Caring for Patients with Immune
Disorder
Ajibade O.S.
• Structures of the immune system
• Types of immunity
• Immune-mediated disorders: Allergy
• Chronic fatigue syndrome
Review of related anatomy and physiology
• Introduction to the human immune system
• Different types of immunity:
Acquired Immune System and
Innate Immune System
• Structure and organs of the immune system
– The lymphatic system
– Lymphoid tissue
– Lymph nodes
– Thymus
– Spleen
Introduction to the human immune system
• The human body is constantly under attack
from things that are trying to do it harm.
• These include toxins, bacteria, fungi, parasites
and viruses.
• All of these can, under the right conditions,
cause damage and destruction to parts of the
body and if these were left unchecked, the
human body would not be able to function.
• The purpose of the immune system is to act as
the body’s own army, in defense against this
constant stream of possible infections and
toxins.
• The human immune system is divided into
two broad groups called:
• Acquired Immune System and
• Innate Immune System.
• Parts of the body that play a role in immunity
include:
• The lymphatic's
• Lymph nodes
• Thymus
• Spleen
Different types of immunity
• Innate immune system is always working to
protect the body and does not require any
special preparation to stop infection.
• Acquired immune system needs to be ‘primed’
before it can work to its full effectiveness, and is
only really effective after it has seen a possible
infective agent before.
Immunity
• Resistance to disease
• Immune system
– Two intrinsic systems
• Innate (nonspecific) defense system
• Adaptive (specific) defense system
Immune System
• Functional system rather than organ system
• Innate and adaptive defenses intertwined
• Release and recognize many of same
defensive molecules
• Innate defenses do have specific pathways for
certain substances
• Innate responses release proteins that alert
cells of adaptive system to foreign molecules
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Immunity
• Innate defense system has two lines of
defense
– First - external body membranes (skin and
mucosae)
– Second - antimicrobial proteins, phagocytes, and
other cells
• Inhibit spread of invaders
• Inflammation most important mechanism
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Immunity
• Adaptive defense system
– Third line of defense attacks particular foreign
substances
• Takes longer to react than innate system
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Figure 21.1 Overview of innate and adaptive defenses.
Surface barriers
• Skin
• Mucous membranes
Innate
defenses Internal defenses
• Phagocytes
• Natural killer cells
• Inflammation
• Antimicrobial proteins
• Fever
Humoral immunity
• B cells
Adaptive
defenses
Cellular immunity
• T cells
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Innate Defenses
• Surface barriers ward off invading pathogens
– Skin, mucous membranes, and their secretions
• Physical barrier to most microorganisms
• Keratin resistant to weak acids and bases, bacterial
enzymes, and toxins
• Mucosae provide similar mechanical barriers
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Surface Barriers
• Protective chemicals inhibit or destroy
microorganisms
– Acidity of skin and secretions – acid mantle –
inhibits growth
– Enzymes - lysozyme of saliva, respiratory mucus,
and lacrimal fluid – kill many microorganisms
– Defensins – antimicrobial peptides – inhibit
growth
– Other chemicals - lipids in sebum, dermcidin in
sweat – toxic
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Surface Barriers
• Respiratory system modifications
– Mucus-coated hairs in nose
– Cilia of upper respiratory tract sweep dust- and
bacteria-laden mucus toward mouth
• Surface barriers breached by nicks or cuts -
second line of defense must protect deeper
tissues
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Internal Defenses: Cells and Chemicals
• Necessary if microorganisms invade deeper
tissues
– Phagocytes
– Natural killer (NK) cells
– Antimicrobial proteins (interferons and
complement proteins)
– Fever
– Inflammatory response (macrophages, mast cells,
WBCs, and inflammatory chemicals)
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Phagocytes
• Neutrophils most abundant but die fighting
– Become phagocytic on exposure to infectious material
• Macrophages develop from monocytes – chief
phagocytic cells – robust cells
• Free macrophages wander through tissue spaces, e.g.,
alveolar macrophages
• Fixed macrophages permanent residents of some
organs; e.g., stellate macrophages (liver) and microglia
(brain)
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Mechanism of Phagocytosis
• Phagocyte must adhere to particle
– Some microorganisms evade adherence with
capsule
• Opsonization marks pathogens—coating by
complement proteins or antibodies
• Cytoplasmic extensions bind to and engulf
particle in vesicle called phagosome
• Phagosome fuses with lysosome
phagolysosome
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Figure 21.2a Phagocytosis.
