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ANATOMY AND PHYSIOLOGY
IMMUNITY




Maria Carmela L. Domocmat, RN, MSN
Instructor
School of Nursing
Northern Luzon Adventist College
   To protect the body against pathogens, the
    immune system relies on a multilevel network of
    physical barriers, immunologically active cells,
    and a variety of chemicals.
     first line of defense – any barrier that blocks invasion
      at the portal of entry – nonspecific
     second line of defense – protective cells and fluids;
      inflammation and phagocytosis – nonspecific
     third line of defense – acquired with exposure to
      foreign substance; produces protective antibodies and
      creates memory cells – specific

                                                                 2
Nonspecific and Specific responses of the
            Immune System
Physical or Anatomical Barriers
Skin and mucous membranes of respiratory,
  urogenital, eyes and digestive tracts
   outermost layer of skin is composed of epithelial cells
      compacted, cemented together and impregnated with
      keratin; few pathogens can penetrate if intact
     flushing effect of sweat glands
     damaged cells are rapidly replaced
     mucous coat impedes attachment and entry of bacteria
     blinking and tear production
     stomach acid
     nasal hair traps larger particles

                                                              5
   Sebaceous secretions
   Lysozyme, an enzyme that hydrolyzes the cell wall
    of bacteria, in tears
   High lactic acid and electrolyte concentration in
    sweat
   Skin’s acidic pH
   Hydrochloric acid in stomach
   Digestive juices and bile of intestines
   Semen contains antimicrobial chemical.
   Vagina has acidic pH.
                                                        6
7
   Some hosts are genetically immune to the
    diseases of other hosts.
   Some pathogens have great specificity.
   Some genetic differences exist in
    susceptibility.




                                               8
    The study of the body’s second and third
     lines of defense is called immunology.
    Functions of a healthy immune system:
    1. Constant surveillance of the body
    2. Recognition of foreign material
    3. Destruction of entities deemed to be foreign




                                                      9
10
    Large, complex, and diffuse network of
     cells and fluids that penetrate into every
     organ and tissue
    Four major subdivisions of immune
     system are:
    1. Reticuloendothelial system (RES)
    2. Extracellular fluid (ECF)
    3. Bloodstream
    4. Lymphatic system

                                                  11
12
   Network of connective tissue fibers that
    interconnects other cells and meshes with the
    connective tissue network surrounding organs
   Inhabited by phagocytic cells – mononuclear
    phagocyte system – macrophages ready to
    attack and ingest microbes that passed the
    first line of defense



                                                    13
   Whole blood consists of plasma and blood
    cells – red blood cells and white blood
    cells.
     Serum is the liquid portion of the blood after a
     clot has formed-minus clotting factors.
   Plasma – 92% water, metabolic proteins,
    globulins, clotting factors, hormones and
    all other chemicals and gases to support
    normal physiological functions

                                                         14
   Neutrophils- 55-90% - lobed nuclei with lavender
    granules; phagocytes
   Eosinophils – 1-3% - orange granules and bilobed
    nucleus; destroy eucaryotic pathogens
   Basophils, mast cells – 0.5% - constricted nuclei,
    dark blue granules; release potent chemical
    mediators
   Lymphocytes – 20-35% - large nucleus B (humoral
    immunity) and T cells (cell-mediated immunity)
    involved in the specific immune response
   Monocytes, macrophages – 3-7%- large nucleus;
    phagocytic

                                                         15
Immune system
Immune system
1.   Provides an auxiliary route for return of
     extracellular fluid to the circulatory
     system
2.   Acts as a drain-off system for the
     inflammatory response
3.   Renders surveillance, recognition, and
     protection against foreign material



                                                 18
19
   Lymph is a plasma-like liquid carried by
    lymphatic circulation
   Formed when blood components move
    out of blood vessels into extracellular
    spaces
   Made up of water, dissolved salts, 2-5%
    proteins
   Transports white blood cells, fats, cellular
    debris and infectious agents


                                                   20
   Lymphatic capillaries permeate all parts of
    the body except the CNS.
   Thin walls easily permeated by
    extracellular fluid which is then moved
    through contraction of skeletal muscles
   Functions to return lymph to circulation;
    flow is one-direction-toward the heart-
    eventually returning to blood stream


                                                  21
 Classified as primary and secondary
 Primary lymphoid organs – sites of lymphocytic
  origin and maturation – thymus and bone
  marrow
 Secondary lymphoid organs and tissues –
  circulatory-based locations such as spleen and
  lymph nodes; collections of cells distributed
  throughout body tissues – skin and mucous
  membranes – SALT, GALT, MALT



                                                   22
23
   Thymus – high rate of growth and activity
    until puberty, then begins to shrink; site of T-
    cell maturation
   Lymph nodes - small, encapsulated, bean-
    shaped organs stationed along lymphatic
    channels and large blood vessels of the
    thoracic and abdominal cavities
   Spleen – structurally similar to lymph node;
    filters circulating blood to remove worn out
    RBCs and pathogens

                                                       24
Nonspecific response
• Inflammation
• Fever
• Phagocytosis, NK cells, Interferon
• Complement




                                       26
Classic signs and symptoms characterized by:
   Redness – increased circulation and vasodilation in
    injured tissue in response to chemical mediators
    and cytokines
   Warmth – heat given off by the increased blood
    flow
   Swelling – increased fluid escaping into the tissue
    as blood vessels dilate-edema; WBC’s, microbes,
    debris and fluid collect to form pus; helping prevent
    spread of infection
   Pain – stimulation of nerve endings
   Possible loss of function


                                                            27
   pain (dolor)
   heat (calor)
   redness (rubor)
   swelling (tumor)
   loss of function
    (functio laesa).
Insert figure 14.13
 Events in inflammation




