15. Immune System Flashcards
What is the immune system?
A versatile defence system that protects us from pathogenic microbes
What are the layers of the defence strategy?
- First line - innate immunity
- Second line - innate immunity
- Third line - specific/adaptive immunity
What is the first line of defence - innate immunity?
Physical barrier created by the skin and mucous membranes
What is the second line of defence - innate immunity?
Non-specific immune response that includes some immune cells, proteins, fever and inflammation
What is the third line of defence - specific/adaptive immunity?
Activated by the innate immune system, producing a response towards a specific pathogen
What is a pathogen?
An infectious agent that can cause disease in a host
How can pathogens enter the body?
Breaks in the skin Respiratory system Digestive system Reproductive system (male and female) Eyes
What is an antigen?
A substance that can be recognised by leukocytes
What are the two types of antigen?
- Foreign antigens
2. Self-antigens
What are foreign antigens?
Microbes
Food
Drugs
What are self-antigens?
Found on cell membranes
What do antigens usually consist of?
Proteins (specific 3D shape)
What are antibodies?
Proteins produced in response to a specific antigen
What do antibodies and the specific antigens do?
Combine
What makes the skin a first line of defence against pathogens?
Made up of layers of tightly packed epithelial cells
Outer epidermis - consists of dead epithelial cells which sheds every 40 days to remove microbes
Dermis - contains accessory structures such as sebaceous glands and sweat glands
How does sweat perform an immune function?
Removes microbes from skin
Contains IgA
How does sebum perform an immune function?
Contains fatty acids which inhibit microbial growth
Where can mucous membranes be found?
Digestive tract
Respiratory tract
Urogenital tract
Conjunctiva
What is the function of mucous membranes?
Prevent entry into the membrane
How do the mucous membranes perform an immune function?
Mucous traps microbes and foreign particles
Saliva, tears and mucous secretions wash away the trapped microbes
They also contain anti-microbial substances
How does the immune function work in the respiratory tract?
Mucocillary escalator
Cilia propel any foreign substances towards the pharynx where they are swallowed or coughed up
How do tears and saliva perform an immune function?
Contain IgA and lyzozymes
Lyzozymes are enzymes that break down bacterial cell walls
How does the nose perform an immune function?
Hairs in the nose filter air
How does the vagina perform an immune function?
In menstruating women, vagina is acidic making it unfavourable for microbes
How does gastric acid perform an immune function?
Acidity destroys many bacteria
How do microflora perform an immune function?
Outcompete pathogens for attachment sites on epithelial cell surfaces (e.g. GALT)
How does the excretion of urine and faeces perform an immune function?
Both expel microbes
How does vomiting and diarrhoea perform an immune function?
Both rapid means of expelling pathogens
When does the second line of defence get activated?
When pathogens penetrate the physical and chemical barriers of the skin and mucous membranes
What does the second line of defence consist of?
Transferrins Complement system Phagocytes Natural killer cells Inflammation Cytokines Fever
What are transferrins?
Iron-binding proteins in blood
How do transferrins work?
Inhibit the growth of certain bacteria by reducing the amount of available iron
Why are transferrins necessary?
Without transferrins, bacteria would use the iron available for their growth
What is the complement system?
Secondary defence system made up of over 30 proteins produced by the liver
How are complement proteins identified?
By a letter (mostly C) and a number e.g. C3
How does a complement protein start out?
Inactive
Only become active when split by enzymes into active fragments e.g. C3 = C3a and C3b
What happens when a complement protein is activated
Acts in a cascade
What is the most common mechanism through which complement proteins are activated?
Classical pathway
What is the ‘classical pathway’?
Where antigens and antibodies join together
What is the role of complement proteins?
- Promoting phagocytosis
- Contributing to inflammation
- Causing cytolysis
How do complement proteins promote phagocytosis?
The fragment C3b coats a microbe in a process called opsonisation
This promotes the attachment of a phagocyte to a microbe
How do complement proteins contribute to inflammation?
C3a and C5a bind to mast cells and cause them to release histamine
How do complement proteins cause cytolysis?
The final complement proteins join together and create a hole in the foreign cell
The hole fills with tissue fluid and makes the cell swell and rupture
What are cytokines?
Small protein hormones that stimulate or inhibit normal cell functions
Mediate the connection between the innate immune system and the adaptive immune system
What are cytokines secreted by?
Leukocytes
What are the types of cytokines?
Interleukins
Interferons
Tumour necrosis factor
What are interleukins?
Mostly produced by T-helper cells
Mediators between leukocytes
What are interferons?
