LITERATURE READING

BASIC IMMUNOLOGY

Ratna Windyaningrum

Supervisor : dr. Arif Dermawan, M.Kes., Sp. T.H.T.K.L (K)

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INTRODUCTION

Understanding immunology is fundamental

to understanding the pathophysiology,
diagnosis, and treatment of many diseases

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 Definitions
 Immune system = cells, tissues, and molecules that
mediate resistance to infections
 Immunology = study of structure and function of the
immune system
 Immunity = resistance of a host to pathogens and
their toxic effects
 Immune response = collective and coordinated
response to the introduction of foreign substances in
an individual mediated by the cells and molecules of
the immune system

World Health Organization. Basic Immunology. Laboratory Training for Field

Epidemiologist. 2010.
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 Role of the immune system
 Defense against microbes
 Defense against the growth of tumor cells
 kills the growth of tumor cells
 Homeostasis
 destruction of abnormal or dead cells
(e.g. dead red or white blood cells, antigen-antibody
complex)

World Health Organization. Basic Immunology. Laboratory Training for Field

Epidemiologist. 2010.
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THE IMMUNE RESPONSE AND IMMUNITY

Innate (non
spesific) Primary
Immune
Response
Adaptive
(Specific)
Secondary

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 Natural
Acquisition
of Immunity
Artificial

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 INNATE IMMUNITY
Innate immunity controls and eliminates
infection with the help of the
 complement system,
 NK-cell activation, and
 TLR activation.

If the innate immune system is unable to remove

pathogens, the adaptive immune response is
activated
Mohamad R. Chaaban, Robert M. Naclerio, Immunology and Allergy, in Bailey”s , Byron J.; Head & Neck Surgery
Otolaryngollogy, . 5th ed. 2014 p.379-411

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 ADAPTIVE IMMUNE SYSTEM
The adaptive immune system, in
contrast to the innate immune system,
is
 highly specific in nature,
 benefits from gene rearrangement
 capable of developing memory

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Immune system

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Immune system

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 CELLS OF INNATE IMMUNITY
 Neutrophil :
Principal phagocytic cell of innate immunity
 Eosinophil :
Principal defender against parasites
 Basophil :
Functions similar to eosinophils and mast cells

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 Cells of The INNATE Immunity
 Derived from pluripotent hematopoietic cells.

Neutrophil Eosinophil Basophils

- Principal -Circulate in the -Functions similar to

phagocytic cell blood eosinophils and
of innate immunity. and localize to mast
- Circulating and inflamed cells.
marginal pool. tissues. -Granulocytes that
- In allergy, -Principal defender posses
neutrophils against parasites. high-affinity IgE
are recruited during receptors.
the -Contain histamine
late response to Ag and
challenge. other mediators,
including cytokines.
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 Cells of The INNATE Immunity
Monocyte Macrophage Dendritic Cell
-Leukocytes with -Mononuclear -Cells with
bean phagocytic dendriform
shaped or brain- cells in tissue (star
like -Derive from blood shaped)morpholog
convoluted nuclei monocytes y
-Circulate in blood -Participate in -Interdigitating
with innate and reticular
half life of 8 hours adaptive cells (synonym)
- Precursors of immunity -Capture and
tissue present
macrophages antigens to T
lymphocytes
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Cells of The INNATE Immunity
Mast Cell
-Located in mucous
membrane and
connective tissue
throughout body
-Major effector cell in
allergy
-Modulation of initial
immune response

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 CELLS OF ADAPTIVE IMMUNITY
Lymphocytes
B cells (CD19)
T cells (CD3, CD4 or CD8)
Adaptive immunity

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 THE INNATE IMMUNE RESPONSE
 Mediated (initiated) by phagocytes, NK cells and soluble proteins
 Phagocytes
 Cells specialized in the process of phagocytosis
 Macrophages : Reside in tissues and recruit neutrophils
 Neutrophils : Enter infected tissues in large numbers
 Recognize common molecules of bacterial cell surface using a
few surface receptors
 Phagocytosis : Capture, engulfment and breakdown of bacterial
pathogen

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 THE INNATE IMMUNE RESPONSE
 Inflammatory response enhances phagocytosis through acute
phase proteins
 Mannose-binding lectin (MBL)
 Binds to bacterial surface with particular spatial
arrangement of mannose or fucose
 C-reactive protein (CRP)
 Binds to phosphorylcholine on bacterial surface
 Complement
 Set of proteins which bind to bacterial surface
 Inflammatory response
 Accumulation of fluid and cells at infection site (swelling,
redness, heat and pain)
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THE ADAPTIVE IMMUNE RESPONSE
 Createsmillions of different B and T cells
 Antibody-Mediated Immunity (AMI)
 Involves B lymphocytes, plasma cells and antibodies
 Humoral immunity

 Cell-Mediated Immunity (CMI)

 Involves T lymphocytes, antigen-presenting cells and MHC
(major histocompatibility complex) molecules
 Cellular immunity

Mohamad R. Chaaban, Robert M. Naclerio, Immunology and Allergy, in Bailey”s , Byron J.; Head & Neck
Surgery Otolaryngollogy, . 5th ed. 2014 p.379-411

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ANTIBODY-MEDIATED
(HUMORAL) IMMUNITY
 Directed against extracellular microorganisms and toxins
 B-lymphocytes (B cells)
 Differentiate into plasma cells which produce antibodies
 Function as antigen-presenting cells (APC’s)
 Immunoglobulin E (IgE)
 Classification of Antibodies (Immunoglobulins)
 Immunoglobulin M (IgM)
 Immunoglobulin G (IgG)
 Immunoglobulin A (IgA)
 Immunoglobulin D (IgD)