                          29
   Diapedesis – migration of cells out of
    blood vessels into the tissues
   Chemotaxis – migration in response to
    specific chemicals at the site of injury or
    infection




                                                  30
31
Inflammation




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 97&tbnw=149&hl=en&start=9&prev=/images%3Fq%3Dimmune%2Bresponse%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG
Immune system
   Initiated by circulating pyrogens which reset the
    hypothalamus to increase body temperature;
    signals muscles to increase heat production and
    vasoconstriction
     exogenous pyrogens – products of infectious agents
     endogenous pyrogens – liberated by monocytes,
      neutrophils, and macrophages during phagcytosis;
      interleukin-1 (IL-1) and tumor necrosis factor (TNF)
   Benefits of fever:
     inhibits multiplication of temperature-sensitive
      microorganisms
     impedes nutrition of bacteria by reducing the available
      iron
     increases metabolism and stimulates immune reactions
      and protective physiological processes
                                                                34
3 main types of phagocytes:
  1. Neutrophils – general-purpose; react early to
     bacteria and other foreign materials, and to
     damaged tissue
  2. Eosinophils – attracted to sites of parasitic
     infections and antigen-antibody reactions




                                                     35
   3. Monocytes
     called wandering cells until they enter a tissue where
      they become fixed and turn into macrophages
     Macrophages
      scavenge and process foreign substances to prepare
       them for reactions with B and T lymphocytes
      ▪ destroy old, damaged and dead cells in the body
      ▪ macrophages are found in the liver, spleen, lungs,
        lymph nodes, skin and intestine
Macrophages in action




 Copyright © 2006 Dr. Salme Taagepera, All rights reserved.
General activities of phagocytes:
1. To survey tissue compartments and
   discover microbes, particulate matter and
   dead or injured cells
2. To ingest and eliminate these materials
3. To extract immunogenic information
   from foreign matter



                                               38
39
   Small protein produced by certain white blood
    cells and tissue cells
     alpha interferon- lymphocytes and macrophages
     beta interferon – fibroblasts and epithelial cells
     gamma interferon – T cells
 Produced in response to viruses, RNA, immune
  products, and various antigens
 Bind to cell surfaces and induce expression of
  antiviral proteins
 Inhibit expression of cancer genes




                                                           40
41
   Consists of 26 blood proteins that work in concert
    to destroy bacteria and viruses
   there are only a handful of proteins in the
    complement system, and they are floating freely
    in your blood.
   manufactured in the liver.
   activated by and work with (complement) the
    antibodies, hence the name.
   they cause lysing (bursting) of cells and signal to
    phagocytes that a cell needs to be removed



                                                      42
43
Immune system
45
Specific defense
Third line of defense – acquired
 Production of specific antibodies by dual system of
  B and T lymphocytes in response to an encounter
  with a foreign molecule, called an antigen
 Two features that characterize specific immunity:
   specificity – antibodies produced, function only against
    the antigen that they were produced in response to
   memory – lymphocytes are programmed to “recall” their
    first encounter with an antigen and respond rapidly to
    subsequent encounters


                                                               47
Nonspecific and Specific responses of the
                    Immune System




                                                                                                          T cells                                B cells
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nh=97&tbnw=149&hl=en&start=9&prev=/images%3Fq%3Dimmune%2Bresponse%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG
   Made up of two cellular systems (lymphocytes)
    1. humoral or circulating antiBody system - B cells
    2. cell mediaTed immunity - T cells
B cells make
                                                         antibodies




                                                      T cells mount
                                                       direct attack on
                                                        foreign/infected
                                                        cell




http://www.people.virginia.edu/~rjh9u/gif/irsum.gif
Immune system
   Aka: humoral immunity
   Involves antigen-antibody interactions to
    neutralize, eliminate, or destroy foreign
    proteins.

   Purpose:
     Main function of B-cells: to become sensitized to a
     specific protein (antigens) and to produce
     antibodies directed specifically against that
     protein
   B-cells
   Macrophages
   T-lymphocytes

   All these work with B-cells to start and
    complete antigen-antibody interactions
   Therefore: for optimal AMI, the entire
    immune system must function adequately
   Start in bone marrow
   Released in the blood
   Then migrate into secondary lymphoid
    tissues where maturation is completed
     Spleen
     Parts of lymph nodes
     Tonsils
     Peyer’s patches of GIT
Immune system
Two main functions:

1) Return tissue fluid
  to circulation

2) Fights infection
  - both specific and
  non-specific
    resistance.

Lymph- fluid carried by
  lymphatic vessels
- fluid enters lymphatic system by diffusing into dead-
end lymphatic capillaries

- infection-fighting activities occur in the lymph nodes
   Lymphocytes (25-35% of WBCs)

     T-cells: 70% of lymphocytes
     ▪ Cell mediated immunity

     B-cells: 20-25% of lymphocytes
     ▪ Humoral immunity
   Body learns to make enough of any specific
    antibody to provide long-lasting immunity
    against specific organisms or toxins

   7 Steps needed to make a specific antibody
    against an antigen
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
   B cell activation occurs in response to
    exposure to a specific foreign antigen
   Invasion must occur in large #s that some
    may evade detection by other lines of
    defense
       Helper T cells secrete a chemical called
        interleukins
        Interleukin 6 – induces maturation of B cells and
         proliferation of T cells
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
   “virgin” or “naïve” unsensitized B-cells must
    recognize the antigen as non-self
   Need help of macrophages and
    helper/inducer T-cells
Immune system
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
   Virgin B-cell can be sensitized only once
   Therefore each B-cell can be sensitized to
    only one type of antigen
   Immediately after it is sensitized –it divides
    and form two types of B-lymphocytes
   B cells divide:
    1. Plasma cells = synthesize and secrete large
         numbers of antibodies with the same antigen
         target
     ▪    Can make as much as as 300 molecules of antibody
          /sec
    2. Memory B cells = remain in reserve for future
         attacks by the same antigen
   When an antibody binds to the outer coat of a
    virus particle or the cell wall of a bacterium it
    can stop their movement through cell walls.
   Or a large number of antibodies can bind to
    an invader and signal to the complement
    system that the invader needs to be
    removed.
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
   Antibody molecules are released in blood and
    other body fluids as free antibody
   Each remain in the blood for 3 to 30 days

