Immunology Week 15 of the Course “Medical English”

1. Immunology Week 15 of the Course “Medical English” for Sophomore Medical Students of Taipei Medical University School of Medicine Taipei Medical University Winston W. Shen, M.D. Professor and Chairman Department of Psychiatry Taipei Medical University College of Medicine and Chief, Department of Psychiatry TMU-Wan Fang Medical Center Taipei, TAIWAN E-mail address: Shenwinw@gmail.com

2. The Schedule for the Course “Medical English” (Version of 3/29/07) • Week 1 (March 1) The Digestive System • Week 2 (March 8) The Respiratory System • Week 3 (March 15) The Cardiovascular System • Week 4 (March 22) The Musculoskeletal System (Turning in a 400-word essay on “My Visit to the Clinic (Hospital)” (in double-line space hard copy) • Week 5 (March 29) The Central Nervous System • Week 6 (April 5) No class (Spring break) • Week 7 (April 12) Urinary and Reproductive Systems • Week 8 (April 19) The First Examination • Week 9 (April 26) Medical Records (Turning in a 400-word essay on “My Favorite Book” (in double-line space hard copy) • Week 10 (May 3) Scientific Papers • Week 11 (May 10) Hematology • Week 12 (May 17) Infectious Diseases • Week 13 (May 24) The Second Examination • Week 14 (May 31) Endocrinology (Turning in a 400-word essay on “How to Be a Good Physician” (in double line space hard copy) • Week 15 (June 7) Immunology (actual class date: June 4) • Week 16 (June 14) Oncology • Week 17 (June 21) No Class • Week 18 (June 28) Final (The Third) Examination

3. Im·mu·nol·o·gy     [im-yuh-nol-uh-jee] (Origin: 1400–50; late ME < Limmūnis, exempt, equiv. to im- im- + -mūnis; common) “the branch of science dealing with the components of the immune system, immunity from disease, the immune response, and immunologic techniques of analysis.” Immune - adjective 1. protected from a disease or the like, as by inoculation. 2. of or pertaining to the production of antibodies or lymphocytes that can react with a specific antigen: immune reaction. 3. exempt or protected: immune from punishment. 4. not responsive or susceptible: immune to new ideas. - noun 5. a person who is immune. The Random House Unabridged Dictionary, Random House, Inc. 2006.

4. The Immune System The cells’ immunity consists in the lymphocytes. In the body, there are the antibodies created by lymphocytes. • The B lymphocytes are created by the marrow and contain the defensive proteins, antibodies, that chain up themselves to the heterogeneous elements. • The antibodies 100 millions of the immunity substances, which the body has got at its disposal are acquisited by the changes of particular protein-fragments. H partly, L completely. If one lymphocyte T4 allows the release of the antibodies into the plasma, IgA, IgG, IgM – we are immunized!

5. The Formidable Range of Infectious Agents Guinea worm disease is a parasitic worm infection that occurs mainly in Africa. It is also called dracunculiasis [dra-KUNK-you-LIE-uh-sis]. People get infected when they drink standing water containing a tiny water flea that is infected with the even tinier larvae of the Guinea worm

6. The First Lines of Defense against Infection (1/2) Mu.cus (Origin: 1655–65; < Lmūcus snot; akin to Gkmykt r nose, mýxa slime) a viscous, slimy mixture of mucins, water, electrolytes, epithelial cells, and leukocytes that is secreted by glands lining the nasal, esophageal, and other body cavities and serves primarily to protect and lubricate surfaces. A viscous, slimy mixture of mucins, water, electrolytes, epithelial cells, and leukocytes that is secreted by glands lining the nasal, esophageal, and other body cavities and serves primarily to protect and lubricate surfaces. “Singapore is a dry snot-sized country.” By Mark (Tan Shan) Chen Minister of Foreign Affairs, Taiwan Cilia (Origin: 1705–15; NL, pl. of cilium eyelash) Lactic acid and fatty acids in the sweat and sebaceous glands generate low pH. Staphylococcus aureus often infects the relatively vulnerable hair follicles and glands. Furuncle is also known as boil, is a type of abscesses of hair follicles. Sebacious gland1728, from L. sebaceus, from sebum "tallow, grease," probably related to sapo "soap".

