Chapter 4
Immune System
Homeostatic imbalances of immunity:
i) Immunodeficiency
ii) Autoimmune disease
iii) Hypersensitivities
1) Immunodeficiencies
A medical condition in which your body does
not have the normal ability to resist infection
Congenital or acquired condition that impairs
the function of immune cells or production of
certain molecules (phagocytes or complement
system)
Causes immune cells to behave abnormally.
Eg: SCID and AIDS
SCID
Severe combined immunodeficiency
syndromes.
Genetic defects that produce a marked deficit
of B and T cells.
Also abnormalities in interleukin receptors.
Children afflicted have little or no protection
against disease-causing organisms.
Fatal if untreated, usually treatment from bone
marrow transplants.
‘Bubble baby disease’
SCID = bubble baby
disease
Result of an immune system
so highly compromised that
it is considered almost
absent.
Victims are extremely
vulnerable to infectious
diseases
David Vetter, become
famous for living in a sterile
environment.
AIDS
AIDS is caused by the human immunodeficiency virus (HIV)
HIV virus transmitted in body secretions : blood, semen,
vaginal secretions, infected mothers can also transmit to her
fetus
Commonly enters body via blood transfusions or blood-
contaminated needles and during sexual intercourse.
HIV virus specifically targets and destroys helper T cells
Without helper T cells, cytotoxic T cells and B cells cannot be
activated or maintain a topsy-turvy immune system.
Virus multiply steadily in the lymph nodes throughout most of
the asymptomatic period (average 10 years in absence of
treatment).
Help activate B cells to secrete antibodies and macrophages to
destroy ingested microbes, but they also help activate cytotoxic T
cells to kill infected target cells.
AIDS
Characterized by:
Severe weight loss
Night sweat
Swollen lymph nodes
Increase frequent
opportunistic infections:
➢ Pneumonia(Pneumocystis
pneumonia)
➢ Kaposi’s sarcoma (cancer
of blood vessels
Development of AIDS
Phase I:
lasts from a few weeks to a few years after initial exposure to
the virus.
Has flulike symptoms of swollen lymph nodes, chills & fever,
fatigue, and body aches.
T cell population may decline briefly, then rebound as more
cells and antibodies are produced in the body to fight
against the virus.
The person having these antibodies is said to be “HIV-
positive”, but, he or she is not having the disease AIDS yet.
The antibodies do not destroy the virus entirely because
many of the virus remain inside cells, where antibodies and
immune cells cannot reach them.
Phase II:
Can occur for 6 months or > 10 years
before progress to phase III.
The virus begins to do its damage, wiping
out more and more of the helper T cells.
The person becomes more vulnerable to
opportunistic infections.
May have persistent or recurrent flulike
symptoms.
Phase III:
When the number of helper T cells
<200/mm3 of blood and has an
opportunistic infection or the type of
cancer associated with HIV infection the
person is said to have AIDS.
Eg. of cancers associated with AIDS:
pneumonia, meningitis, tuberculosis,
encephalitis, Kaposi’s sarcoma, non-
Hodgkin’s lymphoma, etc.
2) Autoimmune Diseases
Produced by failure of the immune system to recognize
and tolerate self-antigens.
Immune system loses its ability to distinguish friend (self)
from foe (foreign antigens).
Then arise an overactive immune response of the body
against substances and tissues normally present in the
body.
In other words, the body attacks its own cells.
This may be restricted to certain organs or involve a
particular tissue in different places.
Autoimmune Diseases
The disease occurs 9x more often in
women than in men.
SLE symptoms vary widely and
come and go unpredictably.
Classic malar rash (or butterfly
rash).
Autoimmune Diseases
Some important autoimmune disease:
Rheumatoid arthritis : destroy joints
Systemic lupus erythematosus (SLE)
Multiple sclerosis (MS): destroy the myelin of the
white matter of the brain and spinal cord
SLE most often harms the heart, joints, skin, lungs,
blood vessels, liver, kidneys, and nervous system.
Examples of Autoimmune Diseases:
Multiple sclerosis (MS)
Myasthenia gravis
Graves’ disease
Juvenile (type I) diabetes mellitus
Systemic lupus erythematosus (SLE)
Glomerulonephritis
Rheumatoid arthritis (RA)
1. Multiple sclerosis
The most common autoimmune disorder
affecting the central nervous system.
The disease usually begins between the ages of
20 and 50 and is twice as common in women as
in men.
It destroys the white matter (myelin sheaths) of
the brain and spinal cord.
The three main characteristics of MS are the
formation of lesions in the central nervous system
(also called plaques), inflammation, and the
destruction of myelin sheaths of neurons.