   Note: circulating antibodies can be
    transferred from one person to another to
    provide the receiving person with immediate
    immunity of short duration
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
   When a pathogen enters the
    body it stimulates specific
    lymphocytes to make
    antibodies
   These antibodies are
    proteins of a very specific
    shape and they will attach to
    the specific antigens on the
    surface of the pathogen
   Binding of the antibody to
    the pathogen targets the
    pathogen for destruction by
    macrophages
http://www.biology.arizona.edu/immunology/
              tutorials/antibody/graphics/antibody.gif
                                                           http://www.blc.arizona.edu/courses/181summer/graphics/gr
                                                           aphics%20lect16/Life7e-Fig-18-10-
                                                           2%20structure%20of%20antibody%20p2.jpg


Antibodies are protein complexes made of 2 heavy chain and 2 light chain peptides
    •Constant region (shown dark blue and dark red) = same in all antibodies
    •Variable region (shown light blue and light red)= unique in each antibody
http://www.accessexcellence.org/RC/VL/GG/images/Fig_5.03b.jpg
Immune system
Type   Number of    Site of action            Functions
       ag binding
       sites
IgG    2            •Blood                    •Increase
                    •Tissue fluid             macrophage activity
                    •CAN CROSS                •Antitoxins
                    PLACENTA                  •Agglutination

IgM    10           •Blood                    Agglutination
                    •Tissue fluid

IgA    2 or 4       •Secretions (saliva,      •Stop bacteria
                    tears, small intestine,   adhering to host
                    vaginal, prostate,        cells
                    nasal, breast milk)       •Prevents bacteria
                                              forming colonies on
                                              mucous membranes
IgE    2            Tissues                   •Activate mast cells
                                                HISTAMINE
                                              •Worm response
IgG (75% of Total Immunoglobulin)
• Appears in serum and tissues (interstitial fluid)
• Assumes a major role in bloodborne and tissue infections
• Activates the complement system
• Enhances phagocytosis
• Crosses the placenta
IgA (15% of Total Immunoglobulin)
• Appears in body fluids (blood, saliva, tears, breast milk, and
pulmonary, gastrointestinal, prostatic, and vaginal secretions)
• Protects against respiratory, gastrointestinal, and genitourinary
infections
• Prevents absorption of antigens from food
• Passes to neonate in breast milk for protection
IgM (10% of Total Immunoglobulin)
• Appears mostly in intravascular serum
• Appears as the first immunoglobulin produced in response
to bacterial and viral infections
• Activates the complement system
IgD (0.2% of Total Immunoglobulin)
• Appears in small amounts in serum
• Possibly influences B-lymphocyte differentiation, but role
is unclear
IgE (0.004% of Total Immunoglobulin)
• Appears in serum
• Takes part in allergic and some hypersensitivity reactions
• Combats parasitic infections
   IgD
   IgG
   IgA
   IgM
   IgE
Immune system
   Actual binding of antibody to antigen is
    usually not lethal to the antigen

   Instead it starts other actions that neutralize,
    eliminate, or destroy antigen
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
   Agglutination
   Lysis
   Complement fixation
   Precipitation
   Inactivation-neutralization
1.   Exposure (invasion)
2.   Antigen recognition
3.   Lymphocyte sensitization
4.   Antibody production and release
5.   Antigen-antibody binding
6.   Antibody-binding actions
7.   Sustained immunity: Memory
Immune system
The first exposure to a
                                                           pathogen gives only a
                                                           slow and small immune
                                                           response




Levels of antibodies in the blood build up slowly when you are first exposed to
a particular pathogen.
    •It takes over 5 days for the antibodies to reach a level that will fight off the
    infection.
    •During this time, you will feel the symptoms of the infection and damage will
    be caused to your body tissues.
    •In serious diseases, this can be fatal.
•The first exposure to a pathogen gives only a slow and small immune response.
•Repeated exposure to the same pathogen gives a much stronger and quicker memory response.
 When your body is first infected with a pathogen, the
  main task of the immune system is to combat the
  infection. However, it also produces lymphocytes that
  remain in your body for many years and remember
  the pathogen in case it returns.
 Immune memory
     If you get infected a second time, your immune system is
      already prepared for the pathogen and can quickly make
      enough antibodies to kill the infection before any symptoms
      are felt.
     Vaccination takes advantage of this feature of the immune
      system.
Immune system
Once a T cell is activated by the presentation of the
combined MHC/Ag, it will clone (by mitosis) &
differentiate into:
     cytotoxic T cells
     helper T cells
     memory T cells
     suppressor T cells
T-cell receptor structure similar to antibody
1.       Cytotoxic T cells
          attack foreign cells
          seek out the specific pathogen/infected cell that
           contains the targeted Ag & destroys it by secreting
           various chemicals