Innate defenses Internal defenses
A macrophage (purple) uses its cytoplasmic
extensions to pull rod-shaped bacteria
(green) toward it. Scanning electron
micrograph (4800x).
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Figure 21.2b Phagocytosis. Slide 1
1 Phagocyte
adheres to
pathogens or debris.
2 Phagocyte forms
pseudopods that
Phagosome eventually engulf the
(phagocytic particles, forming a
vesicle) phagosome.
Lysosome
3 Lysosome fuses
with the phagocytic
vesicle, forming a
phagolysosome.
Acid
hydrolase
enzymes 4 Lysosomal
enzymes digest the
particles, leaving a
residual body.
5 Exocytosis of the
vesicle removes
indigestible and
residual material.
Events of phagocytosis.
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Mechanism of Phagocytosis
• Pathogens killed by acidifying and digesting with
lysosomal enzymes
• Helper T cells cause release of enzymes of
respiratory burst, which kill pathogens resistant to
lysosomal enzymes by
– Releasing cell-killing free radicals
– Producing oxidizing chemicals (e.g., H2O2)
– Increasing pH and osmolarity of phagolysosome
• Defensins (in neutrophils) pierce membrane
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Natural Killer (NK) Cells
• Nonphagocytic large granular lymphocytes
• Attack cells that lack "self" cell-surface
receptors
– Induce apoptosis in cancer cells and virus-infected
cells
• Secrete potent chemicals that enhance
inflammatory response
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Inflammatory Response
• Triggered whenever body tissues injured
• Prevents spread of damaging agents
• Disposes of cell debris and pathogens
• Alerts adaptive immune system
• Sets the stage for repair
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Inflammatory Response
• Cardinal signs of acute inflammation:
1. Redness
2. Heat
3. Swelling
4. Pain
(Sometimes 5. Impairment of function)
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Inflammatory Response
• Begins with chemicals released into ECF by
injured tissues, immune cells, blood proteins
• Macrophages and epithelial cells of boundary
tissues bear Toll-like receptors (TLRs)
• 11 types of TLRs recognize specific classes of
infecting microbes
• Activated TLRs trigger release of cytokines
that promote inflammation
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Inflammatory Response
• Inflammatory mediators
– Kinins, prostaglandins (PGs), and complement
• Dilate local arterioles (hyperemia)
– Causes redness and heat of inflamed region
• Make capillaries leaky
• Many attract leukocytes to area
• Some have inflammatory roles
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Inflammatory Response: Edema
• Capillary permeability exudate to tissues
– Fluid containing clotting factors and antibodies
– Causes local swelling (edema)
– Swelling pushes on nerve endings pain
• Pain also from bacterial toxins, prostaglandins, and
kinins
– Moves foreign material into lymphatic vessels
– Delivers clotting proteins and complement
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Inflammatory Response
• Clotting factors form fibrin mesh
– Scaffold for repair
– Isolates injured area so invaders cannot spread
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Figure 21.3 Inflammation: flowchart of events.
Innate defenses Internal defenses
Initial stimulus
Physiological response
Signs of inflammation
Tissue injury Result
Release of inflammatory chemicals Release of leukocytosis-
(histamine, complement, inducing factor
kinins, prostaglandins, etc.)
Leukocytosis
(increased numbers of white
blood cells in bloodstream)
Arterioles Increased capillary Attract neutrophils,
dilate permeability monocytes, and
lymphocytes to Leukocytes migrate to
area (chemotaxis) injured area
Local hyperemia Capillaries
(increased blood leak fluid Margination
flow to area) (exudate formation) (leukocytes cling to
capillary walls)
Diapedesis
Leaked protein-rich Leaked clotting (leukocytes pass through
fluid in tissue spaces proteins form interstitial capillary walls)
clots that wall off area
to prevent injury to
surrounding tissue
Phagocytosis of pathogens
Heat Redness Pain Swelling and dead tissue cells
(by neutrophils, short-term;
by macrophages, long-term)
Locally increased Possible temporary Temporary fibrin Pus may form
temperature increases impairment of patch forms
metabolic rate of cells function scaffolding for repair Area cleared of debris
Healing
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Phagocyte Mobilization
• Neutrophils lead; macrophages follow
– As attack continues, monocytes arrive
• 12 hours after leaving bloodstream macrophages
• These "late-arrivers" replace dying neutrophils and
remain for clean up prior to repair
• If inflammation due to pathogens,
complement activated; adaptive immunity
elements arrive
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Phagocyte mobilization
• Steps:
• Leukocytosis
• Magination
• Diapedesis
• Chemotaxis
Figure 21.4 Phagocyte mobilization. Slide 1
Innate defenses Internal defenses
Inflammatory
chemicals
diffusing 4 Chemotaxis.
