医学英语-免疫#.ppt

Lymphatic ImmuneSystem Dr JianminLuojml Dept ofPathophysiology SUMC Let sstartwithquestions Question 1Ourenvironmentcontainsagreatvarietyofinfectiousmicrobes whycouldwekeephealthy Question 2Whatshouldwedobeforetransplantingblood Transfusion Let sstartwithquestions Questions 3Whydoweneedtodogenematchingbeforetransplantation Whyisitverydifficulttofindperfectdonorforrecipientintransplantation Question 4Doyouhaveanyexperienceaboutallergy Whatistheallergy Let sstartwithquestions Question 51 Whatisvaccine 2 Howdovaccineswork Outline FundamentsofimmunologyBriefhistoryofimmunologyImmuneresponseHypersensitivity Immunity Allmechanismsusedbythebodytoprotectitselfagainstallthingsforeign Immunity immunitas Latin exempt Immunologyisthestudyofimmunityandofthecellularandmoleculareventsthatoccurafteranorganismencountersmicrobesandotherforeignmacromolecules WhatisthepurposeofImmuneSystem PurposeofImmuneSystemProtectagainstinvaders Non self proteins antigens Immunesystemrecognizesasnon selfandremovesordestroys2 Maintaininternalenvironment self proteins HLA humanleukocyteantigens 1 ThebasicfunctionofImmunesystem ComponentsofImmunesystemImmuneorgansImmunecellsImmunemolecules 2 FunctionsofImmuneSystem ImmunologicaldefenseTheimmunesystemprotectsusfromattackbymicrobesandworms ImmunologicalhomeostasisTheimmunesystemcouldeliminatetheinflammatoryordiedself cells ImmunologicalsurveillanceTheimmunesystemcoulddestroythetumorcellsandprotectsusfromclinicaltumorformation 2 ThecategoryandcharacteristicsofimmuneresponsesImmunity thestateofprotectionfrominfectiousdisease hasbothalessspecificandmorespecificcomponent Innateimmunity providesthefirstlineofdefenseagainstinfection Adaptiveimmunityrespondstothechallengewithahighdegreeofspecificityaswellastheremarkablepropertyof memory Innateimmunesystem Non specificBodysurfacePhagocytes bloodcomponents Anyinbornimmunitythathasalreadypresentthefirsttimeapathogenisencountered Innate nativeimmunity naturalimmunity Adaptiveimmunesystem Acquired specificimmunity Adaptiveimmunitydisplaysahighdegreeofspecificityaswellastheremarkablepropertyof memory Themajorcellularagentsofadaptiveimmunityarelymphocytesandtheantibodiesandothermoleculestheyproduce Adaptiveimmunity Naturalactive bodyresponsetoinvasionofantigen Artificialactive attenuated processed antigensadministeredinsmallamountstodevelopimmunity Passiveimmunity Antibodiestransferredintothepersonfromelsewhere temporaryprotection Fetusviaplacenta Newbornviabreastmilk Immunoglobulininjectionstoboostimmuneresponse ImmunologicalmemoryTheimmunesystem remembers ifithasseenanantigenbeforeanditreactstosecondaryexposurestoanantigeninamannerdifferentthanafteraprimaryexposure Generallyonlyanexposuretothesameantigenwillillicitthismemoryresponse 3 ImmuneDysfunctionandItsConsequencesSometimestheimmunesystemfailstoprotectthehostadequatelyormisdirectsitsactivitiestocausediscomfort debilitatingdisease orevendeath 1 Hypersensitivity 2 Graftrejectionandgraft versus hostdisease 3 Autoimmunedisease 4 Immunodeficiency AllergicDiseasesThemostcommontypesofallergicdiseasesoccurwhentheimmunesystemrespondstoafalsealarm Inanallergicperson anormallyharmlessmaterialsuchasgrasspollen foodparticles mold orhousedustmitesismistakenforathreatandattacked 4 Applicationofimmunology 1 Immunotherapy 2 Immunoprophylaxis 3 Immunodiagnosis Smallpox Causedbythevariolavirus EdwardJennerandthecowpoxvaccineSmallpoxvaccineisthefirstvaccinetobeusedandthefirstvaccinetobediscontinued BriefHistoryandProspectofImmunology DevelopmentofIdeasinImmunology AimsPeroidsPioneersNotionsApplications1870 1890Pasture MetchnikoffImmunization PhagocytosisDescription1890 1910Behring EhrlichAntibodies CellReceptors1910 1930Bordet LandsteinerSpecificity HaptensMechanisms1930 1950SubcellularAbsynthesis Agtemp 1950 1970CellularClonalselectionSystemicAnalysis1970 1983MulticellularNetworkCooperationImmuneregulationModernImmunol 1983 presentPost TCREraMolecularMechanisms Immuneorganandtissue primaryorgans bonemarrowandthethymusglandsecondaryorgansatornearpossibleportalsofentryforpathogens adenoids tonsils spleen lymphnodes Peyer spatches withintheintestines andtheappendix CentralImmuneOrgansandtissues BoneMarrow Everycellfromimmunesystemisderivedfrombonemarrow Apluripotent多能性的stemcell干细胞differentiateseitheracommonlymphoidprogenitorcell淋巴祖细胞oramyeloidstemcell骨髓干细胞 CommonlymphoidprogenitorcellsgiverisetoB T andNK naturalkiller cells BoneMarrow Thymus Thymus TheThymus functionistoproducemature T cells ImmatureTlymphocytes Prothymocytes emergefromtheperson sbonemarrowandmoveintotheirthymus MatureTcellsarereleasedintotheperson sbloodstream