                                         Killer cell   Target cell
2.       Memory T-cells
         remain in reserve
         When body sees the same antigen again, these cells
          produce a rapid, specific response
         these cells can immediately differentiate into cytotoxic &
          helper T cells, causing a swift secondary response to the
          invasion
3.       Suppressor T-cells
         depress the response of T and B cells
         are slow to activate but effectively “put on the brakes” or
          end the immune response
         activated more slowly than the other T cells
         inhibit the response of the immune cells to prevent
          potential “autoimmune” response
4.        Helper T cells
           orchestrate immune response
           necessary for coordination of both specific & non-specific
            defenses, as well as for stimulating both cell-mediated &
            antibody-mediated immunity.
          In cell-mediated immunity they release chemicals
           (cytokines) that strengthen the activity of cytotoxic T cells.
          In antibody-mediated immunity they release cytokines
           that stimulate activated B cell division & differentiation
           into plasma cells
Helper T cells
   release a variety of compounds called cytokines
   cytokines
    1. coordinate both specific and non-specific defenses
    2. stimulate production of more t cells
    3. stimulate production of antibodies by B cells
   T lymphocytes (T cells) – they mature in the thymus and
    are responsible for cell-mediated immunity
   a) Helper T cells – direct the rest of the immune system by
    releasing cytokines
   b) Cytotoxic T cells – release chemicals that break open
    and kill invading organisms
   c) Memory T cells – remain afterwards to help the immune
    system respond more quickly if the same organism is
    encountered again
   d) Suppressor T cells – suppress the immune response so
    that it does not get out of control and destroy normal cells
    once the immune response is no longer needed
Activated T cells clone &
                                               differentiate into:
                                                                   stimulate
              Direct physical &                 Cytotoxic T cells
                                                Helper T cells                   B cell
                                                                                  activation
              chemical attack
                                                Memory T cells
                                                Suppressor T cells
                                                                               Prevent
                                                                               autoimmune
   Antigens                       Remain in
                                                                               response

                                  reserve     CELL MEDIATED IMMUNITY

 ANTIGENS
bacteria
                       SPECIFIC               APC’s phagocytize Ag & activate T
bacteria               DEFENSES               cells
  viruses              (Immune
                       response)

viruses
Immune system
Immune system
Immune system
   Immunization raises host resistance,
    defenses, and immunity
Immunity is the resistance to injuries/disease caused by specific pathogens

Types of immunity:




http://faculty.ircc.edu/faculty/tfischer/images/t
ypes%20of%20immunity.jpg
Overview of Immunity
   present at birth
   independent of previous exposure to Ag
   genetically determined
   species dependent
   arises throughout life by active or passive
    means
Active immunity
 Lymphocytes are activated by antigens on
  the surface of pathogens

   Takes time for enough B and T cells to be
    produced to mount an effective response.
   Natural active immunity
     naturally acquired active immunity
     acquired due to infection
     natural exposure results in immune response &
      development of long term immunity

   Artificial active immunity
     Vaccination
     induced (artificial) active immunity – deliberate “artificial”
      exposure to Ag (i.e. vaccine/immunization)
   Passive immunity – development of immunity
    due to transfer of “pre-made” antibodies
     naturally acquired passive immunity – Ab’s
      transferred from mom  baby across placenta or in
      breast-milk
     induced (artificial) passive immunity – administration
      of Ab’s to fight disease after exposure to pathogen
Passive immunity
 B and T cells are not activated and plasma
  cells have not produced antibodies.
 The antigen doesn’t have to be encountered
  for the body to make the antibodies.
 Antibodies appear immediately in blood but
  protection is only temporary.
       Used when a very rapid immune response
    is needed
     e.g. after infection with tetanus. Human
      antibodies are injected. In the case of tetanus
      these are antitoxin antibodies.
     Antibodies come from blood donors who have
      recently had the tetanus vaccination.

   Only provides short term protection as abs
    destroyed by phagocytes in spleen and liver.
   A mother’s antibodies pass across the
    placenta to the foetus and remain for several
    months.
   Colostrum (the first breast milk) contains lots
    of IgA which remain on surface of the baby’s
    gut wall and pass into blood
Immune system
A preparation containing antigenic
material:
 Whole live microorganism
 Dead microorganism
 Attenuated (harmless) microorganism
 Toxoid (harmless form of toxin)
 Preparation of harmless ags
   Injection into vein or muscle
   Oral
117
Why aren’t they always effective?
 Natural infections persist within the body for a
  long time so the immune system has time to
  develop an effective response, vaccinations from
  dead m-os do not do this.
 Less effective vaccines need booster injections
  to stimulate secondary responses
 Some people don’t respond well/at all to
  vaccinations
 Defective immune systems
 Malnutrition particularly protein
 Antigenic variation caused by mutation
 Antigenic drift – small changes (still recognised by
  memory cells)
 Antigenic shift – large changes (no longer recognised)
 No vaccines against protoctists (malaria and sleeping
  sickness)
 Many stages to Plamodium life cycle with many
  antigens so vaccinations would have to be effective
  against all stages (or be effective just against infective
  stage but given in very small time period).
   Sleeping sickness – Trypanosoma has a
    thousand different ags and changes them
    every 4-5 days
   Antigenic concealment parasites live inside
    body cells
   Plasmodium – liver and blood cells
   Parasitic worms – cover themselves in host
    proteins
   HIV – live inside T-helper cells
Review of the immune response

                                                            Non-
                                                            specific
                                                            response




                                                            Specific
                                                            response




               NOTE: key role played by Helper T cells!!!
http://www.vacadsci.org/jsr/imuneR.jpg
   Recommended Adult        Recommended
    Immunization              pediatric immunization
    Schedule                  schedule