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CELL-MEDIATED IMMUNITY
 Directed against intracellular microorganisms
 Non-phagocytic cells and phagocytic cells
 T-lymphocytes (T cells)
 Differentiate into effector cells following
antigen presentation by antigen presenting
cells (APC’s)
 Functional types of T cells
 Helper (CD4 T cells)
TH1 and TH2 cells
 Cytotoxic (CD8 T cells)
 Regulatory
CD4 and CD8 Tregs
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CORRELATION BETWEEN INNATE
IMMUNITY AND ADAPTIVE IMMUNITY
 There is communication between innate
response and adaptive response
 TLR as part of innate immune system has
important role in regulation of APC’s
which will increase molecular regulation
that can induce interferon response 
APC’s can interact with adaptive immune
response

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 CYTOKINES, INTERFERONS, AND
CHEMOKINES
 Cytokines are soluble mediators that have growth,
differentiation, and activation functions for immune
responses

 Cytokines predominantly APCs or T lymphocyte

derived, mediate cytotoxic (antiviral and
anticancer),humeral, cell-mediated (Th1 and Thl7), or
allergic immunity (Th2), or that are immuno
suppressive (Treg cells) by lymphocytes
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CYTOKINES, INTERFERONS,
AND CHEMOKINES
Chemokines are a group of small (8 to 12
kD) proteins with the ability to affect cell
migration or chemotaxis

These cells include the neutrophils,

monocytes, lymphocytes, eosinophils,
fibroblasts, and keratinocytes.
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Classification
 Coombs and Gell classification

1-Type I – immediate hypersensitivity ( atopic, or

anaphylactic)
2-Type II - antibody-dependent
3-Type III - immune complex
4-Type IV - cell-mediated or delayed

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 The hypersensitivity reactions

Figure 12-2

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TYPE I HYPERSENSITIVITY
Type I hypersensitivity is also known
as immediate hypersensitivity.

The reaction may involve skin

(urticaria and eczema), eyes
(conjunctivitis), nasopharynx
(rhinorrhea, rhinitis),
bronchopulmonary tissues (asthma)
and gastrointestinal tract
(gastroenteritis)
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Type I hypersensitivity is also known
as immediate hypersensitivity.

The reaction may involve skin

(urticaria and eczema), eyes
(conjunctivitis), nasopharynx
(rhinorrhea, rhinitis),
bronchopulmonary tissues (asthma)
and gastrointestinal tract
(gastroenteritis)
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 Immediate hypersensitivity is mediated by
IgE.
 The primary cellular component in this
hypersensitivity is the mast cell or
basophil.
 The reaction is amplified and/or modified
by platelets, neutrophils and eosinophils.
 A biopsy of the reaction site demonstrates
mainly mast cells and eosinophils.

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Mechanism:

The mechanism of reaction involves

preferential production of IgE, in response to
certain antigens (allergens).
 IgE has very high affinity for its receptor on
mast cells and basophils.
A subsequent exposure to the same allergen
cross links the cell-bound IgE and triggers the
release of various pharmacologically active
substances

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Cross-linking of IgE Fc-receptor is important
in mast cell triggering. Mast cell
degranulation is preceded by increased Ca++
influx, which is a crucial process; ionophores
which increase cytoplasmic Ca++ also
promote degranulation, whereas, agents
which deplete cytoplasmic Ca++ suppress
degranulation.

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 Mast cells may be triggered by other

stimuli such as
-Exercise,
-Emotional stress
-Chemicals (e.g., photographic developing
medium, calcium ionophores, codeine,
etc.),
-Anaphylotoxins (e.g., C4a, C3a, C5a,
etc.).
 These reactions are not hypersensitivity
reactions although they produce the same
symptoms.
 The Allergic Response

The Early Response

The Late Response

Mohamad R. Chaaban, Robert M. Naclerio, Immunology and Allergy, in Bailey”s , Byron J.; Head & Neck
Surgery Otolaryngollogy, . 5th ed. 2014 p.379-411

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 The Early Response
 The allergen occurs within minutes and is
characterized by mast cell degranulation
 The release of preformed mediators, including
histamine and proteases
vasodilatation,vasculature leakage of fluids, and
glandular and neural stimulation
 It is symptomatically characterized initially
itching, then sneezing, rhinorrhea,watering of the
eyes, and then, nasal congestion
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 The Late Response
The late response to nasal challenge with
antigen occurs hours after antigen exposure
with a recrudescence of allergic symptoms
mediated by influx of cellular elements such as
eosinophils (responding to the early phase
release of IL-5) and activated T cells

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 Immediate & Late Phase Reaction

Abbas, AK, Lichtman AH, Pillai S. Immediate Hypersensitivity.

In: Cellular And Molecular Immunology, International Edition, Sixth edition, Saunder Elsivier,
2007 37
 HIGHLIGHTS
The cells associated with innate immunity
include neutrophils, monocytes, mast cells,
eosinophils,basophils, and DCs and is a first
line defense against newly encountered
pathogens

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 HIGHLIGHTS
Innate immunity
relies on mechanisms already existing before
microbe infects host
is the first line of defense
has no memory for subsequent exposure
relies on non specific mechanisms

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 HIGHLIGHTS
 Adaptive immunity
 develops following entry of microbe into the host
 comes into action after innate immunity fails to get
rid of microbe
 has memory to deal with subsequent exposure
 happens through specific cells
T cells (cell mediated)
B cells (antibody mediated)

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HIGHLIGHTS
Type I hypersensitivity is also
known as immediate
hypersensitivity.
The mechanism of reaction
involves preferential production
of IgE, in response to certain
antigens.
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Thank You

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