0-Introduction

Dr. Nasser M. Kaplan

Medical Microbiology

JUST, Irbid, Jordan

Course

Immunology.

M232 (102320).

3 Credit Hours.

Intensive 8-weeks summer course.

Theory (NO lab).

Course Coordinator

Assessment Examinations

5-10 MCQ/PPT.

First = 50 MCQ 30

Second = 50 MCQ (inc 20% First) 30

Final = 100 MCQ (inc 20% First & Second) 40

Make-up (NO MCQ, Written: compare & contrast, relate, discuss, short answers, spaces,

match, T/F).

Re-sit (30+30+40).

Teaching philosophy Interactive process; to do it properly

Objective to pass & score is appreciated.

Organized structured simplified flow of facts, knowledge & fun.

Theory vs. practice (Basic science, lab & clinical implications).

Attendance (exclusion due to absenteeism).

Strategy: (1) What? Study plan.

(2) How? Time management.

Suggestion: PPTs (skirt?, complaint?) + Verbals.

D Lecture (No Qs/Qs).

Nursery, School, Uni or Not

List of recommended textbooks (1) Immunology for Medical Students, 2nd Edition (2007),

Nairn R, Helbert M

(2) Medical Immunology, 10th Edition (2001), Parslow TG, Stites DP, Terr AI, Imboden JB

(3) Cellular & Molecular Immunology, 7th Edition (2012), Abbas AK, Lichtman AH, Pillai S

(4) Basic Immunology: Functions and Disorders of the Immune System, 4th Edition (2014), Abbas AK, Lichtman AH, Pillai S

(5) Immunology, 8th Edition (2013), Male D, Brostoff J, Roth DB, Roitt IM

(6) Others?, USMLE?, Questions?, Past MCQs.

Syllabus

(1) Innate Immunity significance of IS in combating infection & disease.

non-specific (innate) & specific (adaptive) ISs.

mechanisms combating infection/disease (killing pathogens)

pathways of intracellular killing of bacteria by phagocytes & their ccc features.

humoral & cellular components of non-specific IS & their mechanism of action.

effect of humoral components as interferon, TNF, IL-2, complement etc. on cellular components of non-specific IS.

(2) Complement

proteins of complement (C) system. differences & similarities among different pathways of C

activation.

enzymatic & non-enzymatic mechanisms of complement activation.

biological properties of different complement activation products & their role in nonspecific & specific immunity, inflammation & damage to self.

mechanisms of regulating complement activation & its products.

(3) Antigens

to compare & contrast immunogen, antigen & hapten.

factors influencing immunogenicity. chemical nature of immunogens. structures of T-independent & T-dependent

antigens.

concept of hapten-carrier conjugates & their structure.

antigenic determinants. concept of superantigens.

(4) Structure & Function of

Immunoglobulins (Antibodies)

To discuss general properties of all Igs.

To describe basic structure of Igs.

To relate Ig structure with function.

To define Ig hypervariable framework regions.

To define Ig classes, subclasses, types & subtypes.

To describe structures & properties of Ig classes.

(5) Classes of Immunoglobulins

(Antibodies)

To explain structural basis for Ig isotypes, allotypes & idiotypes.

To describe some of uses of isotypes, allotypes & idiotypes.

(6) Genetics of Immunoglobulins

To describe organization & expression of Ig gene families.

To explain origins of antibody diversity.

(7) Antigen-Antibody

Reactions To describe nature of Ag-Ab reactions.

To compare & contrast antibody affinity & avidity.

To delineate basis for antibody specificity & cross reactivity.

To discuss principles of commonly used tests for antigen-antibody reactions.

(8) Antibody Formation

To describe general cccs of specific immune response.

To compare & contrast primary & secondary antibody responses.

To describe molecular events involved in class switching & membrane Ig

expression.

(9) Cells of immune responses

To provide overview of types of cell interactions & molecules required for

specific immunity.

To describe specific immunity & cells involved.

(10) MHC & TCR

structure & function of cell surface molecules involved in immune cell interactions:

(1) class I & class II MHC molecules ( & nature of their polymorphisims).

(2) T cell receptor for antigen ( & genetic basis for generation of diversity in TCR).

(3) CD3 complex, accessory & co-stimulatory molecules.

nature of immunological synapse. requirements for T cell activation.

(11) Response to Antigen

different pathways for processing of endogenous & exogenous antigens & their presentation by class I & class II MHC.

self MHC restriction in antigen presentation to T cells.

major antigen presenting cells (APCs).

presentation of both conventional & superantigens.

role of thymus in determining TCR repertoire (role of positive & negative selection in thymus in generation of self MHC restricted T cells.

(12) Cell-Mediated Immunity

Helper T cell-B cell interactions for antibody formation against hapten-conjugated proteins & complex proteins.

cell-cell interactions w occur in (i) antibody responses to T-dependent antigens (ii) generation of cytotoxic T cells (iii) activation of macrophages & NK cells.

mechanisms of killing by cytotoxic T cells & NK cells.

responses to Thymus (T)-independent antigens.