    • Contraindications
Immune system
Immune system
   Who should not get the vaccine or should wait?
     1. people who have had a life threatening allergic reaction to
        gelatin, neomycin, or a previous dose of the vaccine
       2. people who are moderately or severely ill should wait
       3. pregnant women should wait until after birth, women should
        not get pregnant for 1 month after getting the vaccine
       4. people with HIV/AIDS, immune system problems, taking any
        drugs that affect the immune system, have cancer, or taking
        chemotherapy or x-ray therapy for cancer should check with
        their doctor before receiving the vaccine
       5. people who recently had a blood transfusion should check
        with their doctor
 Live-microbial vaccines should not be given
  simultaneously with blood, plasma, or immune globulin,
  which can interfere with development of desired
  antibodies; ideally, such vaccines should be given 2 wk
  before or 6 to 12 wk after the immune globulins.
 Immunocompromised patients should not receive live-
  virus vaccines, which could provoke severe or fatal
  infections.
 In patients receiving short-term (ie, < 14 days)
  immunosuppressive therapy (eg, corticosteroids,
  antimetabolites, alkylating compounds, radiation), live-
  virus vaccines should be withheld until after treatment.
   Immunity may or may not be life-long with
    vaccines.
   To help keep the antibody levels high enough
    to keep you protected you sometimes need
    to have “booster shots”.
   Nutrition and the immune system
     Malnutrition impairs immune function
     Fish oil: anti inflam
   Stress and the immune system
     Chronic stress has detrimental effects on immune
      system
   Ageing and the immune system
   Vaccination

