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.