7. The First Lines of Defense against Infection (2/2) www.familydoctor.co.uk/htdocs/SEX/images/sex8.jpg www.familydoctor.co.uk/htdocs/SEX/images/sex8.jpg Low pH value and commensals of vagina Flushing of urinary tract [Middle English,sharing a meal, from Medieval Latin commēnsālis : Latin com-, com- + Latin mēnsa, table.]Commensalismin biology refers to a relationship between two living organisms, where one organism benefits and the other is neither harmed nor helped. It is derived from the English word commensal, meaning the sharing of food, and used of human social interaction. The word derives from the Latin com mensa, meaning sharing a table. As with all ecological interactions, commensalisms vary in strength and duration from intimate, long-lived symbioses to brief, weak interactions through intermediaries. Originally it was used to describe the use of waste food by second animals, like the carcass eaters who follow hunting animals, but wait until they have finished their meal. In Spainish, “mesa” is a table, or a flat surface on the top of hill or mountain.

8. The Mechanism of Innate vs. Acquired Immunity • Innate immunity • The immunity power does not improve with repeated exposures to infection. • Two phargocytes (polymorphonuclear neutrophis and macrophages) can engulf bacteria. • The complement system is activated to attract phagocytic cells to the microbes and engulf them. • Acquired immunity • Antibodies are produced by B(one)-cells to act on antigen receptors. • Another class of lymphocytes, the T(hymus)-cells in concerned with intracellular infections. (Origin: 1375–1425; late ME < Linnātus inborn, ptp. of innāscī to be born, arise, equiv. to in-in-2 + nāscī to be born; cf. nascent, nativity )

9. Cells of Immune System • Phagocytes • Mononuclear phagocytes • Polynuclear phagocytes • Lymphocytes • B cells • T cells • Cytotoxic Cells • Large granular lymphocytes • Eosinphil polymorphs • Auxillary Cells • Basophils and mass cells • Platelets Adapted from: Roitt I et. Al.: Immunology, 6th edition, St. Louis: Mosby 2001

10. The Mononuclear Phargocyte System (Polymorphonuclear neutrophil in the bloodstream not shown here)

11. Neural progenitor Glial progenitor Neuronal progenitor Glial cells Neurons thebrain.mcgill.ca/.../i_09_cl_dev_2c.jpg

12. Phagocytosis

13. Figure 1-3 part 1 of 4 plu.ri.po.tent, capable of affecting more than one organ or tissue. Progenitor, a biologically related ancestor: a progenitor of the species(Middle English progenitour, from Old French progeniteur, from Latin prōgenitor, from prōgenitus, past participle of prōgignere, to beget : prō-, forward; see pro-1 + gignere, gen-, to beget) Megakaryocte, a large bone-marrow cell having a lobulate nucleus, regarded as the source of blood platelets.

14. The Prefix “Pro-” Word Family prefix meaning “before, forward, in favor of, in place of,” from L. pro “on behalf of, in place of, before, for,” also in some cases from cognate Gk.pro “before, in front of,” both from PIE *pro-, extended form of base *por- “forward, through” (cf. Skt. para “beyond,” pra- “before, forward, forth;” Gk.paros “before,” para- “from beside, against, beyond;” Goth. faura “before,” O.E. fore “before, for, on account of,” fram “forward, from”). Pro and con is attested from c.1400, short for pro and contra “for and against” (L.pro et contra). Pro.genitor Pro.state Pro.tégé Pro.tein Pro.to.plas.ma Pro.vide Pro.gram Pro.fes.sor Pro.file Pro.cre.ate Pro.duce Pro.cent Pro.claim Pro.mote Pro.hibit Pro.pel Exceptions: Prop.er Prop.er.ty Prov.erb Prov.ince Prow.ess Pro.ximity Pro.xy Proph.e.cy

15. Figure 1-3 part 2 of 4 B cell Also called –(B [one]-derive cell,a type of lymphocyte, developed in bone marrow, that circulates in the blood and lymph and, upon encountering a particular foreign antigen, differentiates into a clone of plasma cells that secrete a specific antibody and a clone of memory cells that make the antibody on subsequent encounters. 2. Also called beta cell.a cell in the islet of Langerhans that produces and secretes insulin. T cell T [hymus]-derived cell,. any of several closely related lymphocytes, developed in the thymus, that circulate in the blood and lymph and orchestrate the immune system's response to infected or malignant cells, either by lymphokine secretions or by direct contact. • NK cells, natural • killer cells, are • activated by double-stranded RNA and • fights off viral • infections and • tumors.