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Immune system

  • 1. ANATOMY AND PHYSIOLOGY IMMUNITY Maria Carmela L. Domocmat, RN, MSN Instructor School of Nursing Northern Luzon Adventist College
  • 2. To protect the body against pathogens, the immune system relies on a multilevel network of physical barriers, immunologically active cells, and a variety of chemicals.  first line of defense – any barrier that blocks invasion at the portal of entry – nonspecific  second line of defense – protective cells and fluids; inflammation and phagocytosis – nonspecific  third line of defense – acquired with exposure to foreign substance; produces protective antibodies and creates memory cells – specific 2
  • 3. Nonspecific and Specific responses of the Immune System
  • 5. Skin and mucous membranes of respiratory, urogenital, eyes and digestive tracts  outermost layer of skin is composed of epithelial cells compacted, cemented together and impregnated with keratin; few pathogens can penetrate if intact  flushing effect of sweat glands  damaged cells are rapidly replaced  mucous coat impedes attachment and entry of bacteria  blinking and tear production  stomach acid  nasal hair traps larger particles 5
  • 6. Sebaceous secretions  Lysozyme, an enzyme that hydrolyzes the cell wall of bacteria, in tears  High lactic acid and electrolyte concentration in sweat  Skin’s acidic pH  Hydrochloric acid in stomach  Digestive juices and bile of intestines  Semen contains antimicrobial chemical.  Vagina has acidic pH. 6
  • 7. 7
  • 8. Some hosts are genetically immune to the diseases of other hosts.  Some pathogens have great specificity.  Some genetic differences exist in susceptibility. 8
  • 9. The study of the body’s second and third lines of defense is called immunology.  Functions of a healthy immune system: 1. Constant surveillance of the body 2. Recognition of foreign material 3. Destruction of entities deemed to be foreign 9
  • 10. 10
  • 11. Large, complex, and diffuse network of cells and fluids that penetrate into every organ and tissue  Four major subdivisions of immune system are: 1. Reticuloendothelial system (RES) 2. Extracellular fluid (ECF) 3. Bloodstream 4. Lymphatic system 11
  • 12. 12
  • 13. Network of connective tissue fibers that interconnects other cells and meshes with the connective tissue network surrounding organs  Inhabited by phagocytic cells – mononuclear phagocyte system – macrophages ready to attack and ingest microbes that passed the first line of defense 13
  • 14. Whole blood consists of plasma and blood cells – red blood cells and white blood cells.  Serum is the liquid portion of the blood after a clot has formed-minus clotting factors.  Plasma – 92% water, metabolic proteins, globulins, clotting factors, hormones and all other chemicals and gases to support normal physiological functions 14
  • 15. Neutrophils- 55-90% - lobed nuclei with lavender granules; phagocytes  Eosinophils – 1-3% - orange granules and bilobed nucleus; destroy eucaryotic pathogens  Basophils, mast cells – 0.5% - constricted nuclei, dark blue granules; release potent chemical mediators  Lymphocytes – 20-35% - large nucleus B (humoral immunity) and T cells (cell-mediated immunity) involved in the specific immune response  Monocytes, macrophages – 3-7%- large nucleus; phagocytic 15
  • 18. 1. Provides an auxiliary route for return of extracellular fluid to the circulatory system 2. Acts as a drain-off system for the inflammatory response 3. Renders surveillance, recognition, and protection against foreign material 18
  • 19. 19
  • 20. Lymph is a plasma-like liquid carried by lymphatic circulation  Formed when blood components move out of blood vessels into extracellular spaces  Made up of water, dissolved salts, 2-5% proteins  Transports white blood cells, fats, cellular debris and infectious agents 20
  • 21. Lymphatic capillaries permeate all parts of the body except the CNS.  Thin walls easily permeated by extracellular fluid which is then moved through contraction of skeletal muscles  Functions to return lymph to circulation; flow is one-direction-toward the heart- eventually returning to blood stream 21
  • 22.  Classified as primary and secondary  Primary lymphoid organs – sites of lymphocytic origin and maturation – thymus and bone marrow  Secondary lymphoid organs and tissues – circulatory-based locations such as spleen and lymph nodes; collections of cells distributed throughout body tissues – skin and mucous membranes – SALT, GALT, MALT 22
  • 23. 23
  • 24. Thymus – high rate of growth and activity until puberty, then begins to shrink; site of T- cell maturation  Lymph nodes - small, encapsulated, bean- shaped organs stationed along lymphatic channels and large blood vessels of the thoracic and abdominal cavities  Spleen – structurally similar to lymph node; filters circulating blood to remove worn out RBCs and pathogens 24
  • 26. • Inflammation • Fever • Phagocytosis, NK cells, Interferon • Complement 26
  • 27. Classic signs and symptoms characterized by:  Redness – increased circulation and vasodilation in injured tissue in response to chemical mediators and cytokines  Warmth – heat given off by the increased blood flow  Swelling – increased fluid escaping into the tissue as blood vessels dilate-edema; WBC’s, microbes, debris and fluid collect to form pus; helping prevent spread of infection  Pain – stimulation of nerve endings  Possible loss of function 27
  • 28. pain (dolor)  heat (calor)  redness (rubor)  swelling (tumor)  loss of function (functio laesa).
  • 29. Insert figure 14.13 Events in inflammation 29
  • 30. Diapedesis – migration of cells out of blood vessels into the tissues  Chemotaxis – migration in response to specific chemicals at the site of injury or infection 30
  • 31. 31
  • 34. Initiated by circulating pyrogens which reset the hypothalamus to increase body temperature; signals muscles to increase heat production and vasoconstriction  exogenous pyrogens – products of infectious agents  endogenous pyrogens – liberated by monocytes, neutrophils, and macrophages during phagcytosis; interleukin-1 (IL-1) and tumor necrosis factor (TNF)  Benefits of fever:  inhibits multiplication of temperature-sensitive microorganisms  impedes nutrition of bacteria by reducing the available iron  increases metabolism and stimulates immune reactions and protective physiological processes 34
  • 35. 3 main types of phagocytes: 1. Neutrophils – general-purpose; react early to bacteria and other foreign materials, and to damaged tissue 2. Eosinophils – attracted to sites of parasitic infections and antigen-antibody reactions 35
  • 36. 3. Monocytes  called wandering cells until they enter a tissue where they become fixed and turn into macrophages  Macrophages  scavenge and process foreign substances to prepare them for reactions with B and T lymphocytes ▪ destroy old, damaged and dead cells in the body ▪ macrophages are found in the liver, spleen, lungs, lymph nodes, skin and intestine
  • 37. Macrophages in action Copyright © 2006 Dr. Salme Taagepera, All rights reserved.
  • 38. General activities of phagocytes: 1. To survey tissue compartments and discover microbes, particulate matter and dead or injured cells 2. To ingest and eliminate these materials 3. To extract immunogenic information from foreign matter 38
  • 39. 39
  • 40. Small protein produced by certain white blood cells and tissue cells  alpha interferon- lymphocytes and macrophages  beta interferon – fibroblasts and epithelial cells  gamma interferon – T cells  Produced in response to viruses, RNA, immune products, and various antigens  Bind to cell surfaces and induce expression of antiviral proteins  Inhibit expression of cancer genes 40
  • 41. 41
  • 42. Consists of 26 blood proteins that work in concert to destroy bacteria and viruses  there are only a handful of proteins in the complement system, and they are floating freely in your blood.  manufactured in the liver.  activated by and work with (complement) the antibodies, hence the name.  they cause lysing (bursting) of cells and signal to phagocytes that a cell needs to be removed 42