2. Myasthenia gravis
The hallmark of myasthenia gravis is fatigability.
It impairs communication between nerves and
skeletal muscles.
Muscles become progressively weaker during
periods of activity, and improve after periods of
rest.
Muscles that control eye and eyelid movement,
facial expressions, chewing, talking, and
swallowing are especially susceptible.
3. Graves' disease
An immune system disorder
that results in the
overproduction of thyroid
hormone (hyperthyroidism).
Thyroid gland produces
excessive amounts of
thyroxine.
Usually, there is protrusion of
the eyeballs.
It is more common among
women and before the
age of 40.
4) Juvenile (type I) diabetes mellitus
It destroys pancreatic beta cells, resulting
in deficient production of insulin.
The subsequent lack of insulin leads to
increased blood and urine glucose.
The classical symptoms are polyuria
(frequent urination), polydipsia (increased
thirst), polyphagia (increased hunger) and
weight loss.
5. Lupus erythematosus or Lupus
Our immune system attacks and causes inflamed
connective tissue.
It can affect the skin, joints, kidneys, heart, lungs,
brain, and other organs.
Occur mainly in females between the age of 10 - 50.
Lupus often starts as a red skin rash on the face or
head. Other symptoms include fever, fatigue, joint
pain, and weight loss.
Inflammation can lead to osteoarthritis, pericarditis, or
pleurisy (inflammation of the lining in lungs).
1. Systemic lupus erythematosus (SLE)
most common form of lupus and is generally
considered more serious than the others.
SLE can affect many parts of a person’s body,
including kidneys, heart, lungs, brain, blood and skin.
2. Discoid lupus erythematosus affects the exposed
areas of the skin and causes rashes. These rashes may
be on the face, neck and scalp.
This type of lupus does not affect any of the internal
body organs although 1 in 10 people living with
discoid lupus will develop systemic lupus.
6. Glomerulonephritis
A severe impairment of kidney function.
Characterized by inflammation of the glomeruli
or small blood vessels in the kidneys.
Glomerulonephritis signs & symptoms may
include:
➢ red blood cells in urine (hematuria)
➢ Foamy urine due to excess protein (proteinuria)
➢ High blood pressure (hypertension)
➢ Fluid retention (edema) with swelling evident in face, hands, feet
and abdomen
➢ Fatigue from anemia or kidney failure
7) Rheumatoid arthritis (RA)
Our immune system attacks and causes inflamed
synovial membrane that lines certain joints.
Fingers, wrists, toes or other joints become painful
and stiff.
Without treatment, synovial fluid accumulates
and joints swell.
Neutrophils, lymphocytes and other inflammatory
cells migrate into the joint. Eventually the synovial
membrane thickens, scar tissue forms, and the
bones of the joints may fuse.
Autoimmune Diseases
Condition or event that may trigger self-attack:
Foreign antigen resemble self-antigen
➢ Antibodies made against the foreign antigen can cross-
react with self antigen
➢ Eg: Age-old disease rheumatic fever, antibodies
produced against streptococcal infection react with
heart antigens causing lasting damage to heart muscle
and valves, and also joints and kidney.
New self-antigen appear:
➢ Gene mutation
➢ Changes in structure of self-antigen
➢ Novel self-antigen released by trauma.
3) Hypersensitivities
Abnormal immune responses to antigens.
Result when immune system damage tissues as it
fights off a threat that is harmless to body (such
as pollen and animal dander).
People rarely die but just feel uncomfortable.
Different types of hypersensitivities reactions
distinguished by:
➢ Time course
➢ Involvement of antibodies or T cells
2 major forms :
a) Immediate hypersensitivity
caused by abnormal B lymphocyte (antibodies)
response to an allergen to produce symptoms
within seconds/minutes
What most of us call allergies reaction
Reaction begin within seconds after contact
with allergen and last about half an hour.
Treatment: antihistamines drugs, hormone
epinephrine, allergy shot
Histamine
(Blood vessel
dilate, leaky)
Promote edema,
smooth muscle
contraction
Release of mucus
Outpouring fluid
from capillaries
Constriction of
bronchioles
2 major forms :
b) delayed/subacute hypersensitivity
caused by T cell response that produces
symptoms between 24 and 72 hours.
T cells take longer to appear (1-3 days).
Inflammation and tissue damage result from
action of macrophage or cytotoxic T cells.
Example: allergic contact dermatitis which
follow skin contact with some metals, cosmetics
and deodorant chemicals
Differences between immediate and
delayed hypersensitivity