenthiskindofmix-and-matchstrategyusedbeforetocreatediversity.For example,twentydifferentaminoacidsaremixedandmatchedtocreatethehugenumber ofdifferentproteinsthatourcellsproduce.Andtocreategeneticdiversity,the chromosomesyouinheritedfromyourmotherandfatheraremixedandmatchedtomake thesetofchromosomesthatgoesintoyoureggorspermcells.OnceMotherNaturegetsa goodidea,sheusesitoverandover–andmodulardesignisoneofherverybestideas. TheDNAthatencodesthelightchainoftheantibodymoleculeisalsoassembledbypicking genesegmentsandpastingthemtogetherBecausetherearesomanydifferentgene segmentsthatcanbemixedandmatched,thisschemecanbeusedtocreateabout10 milliondifferentantibodies–notquiteenough.So,tomakethingsevenmorediverse,when thegenesegmentsarejoinedtogether,additionalDNAbasesareaddedordeleted.When thisjunctionaldiversityisincluded,thereisnoproblemcreating100millionBcells,each withtheabilitytomakeadifferentantibody.Themagicofthisschemeisthatbyusing modulardesignandjunctionaldiversity,onlyasmallamountofgeneticinformationis requiredtocreateincredibleantibodydiversity

Clonal selection

Inthehumanbloodstream,thereareaboutthreebillionBcells.Thisseemslikealot,butif thereare100milliondifferentkindsofBcells(toproducethe100milliondifferentkindsof antibodiesweneedforprotection),thismeansthat,onaverage,therewillonlybeabout thirtyBcellsinthebloodthatcanproduceanantibodywhichwillbindtoagivenantigen (eg,aproteinonthesurfaceofavirus)Thepointhereisthat,althoughwehaveBcellsin ourarsenalthatcandealwithessentiallyanyinvader,wedon’thavealotofanyonekindof BcellAsaresult,whenweareattacked,moreoftheappropriateBcellsmustbemade

Indeed,Bcellsaremade“ondemand.”ButhowdoestheimmunesystemknowwhichB cellstomakemoreof?Thesolutiontothisproblemisoneofthemostelegantinallof immunology:theprincipleofclonalselection.

AfterBcellsdotheirmix-and-matchthingandpastetogetherthemodulesrequiredtoform the“recipes”fortheirheavyandlightchainantibodyproteins,arelativelysmallnumberof theseproteinsismade–a“testbatch”ofantibodymolecules,ifyouwill.Thesetester antibodies,calledBcellreceptors(BCRs),aretransportedtothesurfaceoftheBcelland aretetheredtherewiththeirantigen-bindingregionsfacingoutEachBcellhasroughly 100,000BCRsanchoredonitssurface,andalltheBCRsonagivenBcellrecognizethesame antigen.

TheBcellreceptorsonthesurfaceofaBcellactlike“bait.”Whattheyare“fishingfor”is themoleculewhichtheirFabregionshavetherightshapetograsp–theircognate antigen.Sadly,thevastmajorityofBcellsfishinvain.Forexample,mostofuswillnever beinfectedwithpoliovirusorHIV-1Consequently,thoseBcellsinourbodywhichcould makeantibodiesthatrecognizethesevirusesneverwillfindtheirmatch.Itmustbevery frustratingformostBcellsTheyfishalltheirlives,andnevercatchanything!

Onoccasion,however,aBcelldoesmakeacatchAndwhenaBcell’sreceptorsbindtoits cognateantigen,thatBcellistriggeredtodoubleinsizeanddivideintotwodaughtercells –aprocessimmunologistscallproliferation.Bothdaughtercellsthendoubleinsizeand dividetoproduceatotaloffourcells,andsoforth.Eachcycleofcellgrowthanddivision takesabouttwelvehourstocomplete,andthisperiodofproliferationusuallylastsabouta weekAttheendofthistime,a“clone”ofroughly20,000identicalBcellswillhavebeen produced,allofwhichhavereceptorsontheirsurfacethatcanrecognizethesameantigen. NowthereareenoughBcellstomountarealdefense!

AftertheselectedBcellsproliferatetoformthislargeclone,mostofthembegintomake antibodiesinearnest.TheantibodiesproducedbytheseselectedBcellsareslightly differentfromtheantibodymoleculesdisplayedontheirsurfaceinthatthereisno “anchor”toattachthemtotheBcell’ssurface.Asaresult,theseantibodiesaretransported outoftheBcellandintothebloodstream.OneBcell,workingatfullcapacity,canpump outabout2,000antibodymoleculespersecond!Aftermakingthisheroiceffort,mostof theseBcellsdie,havingworkedforonlyaboutaweekasantibodyfactories.

