6193MF01.qxd_cc 2/6/06 11:55 AM Page i LANGE N USMLE ROAD MAP IMMUNOLOGY 6193MF01.qxd_cc 2/6/06 11:55 AM Page ii Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treat- ment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work war- rants that the information contained herein is in every respect accurate or complete, and they disclaim all responsiblity for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be cer- tain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. 6193MF01.qxd_cc 2/6/06 11:55 AM Page iii LANGE N USMLE ROAD MAP IMMUNOLOGY MICHAEL J. PARMELY, PhD Professor Department of Microbiology, Molecular Genetics and Immunology University of Kansas Medical Center Kansas City, Kansas Lange Medical Books/McGraw-Hill Medical Publishing Division New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto 6193MF01.qxd_cc 2/6/06 11:55 AM Page iv USMLE Road Map: Immunology Copyright © 2006 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a data base or retrieval system, without prior written permission of the publisher. 1234567890 DOC/DOC 09876 ISBN: 0-07-145298-2 ISSN: 1559-5765 This book was set in Adobe Garamond by Pine Tree Composition, Inc. The editors were Jason Malley, Harriet Lebowitz, and Mary E. Bele. The production supervisor was Sherri Souffrance. The illustration manager was Charissa Baker. The illustrator was Dragonfly Media Group. The designer was Eve Siegel. The index was prepared by Andover Publishing Services. RR Donnelley was printer and binder. This book is printed on acid-free paper. 6193MF01.qxd_cc 2/6/06 11:55 AM Page v C O N T E N T S Using the Road Map Series for Successful Review . . . . . . . . . . . . . . . . . . . . . . .vii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .viii MECHANISMS AND CONSEQUENCES OF IMMUNE RECOGNITION 1. Innate Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 2. Adaptive Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 3. Antigens and Antibodies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 4. Immunoglobulin Gene Expression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 5. Antigen Recognition by Antibody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 6. T Cell Recognition of and Response to Antigen . . . . . . . . . . . . . . . . . . . . . .64 7. Major Histocompatibility Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 DEVELOPMENT OF IMMUNE EFFECTOR MECHANISMS 8. Complement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 9. B Cell Differentiation and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 10. T Cell Differentiation and Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118 11. Regulation of Immune Responses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 12. Cytokines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137 IMMUNITY IN HEALTH AND DISEASE 13. Immune Tissue Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149 14. Protective Immunity and Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .164 15. Immune Deficiency States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175 16. Autotolerance and Autoimmunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192 17. Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 v 6193MF01.qxd_cc 2/6/06 11:55 AM Page vi 6193MF01.qxd_cc 2/6/06 11:55 AM Page vii U S I N G T H E U S M L E R OA D M A P S E R I E S F O R S U C C E S S F U L R E V I E W What Is the Road Map Series? Short of having your own personal tutor, the USMLE Road Map Series is the best source for efficient review of major concepts and information in the medical sciences. Why Do You Need A Road Map? It allows you to navigate quickly and easily through your immunology course notes and textbook and prepares you for USMLE and course examinations. How Does the Road Map Series Work? Outline Form:Connects the facts in a conceptual framework so that you understand the ideas and retain the information. Color and Boldface:Highlights words and phrases that trigger quick retrieval of concepts and facts. Clear Explanations:Are fine-tuned by years of student interaction. The material is written by authors selected for their excellence in teaching and their experience in preparing students for board examinations. Illustrations:Provide the vivid impressions that facilitate comprehension and recall. CLINICAL Clinical Correlations:Link all topics to their clinical applications, promoting CORRELATION fuller understanding and memory retention. Clinical Problems:Give you valuable practice for the clinical vignette-based USMLE questions. Explanations of Answers:Are learning tools that allow you to pinpoint your strengths and weaknesses. vii 6193MF01.qxd_cc 2/6/06 11:55 AM Page viii Acknowledgments Special thanks go to my colleagues, Thomas Yankee, Kevin Latinis, Glenn Mackay, and David Cue, for their careful review of selected chapters. I am grateful to Harriet Lebowitz for her editorial advice and assistance. viii 6193MF01.qxd_cc 2/6/06 11:55 AM Page ix To Tari, for her constant love, patience, and support. To my students, who teach me something new every day. ix