Immunology Lecture Notes Immunology Lecture Notes Ian Todd MA, PhD, FHEA Associate Professor and Reader in Cellular Immunopathology University of Nottingham School of Life Sciences Queen’s Medical Centre Nottingham Gavin Spickett MA, LLM DPhil, BM BCh, FRCPath, FRCP, FRCPE Consultant and Senior Lecturer in Clinical Immunology Royal Victoria Infirmary Newcastle upon Tyne Lucy Fairclough BSc, MSc, PhD Assistant Professor in Immunology University of Nottingham School of Life Sciences Queen’s Medical Centre Nottingham Seventh Edition This edition first published 2010 © 2015 by John Wiley & Sons, Ltd Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030‐5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley‐blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. 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Set in 8.5/11pt Utopia by SPi Global, Pondicherry, India 1 2015 Contents Preface to the seventh edition, vii From the preface to the first edition, viii Key to symbols used in this edition, ix Overview of the immune system, x Part 1 Immunity and the Immune System 1 The nature of immunity, 3 2 Immune recognition, 14 3 Lymphocyte development and activation, 34 4 Lymphocyte interactions, cytokines and the lymphoid system, 45 5 Immunoglobulins, 63 6 Complement, 79 7 Phagocytes, 87 8 Mast cells, basophils and eosinophils, 94 9 Killer cells, 101 Part 2 Immunopathology 10 Immunity and infection, 111 11 Primary and secondary immunodeficiency disorders, 126 12 The generation of tissue‐damaging responses, 148 13 Mechanisms of immunological tissue damage, 167 14 Lymphoproliferative disease, 179 15 Transplantation, 191 16 Immunological therapy, 203 Part 3 Self-assessment: answers Self-assessment: answers, 215 Index, 221 Preface to the seventh edition The first edition of Lecture Notes: Immunology that New features of this seventh edition have been intro- was published in 1987 was conceived and written by duced to help maximize the reader’s acquisition of Professor Gordon Reeves to provide an introduction knowledge and understanding from the text. Clinical to immunology and show its relevance to students of Case Scenarios have been introduced throughout to medicine and biology in a straightforward and com- give clinical contextualisation of important immuno- prehensible way, avoiding unnecessary detail and logical principles and to illustrate the scientific basis of jargon. These principles have been maintained in clinical understanding and reasoning. The introduc- successive editions, whilst updating the text to take tory chapter has been substantially revised and the account of advances that clarify understanding of the sections on clinically relevant immunological methods immune system and the application of this knowl- in Chapters 4 and 5 have been completely updated. edge to medicine. These criteria have also been The content has been revised throughout to incorpo- applied in formulating this seventh edition of Lecture rate important new knowledge and concepts that aid Notes: Immunology. basic understanding of the immune system and immu- This is the first edition of Lecture Notes: Immunology nopathology. More detail has been added to many of to be published with full colour illustrations. We have the answers to the self‐assessment questions so that taken advantage of this by including photographs of readers can more fully appreciate why their own important clinical features of a number of immuno- answers are right (or wrong!). We hope that all of these pathological conditions. We have also incorporated new features will make the reading of this book both high quality molecular graphic images of key mole- more informative and more enjoyable. cules of the immune system (antibodies, T‐cell recep- tors and HLA proteins); we are especially grateful Ian Todd to our colleague, Dr Paddy Tighe (University of Gavin Spickett Nottingham) for producing these molecular images. Lucy Fairclough From the preface to the first edition The undergraduate student meeting immunology This text is based on the teaching modules developed during a busy medical or biological sciences curricu- in the Nottingham Medical School which have been lum or the qualified doctor attempting to get to grips designed to provide sufficient grounding to enable with the subject for specialist training is often students to comprehend and utilize developments in daunted by what appears to be an opaque wall of immunology in their practice of medicine. Students mystifying jargon surrounding a mass of intricate often feel more comfortable with the detail when they information. The aim of Lecture Notes on Immunology have glimpsed the whole and for this reason the initial is to provide a concise statement covering the basic chapter outlines the salient features of immunity. These facts and concepts that are essential for a first under- are also summarized in an ‘overview of the immune standing of the subject and its relevance to medicine system’ presented as the frontispiece. Many of these and allied disciplines. Nomenclature has been thoughts have been stimulated by the, often penetrating, simplified and appropriately defined and the major questions of first‐year students as well as the more clini- principles introduced in a biological setting. Figures cally informed enquiries of medical graduates and I and tables are used to summarize or highlight impor- hope that this text will assist the questioning process. tant information, and key words are emphasized in the text in bold type. Gordon Reeves