Whenyouthinkaboutit,thisisamarvelousstrategy.First,becausetheyemploymodular design,Bcellsuserelativelyfewgenestocreateenoughdifferentantibodymoleculesto recognizeanypossibleinvader.Second,Bcellsaremadeondemand.Soinsteadoffillingup ourbodieswithahugenumberofBcellswhichmayneverbeused,webeginwitha relativelysmallnumberofBcellsofeachkind,andthenselecttheparticularBcellsthat willbeusefulagainsttheinvader du jour.Onceselected,theBcellsproliferaterapidlyto producealargecloneofBcellswhoseantibodiesareguaranteedtobeusefulagainstthe invader.Third,afterthecloneofBcellshasgrownsufficientlylarge,mostofthesecells becomeantibodyfactorieswhichmanufacturehugequantitiesoftheveryantibodiesthat arerighttodefendagainsttheinvader.Finally,whentheintruderhasbeenconquered, mostoftheBcellsdie.Asaresult,wedon’tfillupwithBcellsthatareappropriateto defendagainstyesterday’sinvader,butwhichwouldbeuselessagainsttheenemythat attacksustomorrow.Ilovethissystem!

What antibodies do

Interestingly,althoughantibodiesareveryimportantinthedefenseagainstinvaders,they don’treallykillanythingTheirjobistoplantthe“kissofdeath”onaninvader–totagitfor destruction.Ifyougotoafancywedding,you’llusuallypassthroughareceivinglinebefore youareallowedtoenjoythechampagneandcake.Ofcourse,oneofthefunctionsofthis receivinglineistointroduceeveryonetothebrideandgroom.Buttheotherfunctionisto besurenooutsidersareadmittedtothecelebration.Asyoupassthroughtheline,youwill bescreenedbysomeonewhoisfamiliarwithalltheinvitedguestsIfshefindsthatyou don’tbelongthere,shewillcallthebouncerandhaveyouremoved.Shedoesn’tdoit herself–certainlynotHerroleistoidentifyundesirables,nottoshowthemtothedoor Andit’sthesamewithantibodies:Theyidentifyinvaders,andletotherplayersdothedirty work.

Indevelopedcountries,theinvadersweencountermostfrequentlyarebacteriaand viruses.Antibodiescanbindtobothtypesofinvadersandtagthemfordestruction. Immunologistsliketosaythatantibodiescanopsonizetheseinvaders.Thistermcomes fromaGermanwordthatmeans“toprepareforeating”Iliketoequateopsonizewith “decorate,”becauseIpicturethesebacteriaandviruseswithantibodieshangingallover them,decoratingtheirsurfaces.Anyway,whenantibodiesopsonizebacteriaorviruses, theydosobybindingtotheinvaderwiththeirFabregions,leavingtheirFctailsavailable tobindtoFcreceptorsonthesurfaceofcellssuchasmacrophages.Usingthisstrategy, antibodiescanformabridgebetweentheinvaderandthephagocyte,bringingtheinvader inclose,andpreparingitforphagocytosis.

Infact,it’sevenbetterthanthisWhenaphagocyte’sFcreceptorsbindtoantibodiesthat areopsonizinganinvader,theappetiteofthephagocyteincreases,makingitevenmore phagocyticMacrophageshaveproteinsontheirsurfacethatcanbinddirectlytomany commoninvaders.However,theabilityofantibodiestoformabridgebetweena macrophageandaninvaderallowsamacrophagetoincreaseitscatalogofenemiesto includeanyinvadertowhichanantibodycanbind,commonoruncommon.Ineffect,

antibodiesfocusamacrophage’sattentiononinvaders,someofwhich(theuncommon ones)amacrophagewouldotherwiseignore.