Anti-viral proteins produced by cells that are infected by a virus
What is tumour necrosis factor?
Protein that attracts accumulation of neutrophils and macrophages to an area
Causes cell death
How do interferons work?
They diffuse to uninfected neighbouring cells and induce synthesis of anti-viral proteins that interfere with viral replication
Do interferons stop a virus attaching to it?
No but they prevent the virus from replicating
What do phagocytes do?
Using phagocytic cells - neutriphils and macrophages. They perform phagocytosis - cell digestion - of anything they don’t recognise
Non-selective
How do phagocytes work?
The ENGULF and digest - They attach to sites of inflammation by chemotaxis
Can be fixed or wandering
What is chemotaxis?
Directed migration of a cell in response to a chemical stimulus
What are the two major types of phagocyte?
Neutrophils
Macrophages
What do neutrophils do?
First to migrate to a scene of inflammation
Like neighbourhood watch
Try to mop up the day to day problems
What do macrophages do?
They follow the neutrophils and eat up the remnants of whatever needs to be broken down and digested
They engulf and digest the pathogen, excrete some of the waste and display the rest on the cell membrane to present to T-lymphocytes
Like the police coming to the scene of a crime
Where can macrophages be found?
In tissue
Where can monocytes be found?
In blood
What do monocytes do?
Migrate to the site of infection and enlarge to form wandering macrophages
What do fixed macrophages do?
Stand guard in specific tissues
In which tissues can fixed macrophages be found?
Histiocytes (connective tissue macrophages)
Kupffer cells - liver
Microglia - nervous tissue
Alveolar - lungs
Langerhans cells - skin
Tissue macrophages - spleen, bone marrow, lymph nodes
What are the stages of phagocytosis?
- Chemotaxis - release of chemicals by leukocytes, damaged tissue and activated complement that attract phagocytes
- Adherence - attachment of phagocyte to target - aided by complement
- Ingestion - cell membrane extends to engulf the microbe
- Digestion - ingested structure merges with lysozymes to be digested
- Excretion - ingested material is excreted
What are natural killer cells?
Non-specific lymphocytes
What percentage of lymphocytes do natural killer cells make up?
5-10%
Where can natural killer cells be found?
Blood
Lymph nodes
Spleen
Bone marrow
How do natural killer cells work?
They attack anything that they don’t recognise including abnormal body cells e.g. cancerous cells
They bind to a target cell and release granules containing the protein perforin
What does perforin do?
It inserts into the cell membrane and creates a channel for tissue fluid to flow into the cell - cytolysis
What is inflammation?
A non-specific defensive response to tissue damage
What can inflammation be caused by?
Pathogens Abrasions Chemicals Cell distortion/disturbance Extreme temperatures
What response does inflammation create?
Non-specific
What are the cardinal signs of inflammation?
Redness Heat Pain Swelling Loss of function
What are the stages of inflammation?
- Vasodilation and increased permeability
- Emigration of phagocytes
- Tissue repair
How does vasodilation help inflammation?
Allows additional blood, oxygen, nutrients, immune cells to get to the area
Toxins and dead cells are removed
How does increased permeability help inflammation?
Permits the movement of immune cells, defensive proteins (antibodies) and clotting factors into the tissue
How do vasodilation and increased permeability work together to help inflammation?
Together they create redness, swelling and heat
What is the pain of inflammation a result of?
Injury to neurons and toxic chemicals released by microbes
What happens when phagocytes migrate to an area?
- Phagocytes migrate to the scene (via chemotaxis)
- Neutrophils stick to the endothelium during vasodilation and squeeze through the vessel wall to reach the damaged area
- Monocytes quickly follow and transform into wandering macrophages
- Dead phagocytes accumulate pus
What are the types of inflammatory mediators?
Histamine
Leukotrienes
Kinins
Prostaglandins
What is histamine and its function?
Released by mast cells and basophils
Causes vasodilation and increased permeability
What are leukotrienes and their function?
Released by basophils and mast cells
They attract phagocytes and increase permeability
What are kinins and their function?
Proteins
Causes vasodilation and increased permeability
Also attract phagocytes and induce pain
What are prostaglandins and their function?
Lipids released by damaged cells
Enhance effects of histamine and kinins (intensifying the pain)
What are the benefits of inflammation?
Promotes phagocytosis through increased temperature
Promotes immune response via vasodilation/permeability
Dilutes toxins
Fibrin formation - isolates affected area and helps bind wound edges
What are the harmful effects of inflammation?
Swelling - dangerous if in cranium
Pain - can become chronic
Adhesions and scar tissue
Atherosclerosis
What are the outcomes of inflammation?
