Clinical Immunology and Serology - A Laboratory Perspective - Christine Stevens

Introduction and Natural Immunity 2 Christine Dorresteyn Stevens Immunity and Immunization 3 Cellular Versus Humoral Immunity 3 External Defense System 4 Internal Defense System 4 Acute-Phase Reactants 4 Cellular Defense Mechanisms 7 Phagocytosis 9 Inflammation 10 Chapter 2: The Lymphoid System 19 Christine Dorresteyn Stevens Primary Lymphoid Organs 20 Bone Marrow 20 Thymus 21 Secondary Lymphoid Organs 22 Spleen 22 Lymph Nodes 22 Other Secondary Organs 23 Surface Markers on Lymphocytes 24 Stages in B-Cell Differentiation 25 Pro-B Cells 25 Pre-B Cells 25 Immature B Cells 25 Mature B Cells 26 Activated B Cells 26 Plasma Cells 26 T-Cell Differentiation 27 Double-Negative Stage 28 Double-Positive Stage 28 Mature T Cells 29 Antigen Activation 29 Third Population or Natural Killer Cells 30 Mechanism of Cytotoxicity 31 Antibody-Dependent Cell Cytotoxicity 31 Laboratory Identification of Lymphocytes 32 Manual Method 32 Chapter 3: Nature of Antigens and Major Histocompatibility Complex 39 Christine Dorresteyn Stevens Factors Influencing the Immune Response 40 Traits of Immunogens 40 Nature of Epitopes 41 Haptens 42 Relationship of Antigens to the Host 42 Adjuvants 43 Major Histocompatibility Complex 43 Genes Coding for MHC Molecules (HLA Antigens) 43 Structure of Class I Molecules 44 Structure of Class II Molecules 45 Role of Class I Molecules 46 Role of Class II Molecules 47 Clinical Significance of MHC 48 Chapter 4: Antibody Structure and Function 54 Christine Dorresteyn Stevens Tetrapeptide Structure of Immunoglobulins 55 Cleavage with Papain 56 Pepsin Digestion 56 The Nature of Light Chains 56 Heavy Chain Sequencing 57 Hinge Region 57 Three-Dimensional Structure of Antibodies 57 IgG 58 IgM 59 IgA 61 IgD 61 IgE 62 Antibody Diversity 62 Contents xi xii CONTENTS Ehrlich’s Side-Chain Theory 62 Clonal Selection 63 Genes Coding for Immunoglobulins 63 Rearrangement of Heavy Chain Genes 63 Light Chain Rearrangement 64 Monoclonal Antibody 64 Hybridoma Production 65 Selection of Specific Antibody-Producing Clones 65 Clinical Applications 65 Chapter 5: Cytokines 72 Timothy Stegall Introduction to Cytokines 73 Cytokines in the Innate Immune Response 74 Interleukin-1 (IL-1) 74 Tumor Necrosis Factor-α (TNF-α) 74 IL-6 75 Chemokines 75 TGF-β 76 IFN-α and IFN-β 76 Cytokines in the Adaptive Immune Response 76 Th1 Cytokines 77 Th2 Cytokines 77 Cytokines Associated with T Regulatory Cells 78 Erythropoietin and Colony Stimulating Factors 79 Cytokines and Anticytokine Therapies 79 Clinical Assays for Cytokines 80 Chapter 6: Complement System 85 Christine Dorresteyn Stevens The Classical Pathway 87 The Recognition Unit 87 The Activation Unit 88 The Membrane Attack Complex