Basic Immunology 2nd ed - A. Abbas, A. Lichtman (Saunders, 2004) WW

323 Pages·2004·94.11 MB·English

Abul K. Abbas
AndrewH. Lichtman *

Sar
a

oes Basic
Immunology

Functions and Disorders
of the Immune System

SAUNDERS) NOT FOR SALE
50) 4 fe

Blymphocyte —_Antibody-secreting Antibody C1 complex
(plasma) coll Ctqnes:

CD4+helper CDA cytolytic T _Antigen-presenting Target cell
Tiymphocyte —jymphocyte (CTL) _ cell (macrophage) for CTL

é ; 4
Dendritic cell Natural killer Neutrophil Apoptotic cell
(NK) cell

(protein) MHC MHC 1
IcAMA B7-1/87-2
BASIC IMMUNOLOGY
BASIC IMMUNOLOGY

Functions and Disorders of the Immune System

Second Edition

Abul K. Abbas, MBBS

Professor and Chair

Department of Pathology

University of California, San Francisco, School of Medicine
San Francisco, California

Andrew H. Lichtman, MD, PhD
‘Associate Professor of Pathology

Harvard Medical School

Brigham and Women’s Hospital

Boston, Massachusetts

IMlustrated by David L. Baker, MA, and Alexandra Baker, MS, CML

(SAUNDERS!
[An Inprntof Ever
‘SAUNDERS
An lepint of Hevier

The Cantis Conter

Independence Square West
Philadelphia, PA 19106-3399 ISBN: 0-7216.€241-X

BASIC IMMUNOLOGY, FUNCTIONS AND DISORDERS OF THE IMMUNE SYSTEM.
Copyright © 2004, 2001 Fleesier Ine. All rights reserved.

[No par of this publication may be reproduced or tenamited in any form or by any mess,
electronic ot mechanical, including photccopy, ecording, or any informaticn storage and
retrieval stem, without ponies in iting fern the publisher

Perrisions may be souht dieetly fom Blbevier Inc. Rights Department in Philadelphis,

USA: phone: [phone], fe (11)215 238 2239, cri: henlbperuisionsleevietcem,
‘You may ako complete your request an-line via the Flsevier Science homepage
(bupefcwncelseviercom), by selecting “Costomner Support” and then "Obtatrang Permissions”

NOTICE

Immurclogy isan ever-changing field. Standard safety precautions must be followed, but 95
nev research and clinical experience bruaden cur knowledge, changes in meatment and drug
thempy may become recestary or appropriste. Readers are advised to check the most curent
produer inferration prewided by the manufacturer ofeach drug to be administered to very
the recommended dose, the method and dursron of administration, and corersindicatins
Icis the responsibility ofthe teatng physician, relying on experience and knowledge of the
patient, 1 determine dosages and the best reatmenc for each individual patent. Neither
the publisher nor the editor asume any liability for any injury andor damage fo persons oF
property arising fees this publication

‘The Publisher

Fit Edition 2001. Second Edition 2004,
Library of Congress Cataloging-in-Publication Data
Abas, Abul K ,
Basic immunclogy: functions and disorders ofthe immune system J Abul K. Abbes,
Andrew H. Licheman; illusreted by David L Baker and Alexanclea Baker. — 7nd ed
Ba am,
Tela ine.
ISBN 0-7216-0241-%

1. Temmundlogy, 2. Immunity. 3. Immunologic deeases 1 Lictinan, Andrew I
I. Tide,
IDNLM: 1, Immunity. 2. Hypersensieiviey. 3. Immune Syscem-phypiclogy
4. Immunclogic Deficiency Syndromes. QW 504 AI2%b 2004]
QRUBI.A8 2004
G1GO79 = 21 7008050607

Acquisitions Editor: Json Malley
Project Manager: Linda Lewis Grigs
Designer: Gene Herris

Bs /CT?