(13) Cytokines

major cytokines w are mediators of (i) natural immunity. (ii) adaptive immunity. (iii) hematopoesis.

Subpopulations of helper T cells: Th1 & Th2.

Cytokines & class (isotype) switching.

Cytokine activation of macrophages & functions.

Maturation & mechanism of killing by cytolytic T lymphocytes (CTL).

Characteristics of killing mechanisms of other cytolytic cells.

Immunoregulatory processes of immune responses.

(14) Immunization

Different modes of acquiring immunity.

Passive & active immunization.

Advantages & disadvantages of different modes of immunization.

Applications & problems of artificial & natural means of immunization.

Rationale for vaccine design.

Risk & benefits of vaccination.

Modern approaches to immunization.

(15) MHC: Genetics & role in Transplantation

MHC loci & their products. Genetics of class I & II MHC molecules. Methods for detecting MHC antigens (tissue typing). Role of polymorphism & crossover in heterogeneity of MHC antigens

in a population.

Genetic basis of MHC heterogeneity in populations. Distribution of MHC molecules on different cells. Role of MHC in host-versus-graft (HGV) & graft-versus-host (GVH)

disease.

Role of MHC in transplantation, immune functions & disease. Immune mechanisms in transplant rejection. Strategies for successful transplantation.

(16) Tolerance & Autoimmunity

Concept & significance of tolerance.

Factors w determine induction of tolerance.

Mechanism of tolerance induction.

Concepts of autoimmunity & disease.

Features of major autoimmune diseases.

Theories of etiology of autoimmune disease.

(17) Hypersensitivity

Reactions classification of hypersensitivity reactions.

diseases associated with hypersensitivity reactions.

mechanisms of damage in hypersensitivity reactions.

diagnostic tests & treatment methods for hypersensitivity diseases.

(18) Tumor Immunology

Evidence for immune reactivity to tumor.

Changes in cellular characteristics due to malignancy.

Host components w affect tumor progression.

Tumor cell components w protect it from IS.

Rationale for tumor immunotherapy & its approaches.

(19) Immunodeficiency

primary & secondary immunodeficiencies.

immunodeficiencies in AIDS & other conditions.

major primary immunodeficiencies & their features.

relationship between site of lesion & resulting immunodeficiency.

Know diagnostic tests for different immunodeficiencies.

(20) Blood Banking &

Immunohematology

Erythrocyte antigens.

Methods for detection of antigen & antibodies to RBCs.

Transfusion reactions.

RH isoimmunization.

Blood component therapy.

Immunology

Dr. Nasser M. Kaplan

Medical Microbiology

JUST, Irbid, Jordan

Immunology is study of IS developed to protect host from pathogens & other foreign

macromolecules/ substances & responses to

them.

Self/ non-self discrimination is one of hallmarks of IS.

immune responses developed against our own proteins (& other molecules) in autoimmunity &

against our own aberrant cells in tumor

immunity.

IS

Non-specific (natural,

native, innate)

System in place prior to exposure to antigen.

Lacks discrimination among antigens.

Can be enhanced after exposure to antigen

through effects of

cytokines.

Specific (acquired,

adaptive)

Induced by antigen.

Enhanced by antigen.

Shows fine discrimination.

Innate or non-specific IS

continually ready to respond to invasion.

first line of defense against foreign organisms are barrier tissues as skin w stop entry of organism into our bodies.

If these barrier layers are penetrated:

(1) body cells include macrophages & neutrophils w respond rapidly, engulf foreign organisms & kill them without need for antibodies.

(2) soluble molecules w deprive invading organism of essential nutrients (as iron).

(3) certain molecules w are found on surfaces of epithelia, in secretions (as tears & saliva) & in blood stream.

Specific or adaptive IS

A second line of defense. may take days to respond to primary invasion by organism. By production of antibodies (soluble proteins w bind to foreign

antigens) & cell-mediated responses in w specific cells recognize foreign pathogens & destroy them.

In case of viruses or tumors, this response is also vital to recognition & destruction of virally-infected or tumorigenic cells.

The response to second round of infection is often more rapid than to primary infection because of activation of memory B & T cells.

cells of IS interact with one another by variety of stimulatory signal molecules coordinated response. These signals may be proteins as lymphokines w are produced by cells of lymphoid system, cytokines & chemokines w are produced by other cells in immune response.

The hallmarks of specific IS are memory & specificity.

Specific IS "remembers" each encounter with a microbe or foreign antigen subsequent encounters stimulate increasingly effective defense mechanisms.

Specific immune response amplifies the protective mechanisms of non-specific immunity, directs or focuses these mechanisms to the site of antigen entry & makes them better able to eliminate foreign antigens.