OVERVIEW

OF
IMMUNOLOGY

Hj.NOORMARTANY. dr, SpPK (K), M.Si

CLINICAL PATHOLOGY OF
MEDICAL FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY

REFERENCES

1. Immunologgy
Ivan Roitt, Jonathan .B, David.M.
2. Essentials of Immunology and Serology
J. Stanley
3. Basic & Clinical Immunology
Daniel P.S, Abba I.T, Tristram G.P.
4. Immunology: an introduction
Tizard
5. Basic Immunology
Abbas A.K & Lichtman A H
6. Imunologi : Diagnosis & Prosedur
Laboratorium
Siti Budina Kresno

Immune system
Innate

No Memory
No Specificity

Adaptive

Memory
Specificity

Immune system

Host Defenses In Innate Immunity

Cells

Antigen Presenting Cells

Basophils
Eosinophils
Mast cells
NK cells
Phagocytes

Humoral Factors Complement proteins

Lactoferin
Lysozyme
Pepsin
Stomach acidity
Anatomical Barriers Cilia
Mucus
Skin
Resident Flora Mainly nonpathogenic bacteria

Cells of Innate Immunity and their

role in host defense
Antigen Presenting Cells Present antigen to T cells
Basophils & Mast cells
Permeability

Increase Vascular

Eosinophils

Destroy helminths

NK cells

Destroy infected cells

(virally invected cells)

Phagocytes

Engulf antigen extracellular

in to vacuole and destroyed

Host Defenses In Adaptive Immunity

Cells

Humoral Factors

B cells
Plasma cells
T cytotoxic cells
T helper cells

Antibodies
Cytokines

THE ELEMENTS
IN
IMMUNOLOGY

IMMUNE RESPONSE
MANIFESTATION

CLINICAL IMMUNOLOGY

IMMUNNOLOGICAL
DIAGNOSTICS

LABORATORY
IMMUNOLOGICAL TECHNIQUES

ANTIGENS
ANTIBODIES
THE ELEMENTS
IN
IMMUNOLOGY

COMPLEMENTS
LYMPHORETICULER
SYSTEM

MHC /HLA
SURFACE LEUCOCYTE
MOLECULES

ANTIGENS
A MOLECULE WHICH
INDUCES THE FORMATION
OF ANTIBODY

ANTIBODY
SECRETED
IMMUNOGLOBULIN
PROTEINS
PARTICULARLY
THOSE THAT CAN
BIND SPECIFICALLY
TO A GIVEN ANTIGEN

Antibodi

ANTIBODIES

Polypeptide Chain Structure Four Human Ig G

Subclasses

Structur of IgG

Structure of Ig D

Structure of Ig E

Structure of Ig M

Structure of sIgA

Structure of IgA1

COMPLEMENTS

COMPLEMENTS

LYMPHORETICULER
SYSTEM

MHC /HLA

HLA CLASS I

HLA CLASS II

SURFACE LEUCOCYTE
MOLECULES

Origin of Cells Involved In The Immune

Response

MANIFESTATION
OF
IMMUNE RESPONSES
HUMORAL
IMMUNE RESPONSES
CELLULAR
IMMUNE RESPONSES
HYPERSENSITIVITY
REACTIONS
INFECTIONS
IMMUNE RESPONSES

Some non-Specific Mechanisms

Involved In Immunity

CLINICAL IMUNNOLOGY
1.

IMMUNODEFICIENCY

2.

LYMPHOPROLIVERATIVE
DISORDERS

3.

HYPERSENSITIVITY

4.

AUTOIMMUN DISEASE

5.

IMMUNE COMPLEX

IMMUNODEFICIENCY

I.

ANTIBODY (B CELL)
IMMUNODEFICIENCY DISORDERS

II. T CELL IMMUNODEFICIENCY

DISORDERS
COMBINED ANTIBODY (B CELL)
III.
AND CELLULAR (T CELL)
IMMUNODEFICIENCY DISORDERS
IV.
V.