Printed in China

Last digt ithe print number 98-765 43.21
To
Ann, Jonathan, Rehana
Sheila, Eben, Ariella, Amos, Ezra
The second edition of Basic Immunology has been
revised to reflect new advances in our understanding
‘of the immune system and to improve on the presen
tation of information in ways most useful to students
and teachers. We have been extremely gratified by
how well the fest edition of Basie Iraruselogy hes
been received by students in. the courses that we
reach, and the guiding principles on which the book
is based have not changed frcm the fist edition. As
teachers of immunology, we are becoming increas-
ingly aware chat assimilating detailed information and
experimental approaches is difficult in many medical
school and undergraluate courses. The problem of
how much detail is appropriate has become a pressing
fone heesuse of the continuous sind rapid increase in
the amount of information in all the biomedical
sciences. ‘This prcblem is compounded by the de-
velopment of integrated curricula in many medical
schools, with reduced time for didactic teaching and
an increasing emphasis on social and behaviccal
ences and primary health care. For all these reasons,
wwe have realized the value for many medical students
of presenting the principles of immunology in a
‘concise and clear manner.

Itis our view that several developments have come
together to make the goal of a concise and modern
consideration of immunology a realistic one. Most
important, immunology has matured as a discipline,
so that it has now reached the stage when the essen-
tial components of the immune system, ard how they
fngoract in immune responses, are understood quite
well There are, of course, many details tobe filed in,
and the longstanding challenge of applying basic
principles to human discases remains a difficule task.

Preface

Nevertheless, we can now teach our students, with,
reasonable confidence, how the immune system
works. The second important development has been.
an increesing emphesis on the roots of immunalegy,
which lie in its role in defense agsinst infections. AS
vw reuilt, we are hetter able to relace experimental
results, using simple mcdels, to the more complex, but
physiologically relevant, isaie of host defense against
infectious pathogens.

‘This hook has been written to axldress the per-
ceived needs of both medical school and under-
graduate curricula and to take advantage of the new
understanding of immunology. We have tried to
achieve several goals. First, we have presented the
mest important principles governing the function of
the immune system. Our fundamental objective has
been to synthesize the key concepts fram the vast
amount of experimental data that emerge in the
rapidly advancing feld of immunology. The choice of
Whar is most important fs based largely on what is
‘most clearly established by experimentation, whar our
students find puzzling, and what explains the wen-
derful eficieney and economy of the immune systern.
Inevitably, however, such a chcice will have an
element of bias, and our bias is toward erophasizing
the cellular interactions in immune responses and
ls
biochemical ané molecular mechanisms to the esen-
tial facts. Second, we have focused on immune
responses against infectious microtes, and all our
discussions of the immune system are in this ccn-
text. Third, we have emphasized immune responses in
fhumans (rather than experimental animals), drawing
on parallels with experimental situations whenever

ting the description of many of the underlying
vill Pretce

necessary. Fourth, we have made liberal use of illus:
trations to highlight important principles but have
reduced factual details that may be found in more
comprehensive textbooks. Fifth, we have discused
immunologic diseases ako from the perspective of
principles, erophasiing their relation tw
immune responses and avoiding details of clinical
syndromes and treatments. We have added selected!
clinical cases in the Appendix, to ilhuerate how the
concepts of immunology may be applied to common
Inuman diseases. Finally, we have realized thar in any
concise discussion of complex phenomena, it is
inevitable that exceptions and caveats will fall by the
wayside. We have avoided exceptions and caveats
without hesitation, but with a willingness to modify
four conclusions as new information continues t

Tris our hope that students will find this book lear,
cogent, and manageable. Most important, we hope
the book will convey cur sense of wonder abour the
immune system and excitement about how the field
has evolved and how it continues to be relevant to

wermal

human health and disease. Finally, although we were
spurced to tackle this project because of our associa-
tions with medical school courses, we hope the book
will be valued more widely by students of allied health
and biology as well. We will have succeeded if the
book can answer many of the questions these students
have about the immune system and, ar the same time,
encourage them to delve even more deeply into
immunology.