Resolution
Chronic inflammation
Granuloma
Fibrosis
What is chronic inflammation?
If the injury-causing agent persists
Can cause chronic pain
Prevalence of macrophages, plasma cells and lymphocytes
What is granuloma?
Cellular attempt to contain a foreign body through aggregation of macrophages surrounded by lymphocytes
What is fibrosis?
Formation of scar tissue
Formed by the secretion of collagen by fibroblasts
Occurs as a result of chronic inflammation
What is a fever?
An abnormally high body temperature
Why does a fever occur?
Because the hypothalamus thermostat resets
When is a fever most likely to occur?
In infection and inflammation
What happens pathophysiologically during a fever?
Bacterial toxins elevate body temperature which triggers release of fever-causing cytokines e.g. interleukin-1
What is the key function of interleukin-1?
To induce fever
What does an elevated body temperature do?
Makes interferons more effective
Inhibits growth of some microbes
Speeds up the reactions that aid repair
What can be granular or agranular?
Leukocytes
Which leukocytes are classed as granular?
Basophils
Eosinophils
Neutrophils
Where can you find basophils?
In blood
Where can you find mast cells?
In tissue
What do basophils and mast cells do?
Release histamine and heparin
Release leukotrienes
Express receptors for IgE
What does histamine do?
Causes vasodilation
Increases vessel permeability
What does heparin do?
Anti-coagulant
What do eosinophils do?
Destroy parasitic worms via phagocytosis
Play a role in inflammation (central in asthma)
What do neutrophils do?
Phagocytic cell
Granules release lysozymes that digest debris
Which is the most abundant leukocyte?
Neutrophils (60%)
Which leukocytes are classed as agranular?
Monocytes/macrophages
Natural killer cells
B and T lymphocytes
Where can you find monocytes?
In blood
Where can you find macrophages?
In tissue
What do monocytes/macrophages do?
Phagocytic
Secrete cytokines e.g. IL-1 and TNF
What do natural killer cells do?
Target foreign cells
Secrete perforin to induce cytosis
What are B and T lymphocytes?
Effector cells of the adaptive (specific) immunity
Which leukocytes are phagocytic?
Neutrophils
Monocytes/macrophages
Name the different types of T-lymphocytes
Cytotoxic T-cells
Helper T-cells
Memory T-cells
Regulatory T-cells
What do helper T-cells do?
Co-ordinate the immune response (head office of FBI)
What do cytotoxic T-cells do?
Immune cells out in the field
What do memory T-cells do?
Create a memory of a pathogen after they’ve been exposed to it
What do regulatory T-cells do?
Turn off the immune response when it’s finished to avoid excessive reactions
Where are T-cells produced/mature?
Produced in bone marrow
Mature in the thymus
Name the different types of B-lymphocytes
Plasma cells
Memory B-cells
Where are B-cells produced/mature?
In red bone marrow
Where do T-cells and B-cells function?
In the 3rd line of defence
Adaptive (specific) immunity
How do T-cells and B-cells know how to respond to foreign antigens?
Through learning
They usually can tell the difference between self and non-self antigens
Which sort of pathogens do T-cells and B-cells go after?
Specific ones
How do T-cells and B-cells know which antigens they’ve met before?
Through immune memory
What does immune memory allow T-cells and B-cells to do?
Produce a quicker and more effective attack next time they encounter the pathogen
When is the 3rd line of defence activated?
When the 1st and 2nd lines fail to destroy the pathogen
Otherwise they are resting
What are major histocompatibility complexes?
Group of proteins on cell surface that are used by the immune system to recognise cells that are self cells vs non-self
What are MHCs formed from?
4 polypeptide chains
How do MHCs work?
They display a protein (a self-antigen) produced by the cell on its binding groove
How do MHCs help T-cells?
By presenting foreign antigens to T-cells
Name the two types of MHC
Class I Major Histocompatibility Complex (MHC-I)
Class II Major Histocompatibility Complex (MHC-II)
Where can you find MHC-I?
On all body cells except erythrocytes
How do MHC-I work?
When body cell is cancerous or invaded by pathogen, the cell starts to produce abnormal proteins
These proteins are combined with MHC-I and displayed on the cell membrane
Flags up to (mostly) cytotoxic T-cells as a non-self antigen
Where can you find MHC-II?
Only on the cell membrane of ‘antigen presenting cells’ - macrophages and B-lymphocytes
How do MHC-II work?
The MHC-II displays the foreign antigen on its binding groove, having ingested the foreign cell
What are MHC-II specifically used for?
