High Yield Immunology

Arthur G. Johnson, Ph.D.

Professor and Head

Department of Medical Microbiology and Immunology University of Minnesota

Lippincqtt Williams & Wilkins

A Wolters Kluwer Company

Acquisitions Editor: Elizabeth A. Nieginski Editorial Director, Development: Julie P. Scardiglia Development Editor: Melanie Cann

Managing Editor: Karla M. Schroeder, Marette Magargle-Smith Marketing Manager: Jennifer Conrad

Copyright © 1999 By Lippincott Williams & Wilkins.

All rights reserved. This book is protected by copyright. No part of it may be produced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy, recording, or otherwise—without the prior written permission of the publisher, except for brief quotations embodied in critical articles, reviews, and testing and evaluation materials provided by the publisher to schools that have adopted its accompanying textbook. Printed in the United States of America. For information, write Lippincott Williams & Wilkins, 227 East Washington Square, Philadelphia, PA 19106.

Materials appearing in this book prepared by individuals as part of their official duties as U.S. Government employees are not covered by the above-mentioned copyright.

Library of Congress Cataloging-in-Publication Data.

Johnson, Arthur G.

High-yield immunology / Arthur G. Johnson.

1. Immunology—Outlines, syllabi, etc. I. Title. II. Series. [DNLM: 1. Immunity outlines. 2. Immunologic Factors outlines. 3. Hypersensitivity outlines. 4- Immunotherapy outlines. QW 18.2 J66h 1999] QR182.55.J64 1999 616.07,9—dc21 DNLM/DLC

for Library of Congress 98-31653

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the publication.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions.

Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.


Preface ix

Acknowledgments xi

1 Overview 1

I. Synopsis 1

11. Concerns in medicine 1

III. Host-parasite equilibrium 2

IV. Development of the immune system 2 V. Clonal selection theory 5

2 Antigens 6

I. Definitions 6

II. Factors determining antigenicity 6 III. Examples of antigens 6

3 Antibodies 8

I. General properties 8

III. IgM 12

IV. IgA 12

VI. IgD 14

4 Immunologic Assays 15

I. Overview 15 II. Protection tests 15

III. Agglutination tests 15

IV. Precipitation reactions 16

V. Complement fixation 18 VI. Fluorescent antibody 20

VII. Western blot 20

5 Immunogenetics 21

I. Genetic control of immunoglobulin chain synthesis 21 II. Genetic control of human leukocyte antigens (HLAs) 21 III. Genetic control of the T-cell antigenic receptor (TCR) 25

6 The Immune Response 27

I. Humoral immunity 27 II. Cell-mediated immunity (CMI) 32

7 Inflammation 35

I. Introduction 35 II. Inflammation process 35

III. Kinetics 36

IV. Mediators of inflammation 39

8 Hypersensitivities 40

I. Overview 40

II. Anaphylaxis (type I) reactions 40

III. Cell surface antigen-antibody (Ag-Ab) cytotoxicity (type II) reactions

IV. Antigen-antibody (Ag-Ab) complex (type III) reactions 44

V. Delayed-type hypersensitivity (type IV) reactions 46

9 Immunodeficiency Diseases 47

I. Overview 47

II. Developmental immunodeficiency disorders 47

III. Acquired immunodeficiency syndrome (AIDS) 49

IV. Cytokine and chemokine deficiencies 51

V. Senescence (aging) of the immune response 51

10 Autoimmune Disorders

I. Overview 52

II. Immunoregulation breakdown 52

III. Systemic autoimmune disorders 53

IV. Organ-specific autoimmune disorders 54

11 Immunologic Aspects of Transplantation

I. Histocompatibility 57 II. Complications of Organ Transplantation 58 III. Immunosuppress ion 5 9

12 Cancer Immunology

I. Definition 61 II. Oncogenes 61

III. Cancer and the immune system

IV. Cancer immunotherapy 62

13 Immunization

I. Overview 64 II. Specific vaccines III. Adjuvants 68


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High-Yield Immunology is a compendium of the knowledge considered necessary by the National Board of Medical Examiners (NBME) to achieve competence in immunology for the United States Medical Licensing Examination (USMLE). Immunology is a science that pervades most medical disciplines; this volume spans the breadth of the discipline and includes basic science, as well as clinical, information. I based my selection of what subject areas to include on the experience I have gleaned from years of teaching medical and graduate students. Topics, which include the following, are presented in a concise, "narrative outline" format:

• Development and function of the organs and cells involved in the immune response

• Properties of antigens and antibodies and the way they interact with each other

• Synthesis, genetic control, and regulation of antibody

• Cell-mediated immunity (CMI) and inflammation

• Immunologic disorders, including hypersensitivity disorders, immunodeficiency disorders, and autoimmune diseases

• The role of the immune system in transplantation and cancer

• Currently available vaccines and recommended immunization schedules

Numerous tables and illustrations round out the presentation by summarizing information and clarifying difficult concepts.

This book is not meant to replace the many excellent textbooks of immunology. Rather, it is my hope that the concise presentation of information in High-Yield Immunology will assist the reader in the quick recall of the facts considered essential for understanding this exciting and rapidly changing science.

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