16. Figure 1-7 A gland near the base of the neck, 1693, Mod. L., from Gk.thymos “a warty excrescence,” used of the gland by Galen, lit. "thyme,“ probably so called because of a fancied resemblance to a bunch of thyme. (O.E.mearg "marrow," earlier mærh, from P.Gmc. *mazga- (cf. O.N. mergr,Du. merg,Ger.Marh "marrow"), from PIE *mozgho- “marrow, brains” (cf. Skt. majjan-, Avestan mazga- “marrow,” O.C.S. mozgu,Lith.smagenes “brain”). Fig. sense of “inmost or central part” is attested from c.1400.)

17. Soluble Mediators of Immunity • Complement protein • Cytokines *(1957, coined in Eng., so called because it "interferes" with the reduplication of viruses.) • Interferons* (IFNs) • Interleukins# (Ils) • Colony-stimulating factors (CSFs) • Chemokines • Other cytokines • Tumor necrosis factors • - TNFa • - TNFb • Transferring growth factor b (TGFb) • Antibodies #Any of a class of lymphokines that that act to stimulate, regulate, or modulate lymphocytes such as T cells.

20. Antigens Antibody generators “substance that causes production of an antibody,” 1908, from Ger., from Fr.antigène (1899), from anti- + Gk.gennan "to produce • –noun • Immunology. any substance that can stimulate the production • of antibodies and combine specifically with them. • 2. Pharmacology. any commercial substance that, when injected or absorbed into animal tissues, stimulates the production of antibodies. • 3. antigens of a particular type collectively • Random House Unabridged Dictionary, Random House, Inc. 2006.

21. Figure 1-32

22. Immune Responses • Recognition of the antigen • Immune effector mechanisms • Neutralization • Phagocytosis • Cytotoxic reactions Adapted from: Roitt I et. Al.: Immunology, 6th edition, St. Louis: Mosby 2001

23. The Pathways Linking Innate and Acquired Immunity

24. Synthesis of the Leukotriene (leuko(cyte) + triene, a compound containing three double bonds [tri– + -ene])

25. Clinical Examples of Immunologic Diseases • Primary immune deficiency diseases e.g. X-linked agammaglobubinemia • Human immunodeficiency virus (HIV) disease • Plasma cell disorders e.g. Multiple myeloma • Amyloidosis • Disorders of Immune-mediated injury • Diseases of immediate type hypersensitivity e.g. Atopic allergy • Immune-complex diseases e.g. Serum sickness, Systematic lupus erythematosis • Systematic sclerosis (Scleroderma) . . .

26. Symptom Trio in Stevens-Johnson Syndrome • Erythema multiforme of the skin • Increase of body temperature • Ulcerations in mucosa www.emedicine.com/derm/images/ www.postgradmed.com/.../

27. Leukotriene-related Anti-asthmatic Drugs Drug Class Leukotriene- receptor antagonists Leukotriene inhibitors Generic Name Montelukast Zileuton Zafirlukast Trade Name Singulair Zyflo Accolate

28. Exercises VI Choosing the Most Appropriate Answers 31. The __________system is considered NOT to be sterile under normal condition. (A) cardiovascular, (B) digestive, (C) central nervous, or (D) genitourinary • Which is a cell-related immunity reaction. (A) phagocytosis, (B) complement reaction, (C) chemokine reaction, or (D) interferon reaction. 33. Which of the following words belongs to the “pro-” prefix family, meaning “before”: (A) province, (B) proxy, (C) professor, or (D) prophesy.