Duringaviralattack,antibodiescandosomethingelsethatisveryimportantVirusesenter ourcellsbybindingtocertainreceptormoleculesonacell’ssurface.Ofcoursethese receptorsarenotplacedtherefortheconvenienceofthevirus.Theyarenormalreceptors, suchastheFcreceptor,thathavequitelegitimatefunctions,butwhichthevirushas learnedtousetoitsownadvantage.Onceithasboundtothesereceptorsandentereda cell,avirusthenusesthecell’smachinerytomakemanycopiesofitselfThesenewlymade virusesburstoutofthecell,sometimeskillingit,andgoontoinfectneighboringcells.Now fortheneatpart:Antibodiescanactuallybindtoaviruswhileitisstilloutsideofacell,and cankeeptheviruseitherfromenteringthecellorfromreproducingonceithasentered. Forexample,someantibodiescanattachtothepartofthevirusthatnormallywouldplug intoitscellularreceptorandpreventthevirusfrom“docking”onthesurfaceofacell Antibodieswiththesespecialpropertiesarecalledneutralizingantibodies.

T cells

Althoughantibodiescantagvirusesforphagocyticingestionandcanhelpkeepviruses frominfectingcells,thereisaweaknessintheantibodydefenseagainstviruses:Oncea virusgetsintoacell,antibodiescan’tgettoit,sothevirusissafetomakethousandsof copiesofitself.Todealwiththispotentialproblem,theimmunesystemevolvedtoinclude anotherweapon:theTcell–anadditionalmemberoftheadaptiveimmunesystemteam.

TheimportanceofTcellsissuggestedbythefactthatanadulthumanhasabout300billion ofthem.TcellsareverysimilartoBcellsinappearance.Infact,underanordinary microscope,animmunologistcan’ttellthemapart.LikeBcells,Tcellsareproducedinthe bonemarrow,andontheirsurfacetheydisplayantibody-likemoleculescalledTcell receptors(TCRs).LiketheBcell’sreceptors(theantibodymoleculesattachedtoits surface),TCRsaremadebyamix-and-match,modulardesignstrategyAsaresult,TCRsare aboutasdiverseasBCRs.Tcellsalsoemploytheprincipleofclonalselection:WhenaT cell’sreceptorsbindtotheircognateantigen,theTcellproliferatestobuildupacloneofT cellswiththesamespecificity.Thisproliferationstagetakesaboutaweek,solikethe antibodyresponse,theTcellresponseisslowandspecific.

Althoughtheyaresimilarinmanyways,therearealsoimportantdifferencesbetweenB cellsandTcellsBcellsmatureinthebonemarrow,whereasTcellsmatureinthethymus (that’swhythey’recalled“T”cells).Bcellsmakeantibodiesthatcanrecognizeanyorganic molecule,butTcellsspecializeinrecognizingproteinantigensAlthoughaBcellcan secreteitsreceptorsintheformofantibodies,aTcell’sreceptorsremaintightlygluedtoits surface.Perhapsmostimportantly,aBcellcanrecognizeanantigen“byitself,”whereasaT cellwillonlyrecognizeanantigenifitis“properlypresented”byanothercell.I’llexplain whatthatmeansinabit.

ThereareactuallythreemaintypesofTcells:killerTcells(frequentlycalledcytotoxic lymphocytesorCTLs),helperTcells,andregulatoryTcells ThekillerTcellisapotent weaponthatcandestroyvirus-infectedcells.Indeed,byrecognizingandkillingthesecells, theCTLsolvesthe“hidingvirus”problem–theweaknessImentionedintheantibody defenseagainstviruses.ThewayakillerTcelldestroysvirus-infectedcellsisbymaking

contactwithitstargetandthentriggeringthecelltocommitsuicide!This“assistedsuicide” isagreatwaytodealwithvirusesthathaveinfectedcells–becausewhenavirus-infected celldies,theviruseswithinthecelldiealso.

ThesecondtypeofTcellisthehelperTcell(Thcell).Asyouwillsee,thiscellservesasthe quarterbackoftheimmunesystemteam.Itdirectstheactionbysecretingchemical messengers(cytokines)thathavedramaticeffectsonotherimmunesystemcells.These cytokineshavenameslikeinterleukin2(IL-2)andinterferongamma(IFN-γ),andwewill discusswhattheydoinlaterlecturesFornow,itisonlyimportanttorealizethathelperT cellsarebasicallycytokinefactories.

ThethirdtypeofTcellistheregulatoryTcellTheroleofthistypeofTcellistokeepthe immunesystemfromoverreactingorfromreactinginappropriately.Immunologistsare stillworkingtounderstandhowTcellsbecomeregulatoryTcellsandexactlyhowthey performtheseimportantfunctions.I’lltellyoumoreaboutregulatoryTcellsinlater lectures.

Antigen presentation

OnethingIneedtoclearupisexactlyhowantigenispresentedtoTcells.Itturnsoutthat

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