  • 43. 43
  • 45. 45
  • 47. Third line of defense – acquired  Production of specific antibodies by dual system of B and T lymphocytes in response to an encounter with a foreign molecule, called an antigen  Two features that characterize specific immunity:  specificity – antibodies produced, function only against the antigen that they were produced in response to  memory – lymphocytes are programmed to “recall” their first encounter with an antigen and respond rapidly to subsequent encounters 47
  • 48. Nonspecific and Specific responses of the Immune System T cells B cells http://images.google.com/imgres?imgurl=http://www.vacadsci.org/jsr/imuneR.jpg&imgrefurl=http://www.vacadsci.org/jsr/tlist2.htm&h=663&w=1009&sz=460&tbnid=w5XN6XPgUBEJ:&tb nh=97&tbnw=149&hl=en&start=9&prev=/images%3Fq%3Dimmune%2Bresponse%26svnum%3D10%26hl%3Den%26lr%3D%26sa%3DG
  • 49. Made up of two cellular systems (lymphocytes) 1. humoral or circulating antiBody system - B cells 2. cell mediaTed immunity - T cells
  • 50. B cells make antibodies T cells mount direct attack on foreign/infected cell http://www.people.virginia.edu/~rjh9u/gif/irsum.gif
  • 52. Aka: humoral immunity  Involves antigen-antibody interactions to neutralize, eliminate, or destroy foreign proteins.  Purpose:  Main function of B-cells: to become sensitized to a specific protein (antigens) and to produce antibodies directed specifically against that protein
  • 53. B-cells  Macrophages  T-lymphocytes  All these work with B-cells to start and complete antigen-antibody interactions  Therefore: for optimal AMI, the entire immune system must function adequately
  • 54. Start in bone marrow  Released in the blood  Then migrate into secondary lymphoid tissues where maturation is completed  Spleen  Parts of lymph nodes  Tonsils  Peyer’s patches of GIT
  • 56. Two main functions: 1) Return tissue fluid to circulation 2) Fights infection - both specific and non-specific resistance. Lymph- fluid carried by lymphatic vessels
  • 57. - fluid enters lymphatic system by diffusing into dead- end lymphatic capillaries - infection-fighting activities occur in the lymph nodes
  • 58. Lymphocytes (25-35% of WBCs)  T-cells: 70% of lymphocytes ▪ Cell mediated immunity  B-cells: 20-25% of lymphocytes ▪ Humoral immunity
  • 59. Body learns to make enough of any specific antibody to provide long-lasting immunity against specific organisms or toxins  7 Steps needed to make a specific antibody against an antigen
  • 60. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 61. B cell activation occurs in response to exposure to a specific foreign antigen  Invasion must occur in large #s that some may evade detection by other lines of defense
  • 62. Helper T cells secrete a chemical called interleukins  Interleukin 6 – induces maturation of B cells and proliferation of T cells
  • 63. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 64. “virgin” or “naïve” unsensitized B-cells must recognize the antigen as non-self  Need help of macrophages and helper/inducer T-cells
  • 66. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 67. Virgin B-cell can be sensitized only once  Therefore each B-cell can be sensitized to only one type of antigen  Immediately after it is sensitized –it divides and form two types of B-lymphocytes
  • 68. B cells divide: 1. Plasma cells = synthesize and secrete large numbers of antibodies with the same antigen target ▪ Can make as much as as 300 molecules of antibody /sec 2. Memory B cells = remain in reserve for future attacks by the same antigen
  • 69. When an antibody binds to the outer coat of a virus particle or the cell wall of a bacterium it can stop their movement through cell walls.  Or a large number of antibodies can bind to an invader and signal to the complement system that the invader needs to be removed.
  • 70. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 71. Antibody molecules are released in blood and other body fluids as free antibody  Each remain in the blood for 3 to 30 days  Note: circulating antibodies can be transferred from one person to another to provide the receiving person with immediate immunity of short duration
  • 72. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 73. When a pathogen enters the body it stimulates specific lymphocytes to make antibodies  These antibodies are proteins of a very specific shape and they will attach to the specific antigens on the surface of the pathogen  Binding of the antibody to the pathogen targets the pathogen for destruction by macrophages
  • 74. http://www.biology.arizona.edu/immunology/ tutorials/antibody/graphics/antibody.gif http://www.blc.arizona.edu/courses/181summer/graphics/gr aphics%20lect16/Life7e-Fig-18-10- 2%20structure%20of%20antibody%20p2.jpg Antibodies are protein complexes made of 2 heavy chain and 2 light chain peptides •Constant region (shown dark blue and dark red) = same in all antibodies •Variable region (shown light blue and light red)= unique in each antibody
  • 77. Type Number of Site of action Functions ag binding sites IgG 2 •Blood •Increase •Tissue fluid macrophage activity •CAN CROSS •Antitoxins PLACENTA •Agglutination IgM 10 •Blood Agglutination •Tissue fluid IgA 2 or 4 •Secretions (saliva, •Stop bacteria tears, small intestine, adhering to host vaginal, prostate, cells nasal, breast milk) •Prevents bacteria forming colonies on mucous membranes IgE 2 Tissues •Activate mast cells  HISTAMINE •Worm response
  • 78. IgG (75% of Total Immunoglobulin) • Appears in serum and tissues (interstitial fluid) • Assumes a major role in bloodborne and tissue infections • Activates the complement system • Enhances phagocytosis • Crosses the placenta IgA (15% of Total Immunoglobulin) • Appears in body fluids (blood, saliva, tears, breast milk, and pulmonary, gastrointestinal, prostatic, and vaginal secretions) • Protects against respiratory, gastrointestinal, and genitourinary infections • Prevents absorption of antigens from food • Passes to neonate in breast milk for protection
  • 79. IgM (10% of Total Immunoglobulin) • Appears mostly in intravascular serum • Appears as the first immunoglobulin produced in response to bacterial and viral infections • Activates the complement system IgD (0.2% of Total Immunoglobulin) • Appears in small amounts in serum • Possibly influences B-lymphocyte differentiation, but role is unclear IgE (0.004% of Total Immunoglobulin) • Appears in serum • Takes part in allergic and some hypersensitivity reactions • Combats parasitic infections
  • 80. IgD  IgG  IgA  IgM  IgE
  • 82. Actual binding of antibody to antigen is usually not lethal to the antigen  Instead it starts other actions that neutralize, eliminate, or destroy antigen
  • 83. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 84. Agglutination  Lysis  Complement fixation  Precipitation  Inactivation-neutralization
  • 85. 1. Exposure (invasion) 2. Antigen recognition 3. Lymphocyte sensitization 4. Antibody production and release 5. Antigen-antibody binding 6. Antibody-binding actions 7. Sustained immunity: Memory
  • 87. The first exposure to a pathogen gives only a slow and small immune response Levels of antibodies in the blood build up slowly when you are first exposed to a particular pathogen. •It takes over 5 days for the antibodies to reach a level that will fight off the infection. •During this time, you will feel the symptoms of the infection and damage will be caused to your body tissues. •In serious diseases, this can be fatal.
  • 88. •The first exposure to a pathogen gives only a slow and small immune response. •Repeated exposure to the same pathogen gives a much stronger and quicker memory response.
  • 89.  When your body is first infected with a pathogen, the main task of the immune system is to combat the infection. However, it also produces lymphocytes that remain in your body for many years and remember the pathogen in case it returns.  Immune memory  If you get infected a second time, your immune system is already prepared for the pathogen and can quickly make enough antibodies to kill the infection before any symptoms are felt.  Vaccination takes advantage of this feature of the immune system.