Communication between themselves and T-helper cells
They present the antigen to the T-helper cells as part of antigen presentation
How does an antigen become associated with MHC-i or II
By the route it’s trafficked through the cell
Which type of immunity do T-cells play a central part in?
Cell-mediated immunity
What is unique about T-cells?
Each has a unique T-cell receptor (TCR) that only recognises a specific antigen
What are T-helper cells also known as?
CD4 cells
because they express the CD4 protein on their surface
What are cytotoxic T-cells also known as?
CD8 cells
To function properly, which traits should T-cells have?
Self-recognition - to recognise self antigens
Self-tolerance - must lack reactivity to fragments of self antigens
What does a lack of self-tolerance lead to?
Autoimmunity
How are T-cells tested?
Against epithelial cells in thymus
Should be able to recognise self antigens
What happens to T-cells if they don’t recognise self antigens?
They undergo apoptosis
What percentage of T-cells make it through the maturing process?
1-5%
What is adaptive immunity?
Ability of the body to defend itself against specific foreign cells
What is adaptive immunity characterised by?
Specificity for particular foreign antigens
Production of immune memory
What are the two types of adaptive immunity?
Cell-mediated
Antibody-mediated
What is cell-mediated immunity?
Driven by T-cells
Cytotoxic T-cells directly attack specific invading antigens
Mostly against intracellular pathogens
What is antibody-mediated immunity?
Driven by B-cells
B-cells transform into plasma cells, which synthesise and secrete specific antibodies (Igs)
Mostly against extracellular pathogens
Which cells are antigen-presenting cells?
Macrophages
B-cells
What happens during antigen presentation?
- Antigen presenting cells break down the antigen into fragments (using lysozymes)
- Some fragments are combined with MHC-II molecules on their cell membrane
- They migrate into lymphatic tissue where they present the antigen to T-helper cells
- Antigen fragment binds with the T-helper cell
- T-helper cell secretes a cytokine called interleukin-2
- Interleukin-2 causes the T-helper cell to undergo clonal selection
What happens during clonal selection of T-cells?
Division and proliferation of activated T-cells
What does the process of T-cell clonal selection produce?
- Cytotoxic T-cells that bind to target cell and destroy it using granzymes and perforin
- Memory T-cells - these are inactive but will recognise the antigen in the future if it appears again
- Helper T-cells that release cytokines which increase the activity of immune cells such as T, B and NK cells
What do granzymes do during T-cell clonal selection?
Break down the foreign cell
What does perforin do during T-cell clonal selection?
Burst the foreign cell
Why are regulatory T-cells important?
Without them the body would continue to fight off a disease that no longer exists and could end up fighting its own cells
What happens during antibody mediated immunity?
- Antigen binds to specific B-cell receptors
- It’s taken into the cell and broken down into fragments
- Fragments are expressed on the MHC-II
- Helper T-cells recognise the antigen complex on the B-cell membrane and stimulate it by releasing IL-2 which triggers B-cell clonal selection
What types of cell does B-cell clonal selection produce?
Plasma cells - secrete antibodies into blood, short lived
Memory B-cells - remain inactive until next immune reaction, long lived
Which group of glycoproteins do antibodies belong to?
Globulins/immunoglobulins
How are antibodies structured?
4 polypeptide chains - 2 heavy, 2 light
Variable region for each type of antibody
2 antigen binding sites
What do antibodies combine with?
The antigen that triggered their production
What does the combining of an antibody with an antigen produce?
Antibody-antigen immune complex
How to antibodies inactivate antigens?
- Neutralising
- Immobilising
- Agglutinating and precipitating
- Activating complement
- Enhancing phagocytosis
What happens when antibodies neutralise an antigen?
Neutralises bacterial toxins or prevent viral attachment to cells
What happens when antibodies immobilise an antigen?
Binds to it on bacterial cilia or flagellae
What happens when antibodies agglutinate and precipitate an antigen?
Antibodies use both of their binding sites to cause a dumping of cells
What happens when antibodies activate a complement?
Antigen-antibody complexes activate the complement cascade
What happens when antibodies enhance phagocytosis?
Antibody acts as a flag to attract phagocytes and aids phagocytosis via agglutination and complement
What are the 4 different types of antibodies?
IgG
IgA
IgM
IgE
IgG - location, how common, function?
Blood, lymph, intestines Most abundant (80%) Protects against bacteria
IgA - location, how common, function?
Sweat, tears, saliva, breast milk
10%
Localised protection of mucous membranes
Decreases with stress
IgM - location, how common, function?
Blood, lymph
10%
Early immune response
IgE - location, how common, function?
