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The immune system distinguishes self from nonself and eliminates potentially harmful nonself molecules and cells from the body. The immune system also has the capacity to recognize and destroy abnormal cells that derive from host tissues (see Tumor Immunology). Any molecule capable of being recognized by the immune system is considered an antigen (Ag).
The skin, cornea, and mucosa of the respiratory, GI, and GU tracts form a physical barrier that is the body's first line of defense. Some of these barriers also involve immune functions and other active defenses:
Breaching of anatomic barriers can trigger 2 types of immune response: innate and acquired. Many molecular components (eg, complement, cytokines, acute phase proteins) participate in both innate and acquired immunity.
Innate
immunity:
Innate (natural) immunity does not require prior exposure to an Ag (ie, memory) to be effective. Thus, it can respond immediately to an invader. However, it recognizes mainly Ag molecules that are broadly distributed rather than specific to one organism or cell. Components include
Phagocytic cells (neutrophils and monocytes in blood, macrophages and dendritic cells in tissues) ingest and destroy invading Ags. Attack by phagocytic cells can be facilitated when Ags are coated with antibody (Ab), which is produced as part of acquired immunity. Ag-presenting cells (macrophages, dendritic cells) present fragments of ingested Ags to T cells (which are part of acquired immunity). Natural killer cells kill virus-infected cells and some tumor cells. Certain polymorphonuclear leukocytes (eosinophils, basophils, mast cells) release inflammatory mediators.
Acquired
immunity:
Acquired (adaptive) immunity requires prior exposure to an Ag and thus takes time to develop after the initial encounter with a new invader. Thereafter, response is quick. The system remembers past exposures and is Ag-specific. Components include
Acquired immunity derived from certain T-cell responses is called cell-mediated immunity. Immunity derived from B-cell responses is called humoral immunity because B cells secrete soluble Ag-specific Ab. B cells and T cells work together to destroy invaders. Some of these cells do not directly destroy invaders but instead enable other white blood cells to recognize and destroy invaders.
Immune
Response
Successful immune defense requires activation, regulation, and resolution of the immune response.
Activation:
The immune system is activated when a foreign Ag is recognized by circulating Abs or cell surface receptors. These receptors may be highly specific (Ab expressed on B cells or T-cell receptors) or broadly specific (eg, pattern-recognition receptors such as Toll-like, mannose, and scavenger receptors on dendritic and other cells). Broadly specific receptors recognize common microbial pathogen-associated molecular patterns in ligands, such as gram-negative lipopolysaccharide, gram-positive peptidoglycans, bacterial flagellin, unmethylated cytosine-guanosine dinucleotides (CpG motifs), and viral double-stranded RNA. Activation may also occur when Ab-Ag and complement-microorganism complexes bind to surface receptors for the crystallizable fragment (Fc) region of IgG (FcγR) and for C3b and iC3b.
Once recognized, an Ag, Ag-Ab complex, or complement-microorganism complex is phagocytosed. Most microorganisms are killed after they are phagocytosed, but others (eg, mycobacteria) inhibit the phagocyte's ability to kill them once they are engulfed. In such cases, T cell–derived cytokines, particularly interferon-γ (IFN-γ), stimulate the phagocyte to produce lytic enzymes and other microbicidal macrophage products, which kill the microorganism.
Unless Ag is rapidly phagocytosed and entirely degraded (an uncommon event), the acquired immune response is recruited. This response begins in the spleen for circulating Ag, in regional lymph nodes for tissue Ag, and in mucosa-associated lymphoid tissues (eg, tonsils, adenoids, Peyer's patches) for mucosal Ag. For example, Langerhans' dendritic cells in the skin phagocytose Ag and migrate to local lymph nodes; there, peptides derived from the Ag are expressed on the cell surface within class II major histocompatibility complex (MHC) molecules, which present the peptide to CD4 helper T (TH) cells. When the TH cell engages the MHC-peptide complex and receives various costimulatory signals, it is activated to express receptors for the cytokine IL-2 and secretes several cytokines. Each subset of TH cells secretes different substances, which effect different immune response (see Biology of the Immune System: T cells).
Class II MHC molecules present peptides derived from extracellular (exogenous) Ag to CD4 TH cells; in contrast, class I MHC molecules present peptides derived from intracellular (endogenous) Ag (eg, viruses) to CD8 cytotoxic T cells. The activated cytotoxic T cell then kills the infected cell.
Regulation:
The immune response must be regulated to prevent overwhelming damage to the host (eg, anaphylaxis, widespread tissue destruction). Regulatory T cells (most of which express Foxp3 transcription factor) help control the immune response via secretion of immunosuppressive cytokines, such as IL-10 and transforming growth factor-β (TGF-β), or via a poorly defined cell contact mechanism. These regulatory cells help prevent autoimmune responses and probably help resolve ongoing responses to nonself Ag.
Resolution:
The immune response resolves when Ag is sequestered and eliminated from the body. Without stimulation by Ag, cytokine secretion ceases, and activated cytotoxic T cells undergo apoptosis. Apoptosis tags a cell for immediate phagocytosis, which prevents spillage of the cellular contents and development of subsequent inflammation. T and B cells that have differentiated into memory cells are spared this fate.
Geriatrics
Essentials
With aging, the immune system becomes less effective in the following ways:
The immune system becomes less able to distinguish self from nonself, making autoimmune disorders more common.
Macrophages destroy bacteria, cancer cells, and other Ag more slowly, possibly contributing to the increased incidence in cancer among the elderly.
T cells respond less quickly to Ag.
There are fewer lymphocytes that can respond to new Ag.
The aging body produces less complement in response to bacterial infections.
Less Ab is produced in response to Ag, and Ab is less able to attach to Ag, possibly contributing to the increased incidence of pneumonia, influenza, infectious endocarditis, and tetanus and the increased risk of death due to these disorders among the elderly. These changes may also partly explain why vaccines are less effective in the elderly.
Last full review/revision September 2008 by Peter J. Delves, PhD
Content last modified September 2008
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