‘Several individuals played key roles in the writing
of this book, Our editor, Jason Malley, has been a
skilled and helpful colleague throughout. We have
been fortunate to again work with David and
Alexandra Baker of DNA Illustrations, who have
translated ideas into pictures that are informative and
aesthetically pleasing. Our project manager, Linda
Grigg, kept the project organized and on track despite
pressures of time and logistics. To al of them we awe
our many thanks.

Abul K, Abbas
“Andrew H. Lichenan
Bl inzroduction to the Immune System
‘The Nomenclature, Gereral Properties, ond
Components of the Immune Syst anes

B nnate immunity
‘The Early Defense Against Infections

(B Ancigen Capture and Presentation to
Lymphocytes
Wha Lymphocys See

W Antigen Recognition in the Adaptive
Immune System
Soructure of Lymphocyte Antigen Receptors
taal dhe Pevslpmane of Fumame Reperties..63

Bh Cat-Mediated Immune Responses
Activation of T Lymphocytes by
Cell-Associated Microbes 83

IB) icctor Mechanisms of Cel Mediated
Temoney

Eradication of Intracellular Microb ovo LO5

Bh Humoral Immune Responses
Aativation of Uamphoryes ‘and Production
of Antibodies mtrmenrnstntrntentente LBS

IBh exfccoe Mechanisms of Humoral Immunity
The Ebmnaion of txtaclulr Microbes
and Toxins. ssseenmnansee ne 143

Contents

IF tmmuncngic Tolerance and
‘Autolmn
Salf-Nonself Discridnaton the Hmune
Spstem and is aie

161

IAB Trnmune Responses Apsnst Tumors and
Tranaplnts
Imma vo Nonnfecous Tnsformed nd

consol TT

Foreign Cells

“Hypersensitivity Diseases
Disorders Caused by Immune Responses.

FB Congenital and Acquired
Immunodeficiencies
Diseases Caused by Defective Irmasie

Responses e209

Suggested Readings

APPENDIX:
Principal Features of CD Molecules cc-eo-229
-APPENO I
Glossary. ann 263
APPENDIX

Clinical Cases —s

Index
rimumity is defined as resistance to disease, specifically

infectious disense. The collection of cells, tissues, and
molecules that mediate sesisiance to infections is called the
immune system, and the coordinated reaction of chese cells and
rmolectiles ro infections microbes is the irmume response.
Immimology is the study of the immune system and its
responses to Invading pathogens. The physiologic function of
the immune system is to prevent infections and to eradicate
established infections, and this is the principal context in
‘which immune responses are discussed throughout thie book.

The importance of the immune systerr: for health is dra
matically illustrated by the frequent observation that individ
uals with defective immune resporses are susceptible to serious,
‘often life-threatening infections (

Papers oT foxtrot
of the Immune System.

Inmate and Aaptive bmmurity
Types of Adeutive lamunity
Properties of Afaptive knmune Responses
* Specificity

= Memary

Phases of Immune Responses

Celts ot he immune System

+ Lymphocytes

+ Antigen Presenting Coll

+ Biector Celis

Tissues of the Immune System

+ Pexpheral Lymphoid Organs,

+ Lymphocyte Recirculation

‘Summary

1). Conversely, stimulating immune responses t

against microbes by the process of vaccination is the most effective method for protect-
ing individuals against infections and is, for example, the approach that has led to the
worldwide eradication of smallpox (Fig. 1-2). The emergence of the acquired immuno
deficiency syndreme (AIDS) since the 1980s has tragically emphasized the importance
of the immune system for defending individuals against infections. But the impact of
immunology goes beyond infectious divease (see Fig. 1-1). The immune response is the
major harrier ro successful organ transplantation, an increasingly used therapy for organ