Blood
0.1%
Allergic reactions
Binds to mast cells
What happens during the primary response of immunological memory?
Slow response
Antibodies start to appear after several days
Slow rise in IgM, followed by IgE
What happens during the secondary response of immunological memory?
Faster response as a full immune response has been developed in the memory cells
Usually so quick, the pathogen is killed off before any signs and symptoms present
How do vaccinations help the immune system?
With immunological memory against the disease the vaccination covered
What do vaccinations contain?
Weakened, whole or partially-killed portions of microbes
What happens after a vaccination is given?
B and T-cells are activated in a primary response
Can take several days
In what 4 ways can you acquire immunity?
- Naturally acquired active immunity
- Naturally acquired passive immunity
- Artificially acquired active immunity
- Artificially acquired passive immunity
What is naturally acquired active immunity?
Natural exposure to a disease
What is naturally acquired passive immunity?
Transfer of IgG antibodies across the placenta from mother to child
Transfer of IgA antibodies from mother to child via breast milk
What is artificially acquired active immunity?
Vaccination
What is artificially acquired passive immunity?
Injection with immunoglobulins e.g. snake anti-venom
What cells can be found in GALT?
Macrophages
B and T-cells
Where can GALT be found?
Tonsils
Oesophagus
Small intestine
Large intestine
What is a hypersensitivity reaction?
An excessive immune response produced by the normal immune system
What are the 4 types of hypersensitivity?
Type I, II and III - antibody mediated
Type IV - cell mediated
What is Type I hypersensitivity?
An allergy
What is a Type I hypersensitivity mediated by?
IgE antibodies that bind to mast cells
Causes degranulation
What are the 2 types of type I hypersensitivity reactions?
Systemic e.g. anaphylaxis
Localised e.g. hay fever, eczema, irritant contact dermatitis
How soon is there a Type I hypersensitivity response?
Immediate - within minutes of exposure
What is Type II hypersensitivity?
Blood transfusion reactions
Haemolytic disease of the newborn
What is a Type II hypersensitivity mediated by?
IgG antibodies which bind to antigen and activate the complement system
How soon is there a Type II hypersensitivity response?
Rapid onset
What is a Type III hypersensitivity mediated by?
IgG
IgA
IgM antibodies
How soon is there a Type III hypersensitivity response?
Within 4-8 hours
In which pathologies does a Type III hypersensitivity reaction occur?
RA
Systemic lupus erythematosus (SLE)
Glomerulonephritis
What happens in a Type III hypersensitivity reaction?
Antibody-antigen complexes form and deposit in capillaries, skin, kidneys, joints etc triggering an immune response
They activate the complement system
What is a Type IV hypersensitivity mediated by?
Cells
What happens in a Type IV hypersensitivity reaction?
Overreaction of T-cells to an antigen
Large numbers of cytotoxic T-cells activated and cytokines released that can damage normal tissue
How soon is there a Type IV hypersensitivity response?
48-72 hours
What is an allergy?
A powerful immune response to an allergen
What is an allergen?
An antigen that generates allergy
Usually harmless
How does an immune response towards an allergy develop?
- Initial exposure causes sensitisation
Slow response as not many cells have learnt how to respond yet to that antigen - Subsequent exposure has a much quicker response
The full immune response has been developed and antibodies are readily available
How does the body prepare for an allergen response?
Body produces IgE specially for that antigen (B-cell):
- Plasma cells activated
- Antibodies produced targeting that specific antigen - one side binds to the antigen, the other side to the mast cell
What are the symptoms of an allergy?
Runny nose
Streaming eyes
Anaphylaxis
What percentage of adults are affected by a food allergy?
2%
What percentage of children are affected by a food allergy?
6%
What is a food allergy?
An IgE-mediated immune response
How is food intolerance different to an allergy?
Food intolerance doesn’t have a defined immune response
What is a food intolerance?
Symptoms triggered by eating a quantity of food and lacking the enzymes/probiotics/bile/HCI and other digestive factors needed to deal with the food
What is missing if a person is lactose intolerant?
The enzyme lactase
What is anaphylactic shock?
Severe, systemic, allergic response to an allergen exposure
How soon can anaphylactic shock appear?
Within 5-10 mins
What happens in the body to create anaphylactic shock?
- Exposure to allergen causes IgE to activate mast cells and basophils
- Histamine is released
- Causes bronchoconstriction, vasodilation and oedema of tissue
Why is anaphylactic shock dangerous?
Can cause occlusion of the airways
What is the treatment for anaphylactic shock?
EpiPen (Epinephrine)