  • 91. Once a T cell is activated by the presentation of the combined MHC/Ag, it will clone (by mitosis) & differentiate into:  cytotoxic T cells  helper T cells  memory T cells  suppressor T cells
  • 92. T-cell receptor structure similar to antibody
  • 93. 1. Cytotoxic T cells  attack foreign cells  seek out the specific pathogen/infected cell that contains the targeted Ag & destroys it by secreting various chemicals Killer cell Target cell
  • 94. 2. Memory T-cells  remain in reserve  When body sees the same antigen again, these cells produce a rapid, specific response  these cells can immediately differentiate into cytotoxic & helper T cells, causing a swift secondary response to the invasion
  • 95. 3. Suppressor T-cells  depress the response of T and B cells  are slow to activate but effectively “put on the brakes” or end the immune response  activated more slowly than the other T cells  inhibit the response of the immune cells to prevent potential “autoimmune” response
  • 96. 4. Helper T cells  orchestrate immune response  necessary for coordination of both specific & non-specific defenses, as well as for stimulating both cell-mediated & antibody-mediated immunity.  In cell-mediated immunity they release chemicals (cytokines) that strengthen the activity of cytotoxic T cells.  In antibody-mediated immunity they release cytokines that stimulate activated B cell division & differentiation into plasma cells
  • 97. Helper T cells  release a variety of compounds called cytokines  cytokines 1. coordinate both specific and non-specific defenses 2. stimulate production of more t cells 3. stimulate production of antibodies by B cells
  • 98. T lymphocytes (T cells) – they mature in the thymus and are responsible for cell-mediated immunity  a) Helper T cells – direct the rest of the immune system by releasing cytokines  b) Cytotoxic T cells – release chemicals that break open and kill invading organisms  c) Memory T cells – remain afterwards to help the immune system respond more quickly if the same organism is encountered again  d) Suppressor T cells – suppress the immune response so that it does not get out of control and destroy normal cells once the immune response is no longer needed
  • 99. Activated T cells clone & differentiate into: stimulate Direct physical &  Cytotoxic T cells  Helper T cells B cell activation chemical attack  Memory T cells  Suppressor T cells Prevent autoimmune Antigens Remain in response reserve CELL MEDIATED IMMUNITY ANTIGENS bacteria SPECIFIC APC’s phagocytize Ag & activate T bacteria DEFENSES cells viruses (Immune response) viruses
  • 103. Immunization raises host resistance, defenses, and immunity
  • 104. Immunity is the resistance to injuries/disease caused by specific pathogens Types of immunity: http://faculty.ircc.edu/faculty/tfischer/images/t ypes%20of%20immunity.jpg
  • 106. present at birth  independent of previous exposure to Ag  genetically determined  species dependent
  • 107. arises throughout life by active or passive means
  • 108. Active immunity  Lymphocytes are activated by antigens on the surface of pathogens  Takes time for enough B and T cells to be produced to mount an effective response.
  • 109. Natural active immunity  naturally acquired active immunity  acquired due to infection  natural exposure results in immune response & development of long term immunity  Artificial active immunity  Vaccination  induced (artificial) active immunity – deliberate “artificial” exposure to Ag (i.e. vaccine/immunization)
  • 110. Passive immunity – development of immunity due to transfer of “pre-made” antibodies  naturally acquired passive immunity – Ab’s transferred from mom  baby across placenta or in breast-milk  induced (artificial) passive immunity – administration of Ab’s to fight disease after exposure to pathogen
  • 111. Passive immunity  B and T cells are not activated and plasma cells have not produced antibodies.  The antigen doesn’t have to be encountered for the body to make the antibodies.  Antibodies appear immediately in blood but protection is only temporary.
  • 112. Used when a very rapid immune response is needed  e.g. after infection with tetanus. Human antibodies are injected. In the case of tetanus these are antitoxin antibodies.  Antibodies come from blood donors who have recently had the tetanus vaccination.  Only provides short term protection as abs destroyed by phagocytes in spleen and liver.
  • 113. A mother’s antibodies pass across the placenta to the foetus and remain for several months.  Colostrum (the first breast milk) contains lots of IgA which remain on surface of the baby’s gut wall and pass into blood
  • 115. A preparation containing antigenic material:  Whole live microorganism  Dead microorganism  Attenuated (harmless) microorganism  Toxoid (harmless form of toxin)  Preparation of harmless ags
  • 116. Injection into vein or muscle  Oral
  • 117. 117
  • 118. Why aren’t they always effective?  Natural infections persist within the body for a long time so the immune system has time to develop an effective response, vaccinations from dead m-os do not do this.  Less effective vaccines need booster injections to stimulate secondary responses  Some people don’t respond well/at all to vaccinations  Defective immune systems  Malnutrition particularly protein
  • 119.  Antigenic variation caused by mutation  Antigenic drift – small changes (still recognised by memory cells)  Antigenic shift – large changes (no longer recognised)  No vaccines against protoctists (malaria and sleeping sickness)  Many stages to Plamodium life cycle with many antigens so vaccinations would have to be effective against all stages (or be effective just against infective stage but given in very small time period).
  • 120. Sleeping sickness – Trypanosoma has a thousand different ags and changes them every 4-5 days  Antigenic concealment parasites live inside body cells  Plasmodium – liver and blood cells  Parasitic worms – cover themselves in host proteins  HIV – live inside T-helper cells
  • 121. Review of the immune response Non- specific response Specific response NOTE: key role played by Helper T cells!!! http://www.vacadsci.org/jsr/imuneR.jpg
  • 122. Recommended Adult  Recommended Immunization pediatric immunization Schedule schedule • Contraindications
  • 125. Who should not get the vaccine or should wait?  1. people who have had a life threatening allergic reaction to gelatin, neomycin, or a previous dose of the vaccine  2. people who are moderately or severely ill should wait  3. pregnant women should wait until after birth, women should not get pregnant for 1 month after getting the vaccine  4. people with HIV/AIDS, immune system problems, taking any drugs that affect the immune system, have cancer, or taking chemotherapy or x-ray therapy for cancer should check with their doctor before receiving the vaccine  5. people who recently had a blood transfusion should check with their doctor
  • 126.  Live-microbial vaccines should not be given simultaneously with blood, plasma, or immune globulin, which can interfere with development of desired antibodies; ideally, such vaccines should be given 2 wk before or 6 to 12 wk after the immune globulins.  Immunocompromised patients should not receive live- virus vaccines, which could provoke severe or fatal infections.  In patients receiving short-term (ie, < 14 days) immunosuppressive therapy (eg, corticosteroids, antimetabolites, alkylating compounds, radiation), live- virus vaccines should be withheld until after treatment.
  • 127. Immunity may or may not be life-long with vaccines.  To help keep the antibody levels high enough to keep you protected you sometimes need to have “booster shots”.
  • 128. Nutrition and the immune system  Malnutrition impairs immune function  Fish oil: anti inflam  Stress and the immune system  Chronic stress has detrimental effects on immune system  Ageing and the immune system  Vaccination