SecondaryLymphoidOrgans LymphnodesPlaceofimmuneresponsetopathogenenteringthetissues Spleen PlaceofimmuneresponsetobloodborneinfectionsMALT Mucosa associatedlymphoidtissuePlaceofimmuneresponsetomucosalsurfaces LymphNodes LymphnodesaremademostlyofBcells Tcells macrophages anddendriticcells Lymphnodesfilteroutantigensfromlymphpriortoreturninglymphtotheperson sbodyforcirculation Inamannermuchlikethespleen dendriticcellsandmacrophagesthatcaptureantigenspresentforeignmaterialstobothBandTcells initiatinganimmuneresponse Spleen ThespleeniscomprisedofTcells Bcells dendriticcells macrophagesandnaturalkillercells MacrophagesanddendriticcellscaptureorbringAntigenstospleen Inaperson sspleen Bcellsareactivatedandproducegreatamountsofantibody Mucosa associatedlymphoidtissues MALT SpecificLymphocytes ProduceantibodiesB cellsmatureinbonemarrowthenconcentrateinlymphnodesandspleenT cellsmatureinthymusBandTcellsmaturethencirculateinthebloodandlymphCirculationensurestheycomeintocontactwithpathogensandeachother Thecomplementsystem求补系统Thecomplementsystemisoneofthemajoreffectorofthehumoralbranchoftheimmunesystemandisalsoanimportanteffectormechanismofinnateimmunity Complementreferstofreshserumcapableoflysingantibody Ab coatedcells ThefunctionsofcomplementsystemTheprincipaleffectorfunctionsofthecomplementarespecifichumoralimmunitytopromotephagocytosisofmicrobes tostimulateinflammation andtoinducethelysisofthesemicrobes Majorhistocompatibilitycomplex主要组织相容性复合体Everymammalianspecies哺乳类possessesatightlylinkedclusterofgenes themajorhistocompatibilitycomplex MHC whoseproductsplayaroleinintercellularrecognitionandindiscriminationbetweenselfandnonself self histocompatible orrejectedasforeign histoincompatible HLAandclinicmedicine1 HLAandrejection2 AbnormalexpressionofHLAanddiseases3 HLAanddiseaserelativityAnumberofdiseaseshavebeenfoundtooccuratahigherfrequencyinindividualswithcertainMHChaplotypes 4 HLAandpaternitytestingandLegalmedicine Immunesystemresponse AntibodymediateorHumoralresponseBlymphocytes plasmaCellmediatedresponseTlymphocytes subpopulation Antigencarbohydrate protein Nucleicacid Antiserum serumwithantibodies antitoxin Antibodystructure4polypeptidechains 2heavy 2lightConstantregions variableregionAntibodiesclasses basedonheavychainIgA IgD IgE IgG IgM ImmunoglobulinsareantibodiesLOCKinKEY surfaceofglobulinIgA secretory insaliva breastmilk vaginalsecretions IgD regulateslymphocytefunctionIgE associatedwithhypersensitivityreactionsIgG mostabundant smallestIgM firsttorespond CellmediatedimmunityTlymphocytestraveltositetodestroyantigenRegulatoryeffects Thelpers Th Tsuppressors Ts regulateBcell antibodyproductionInflammatoryeffects TDTHreleaselymphokinesinducemigrationandactivationofmonocytesandmacrophagesCytotoxineffects Tcytotoxic Tc orkillerTcellsdeliverlethalhit killingtargetcell HypersensitivityReactionsTypeI anaphylaxismediatedbyIgETypeII cytolytic cytotoxicreactionsmediatedbyIgG IgMbindtocell indicatecomplementcascadetuberculinreaction AUTOIMMUNITYmildtolife threateningdisordersTolerance immunesystemheldincheckAntigennotexposed insidecell behindbarrier AntigennotproducedearlyBcells TcellsdeletedAutoimmunity breakdownofToleranceAntigenexposedAntigenproduced viralinfection cancer B Tcellsnotdeleted AutoimmuneDisordersOver80typesExamplesRheumatoidarthritisSystemicLupusErythematosis SLE Rheumatoidarthritiscasestudy22yearoldwithrheumatoidarthritisisanprednisonebuthavingincreasedpain rednessandswellinginherknees anklesandelbows EtiologyofRAUnknown infectionstrigger AutoimmunityGenetic familial3 10 000worldwideIdenticaltwinconcordance 15 20 AutoimmunityImmunecomplexesreleasedestructiveenzymesthatdamagearticularsurfacesproinflammatories tumornecrosisfactor TNF Interleukin 1PathophysiologyofRA Recurrentinflammationofdiarthoidial hingeandpivot joints SymptomsofRAFatigueLimitationofmotionInflammationheat swelling tendernesss pain Systemicdisease Inflammationofbloodvessels tissuesDemineralizationofbone osteoporosisIncreasedsedimentationrate ESR sedrate Serumrheumatoidfactor LaboratoryassessmentRheumatoidfactor in60 80 ofcases butonly40 ofearlycases ofRApositiveAntinuclearantibodies ANA ErythrocytesedimentationRate ESR C reactiveprotein CRP DiseaseModifyingAnti RheumaticDrugsXenobiotics foreign substance Methotrexate inhibitsfolate suppressesTcellsGoldsalts immunosuppressantCyclosporine immunosuppressant GlucocorticoidsNonsteroidalanti inflammatoriesNewCategoryofMedicationselectiveco stimulationmodulatorinhibitsTcellsAbatacept Orencia LupusErythematosus Incidence women menAfrican American Hispanic Asian NativeAmericandescant Cause Virus Genetic Environment Pathophysiologyantigen ant