Immunology PDF
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Lippincott's Illustrated Reviews: Immunology Second Edition Thao Doan, MD Senior Medical Director Abbott Laboratories Abbott Park, Illinois Roger Melvold, PhD Professor Emeritus, Department of Microbiology and Immunology University of North Dakota School of Medicine and Health Sciences Grand Forks, North Dakota Susan Viselli, PhD Professor, Department of Biochemistry Midwestern University Downers Grove, Illinois Carl Waltenbaugh, PhD Professor, Department of Microbiology-Immunology Feinberg School of Medicine Northwestern University Chicago, Illinois . Wolters Kluwer I Lippincott Williams & Wilkins Health Philadelphia· Baltimore New York· London • Buenos Aires· Hong Kong· Sydney· Tokyo Acquisitions Editor: Susan Rhyner Poduct Manager: Jennifer Verbiar Marketing Manager: Joy Fisher-Williams Designer: Holly Mclaughlin Compositor: Absolute Service, Inc. Second Edition Copyright© 2013, 2008 Lippincott Williams Wilkins, a Wolters Kluwer business. & 351 West Camden Street Two Commerce Square Baltimore, MD 21201 2001 Market Street Philadelphia, PA 19103 Printed in China All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. 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. To request permission, please contact Lippincott Williams Wilkins at 2001 Market & Street, Philadelphia, PA 19103, via email at permissions@ lww.com, or via website at lww.com (products and services). 98765432 1 Library of Congress Cataloging-in-Publication Data Immunology /Thao Doan ... [et al.].-2nd ed. p.; em.- (Lippincott's illustrated reviews) Includes index. ISBN 978-1-4511-0937-5 I. Doan, Thao. II. Series: Lippincott's illustrated reviews. [DNLM: 1. Immune System-physiology-Outlines. 2. Immunity-physiology-Outlines. QW 518.2] 616.07'9-dc23 2012010180 DISCLAIMER Care has been taken to confirm the accuracy of the information present and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from applica tion of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and uni versal recommendations. 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 the 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. This is particularly important when the recommended agent is a new or infrequently employed drug. 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. To purchase additional copies of this book, call our customer service department at or fax orders to (800) 638-3030 (301) 223- International customers should call 2320. (301) 223-2300. Visit Lippincott Williams Wilkins on the Internet: http://www.lww.com. Lippincott Williams Wilkins customer service represen & & tatives are available from 8:30am to 6:00pm, ES. This book is dedicated to our students and colleagues who constantly inspire us to reexamine our immunologic concepts Acknowledgments The second edition of LIR: Immunology provides up-to-date information in immu nology. We hope this textbook assists medical students and health professionals to understand, appreciate, and enjoy learning this interesting specialty, immunology, which is the basic foundation connecting to the other medical specialties and im munological diseases. We are grateful to Susan Rhyner, Steve Boehm, Joy Fisher-Williams, Holly Me Laughlin, and other Lippincott Williams Wilkins staff for their guidance, sup & port, and effort on this edition. We also thank Kathleen Scogna, Betty Sun, and Matt Chansky for their contributions to the first edition that are still significant to the second edition. As always, we appreciate the love and continued support from our families. Contents UNIT I: Sense of Being: The Concept of Sef and SelfNonsef Recognition Chapter 1: The Need for Self-Recognition Chapter 2: Antigens and Receptors 11 UNIT The Innate Immune System I: Chapter 3: Barriers to Infection 25 Chapter 4: Cells of the Innate Immune System 34 Chapter 5: Innate Immune Function 42 UNIT The Adaptive Immune System II: Chapter 6: Molecules of Adaptive Immunity 59 Chapter 7: Cells and Organs 79 Chapter 8: Generation of Immune Diversity: Lymphocyte Antigen Receptors 91 Chapter 9: Lymphocyte Development 113 Chapter 1 0: Lymphocyte Activation 123 Chapter 11: Lymphocyte Effector Functions 141 Chapter 12: Regulation of Adaptive Responses 158 UNIT IV: Clinical Aspects of Immunity Chapter 13: The Well Patient: How Innate and Adaptive Immune Responses Maintain Health 169 Chapter 14: Hypersensitivity Reactions 200 Chapter 15: Immune Deficiency 219 Chapter 16: Autoimmunity 243 Chapter 17: Transplantation 260 Chapter 18: Immune Pharmacotherapy 283 Chapter 19: Tumor Immunity 298 Chapter 20: Measurement of Immune Function 312 Review Questions 330 Abbreviations 343 Glossary 348 Index 371 v ("Know thysef") .A fNQ8I YTONI -Words originally inscribed in gold on the pronaos of the Temple of Apollo at Delphi This dictum-short in length but deep in meaning-encapsulates a basic need for all forms of life. In a way, most organisms in our world live alone. They are composed of single cells or particles, and as such, their need to distinguish themselves is seemingly simple. Their single cell or particle is "I," and all else is "them." They need to sense which of "them" is appropriate to mate with or perhaps to congregate with, but otherwise their version of self is limited by their own membrane. Multicellular organisms faced a new problem as they evolved. They gave up some of their independence to reap the advantages of being part of a greater whole-an organism composed of multiple semi-independent units. Initially, any such unit was pretty much like every other one within the greater struc ture, so extending the concept of self to include others that were essentially identical was perhaps a relatively small leap. "I" became "us" but only as mul tiples of "I." As organisms became more complex and the different cells within a single organism began to engage in a division of labor, they generated an array of cells with different forms and functions. Distinguishing "I" or "us" from "them" became increasingly complex: Is that adjoining cell, which seems so different from "I," really a part of "us," or is it an intruder from "them"? The development of commensal arrangements between organisms (e.g., moss and fungi combining to form lichens, humans and normal bacterial lora in the gut and on the skin) required yet more questions: If there is an intruder, does it represent a threat or can it safely be ignored? If it represents a threat, what should be done to eliminate it? These questions are the starting points from which the immune system oper ates. The human immune system uses various methods to ask and answer these questions. Some of these methods have been widely used for eons; others have been developed more recently by more restricted groups of organisms. This unit introduces how the human immune system deals with these questions.
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