from the Neutrophils follow
inflamed chemical trail.
site act as
chemotactic Capillary wall
agents. Basement
membrane
Endothelium
1 Leukocytosis. 2 Margination. 3 Diapedesis.
Neutrophils enter Neutrophils cling Neutrophils flatten
blood from bone to capillary wall. and squeeze out of
marrow. capillaries.
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Antimicrobial Proteins
• Include interferons and complement proteins
• Some attack microorganisms directly
• Some hinder microorganisms' ability to
reproduce
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Fever
• Abnormally high body temperature
• Systemic response to invading microorganisms
• Leukocytes and macrophages exposed to
foreign substances secrete pyrogens
• Pyrogens act on body's thermostat in
hypothalamus, raising body temperature
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Fever
• Benefits of moderate fever
– Causes liver and spleen to sequester iron and zinc
(needed by microorganisms)
– Increases metabolic rate faster repair
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Adaptive Defenses
• Adaptive immune (specific defense) system
– Protects against infectious agents and abnormal
body cells
– Amplifies inflammatory response
– Activates complement
– Must be primed by initial exposure to specific
foreign substance
• Priming takes time
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Adaptive Defenses
• Specific – recognizes and targets specific
antigens
• Systemic – not restricted to initial site
• Have memory – stronger attacks to "known"
antigens
• Two separate, overlapping arms
– Humoral (antibody-mediated) immunity
– Cellular (cell-mediated) immunity
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Humoral Immunity
• Antibodies, produced by lymphocytes,
circulating freely in body fluids
• Bind temporarily to target cell
– Temporarily inactivate
– Mark for destruction by phagocytes or
complement
• Humoral immunity has extracellular targets
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Cellular Immunity
• Lymphocytes act against target cell
– Directly – by killing infected cells
– Indirectly – by releasing chemicals that enhance
inflammatory response; or activating other
lymphocytes or macrophages
• Cellular immunity has cellular targets
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Antigens
• Substances that can mobilize adaptive
defenses and provoke an immune response
• Targets of all adaptive immune responses
• Most are large, complex molecules not
normally found in body (nonself)
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Complete Antigens
• Important functional properties
– Immunogenicity: ability to stimulate proliferation
of specific lymphocytes
– Reactivity: ability to react with activated
lymphocytes and antibodies released by
immunogenic reactions
• Examples: foreign protein, polysaccharides,
lipids, and nucleic acids
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Haptens (Incomplete Antigens)
• Small molecules (haptens) not immunogenic
by themselves
– E.g., peptides, nucleotides, some hormones
• May be immunogenic if attached to body
proteins and combination is marked foreign
• Cause immune system to mount harmful
attack
• Examples: poison ivy, animal dander,
detergents, and cosmetics
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Antigenic Determinants
• Only certain parts (antigenic determinants) of
entire antigen are immunogenic
• Antibodies and lymphocyte receptors bind to
them as enzyme binds substrate
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Antigenic Determinants
• Most naturally occurring antigens have
numerous antigenic determinants that
– Mobilize several different lymphocyte populations
– Form different kinds of antibodies against them
• Large, chemically simple molecules (e.g.,
plastics) have little or no immunogenicity
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Figure 21.7 Most antigens have several different antigenic determinants.
Antigen-
Antigenic determinants
binding
sites
Antibody A
Antigen
Antibody B
Antibody C
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Cells of the Adaptive Immune System
• Three types of cells
– Two types of lymphocytes
• B lymphocytes (B cells)—humoral immunity
• T lymphocytes (T cells)—cellular immunity
– Antigen-presenting cells (APCs)
• Do not respond to specific antigens
• Play essential auxiliary roles in immunity
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• Thanks for listening.