PHAGOCYTIC DYSFUNCTION
DISEASES
COMPLEMENT DEFICIENCIES

LYMPHOPROLIVERATIVE
DISORDERS

ACUTE LYMPHOCYTIC LEUKEMIA

CHRONIC LYPHOCYTIC LEUKEMIA

PLASM CELL NEOPLASMS & DYSCRASIAS

* MULTIPLE MYELOMA
* WALDENSTROMS MACROGLOBULINEMIA
* LYMPHOMA
* MONOCLONAL GAMMOPATHY
UNDETERMINED SIGNIFICANCE (MGUS)
* HEAVY CHAIN DISEASE

HYPERSENSITIVITY
* TYPE I
- ASTHMA
- ECZEMA

- RHINITIS
- HAY FEVE

- URTICARIA

* TYPE II
(ANTIBODY DEPENDENT CYTOTOXIC)

- TRANSFUSION REACTIONS
- HAEMOLYTIC DESEASE OF THE NEWBORN
- AUTOIMUNE HAEMOLYTIC ANEMIA
- MYASTHENIA GRAVIS
* TYPE III
- AUTO IMMUNE COMPLEXES DISEASE
- THE ARTHUS REACTION
* TYPE IV
- DELAYED TYPE OF HYPERSENSITIVITY
- JONES MOTE HYPERSENSITIVITY
- DERMATITIS CONTACT
- TUBERCULIN-TYPE HYPERSENSITIVITY
- GRANULOMATOUS HYPERSENSITIVITY

HYPERSENSITIVITY

SPECTRUM OF
AUTOIMMUNE DISEASE
ORGAN
SPESIFIC

NON
ORGAN
SPESIFIC

Hashimotos thyroiditis
Primary myxoedema
Thyrotoxicosis
Pernicious anemia
Autoimmune atrophic gastritis
Addisons disease
Premature menopause (few cases)
Insulin dependent Diabetes mellitus
Goodpastures syndrome
Myasthenia gravis
Male infertility (few cases)
Pemphigus vulgaris
Pemphigoid
Symphatetic ophthalmia
Phagogenic Uveitis
Multiple Sclerosis (?)
Autoimmune Haemolytic anaemia
Idiophatic Thrombocytopenic purpura
Idiophatic leucopenia
Primay biliary cirrhosis
Active chronic hepatitis (HBsAg - )
Cryptogenic cirrhosis (some cases)
Ulcerative Collitis
Sjogrens Syndrome
Rhematoid arthritis
Dermatomyositis
Scleroderma
Mixed Connective tissue disease
Discoid lupus erythematosus
Systhemic lupus erythematosus

IMMUNE COMPLEX
IMMUNE COMPLEX ALLERGIC DISEASE
* THE ARTHUS REACTION
* SERUM SICKNESS
IMMUNE COMPLEX
GLOMERULONEPHRITIS
IMMUNE COMPLEX SYSTEMIC LUPUS
ERYTHEMATOSUS
IMMUNE COMPLEX HEMOLYTIC
ANEMIA

Deposition of Immune Complexes in

Blood Vessel Wall Type 1&2

The Arthus Reaction

The Site of Complex

Deposition In The Kidney

Immuno diagnostics
Immunologic
Competence
Test

Immuno
diagnostics

Immuno
Serologic
Test

Tumor
Marker
Test

Non
Specific
Immune
Response
Test

Leukocyte
Function
Test
Chemotactic Fs
Test
Ingestion Fs
Test
Intracellular
Killing Fs Test

Immunologic
Competence
Test

Quantitative
Lymphocyte
T & B count
Specific
Immune
Response
Test

Lymphocyte T
Subset count
Qualitative
*Lym.Transfor T.
*DNA Syn.rate T.
*Mixed cult. reac.
*Cytotoxicity.T
*Lym. Produc.T.

Leukocyte
Function
Test

Ingestion
and
metabolism
Function
Test

To analyses
Reduction NBT
To count bacteria
in leukocyte with
Flowcytometry
To analyses Reactive
oxygen species with:
Spectrofotometry,
Flourometry or
Chemiluminescen
Syntesis and
Secretion cytokine
With RIA or ELISA

Immunoserologic
Test

Tumor Marker Test

Typhoid
Streptococcus
Gonococcus
Syphilis
Hepatitis etc

CEA
AFP
PSA
Ca 19-9
Ca 125
MCA
Cyfra 21
HCG
etc

THANK YOU

IMMUNOLOGICAL
TECHNIQUES

*ANTIGEN-ANTIBODY INTERACTIONS
*ISOLATION OF PURE ANTIBODIES
*ASSAY FOR COMPLEMENT
*ISOLATION OF LYMPHOCYTE
POPULATIONS
*EFFECTOR CELL ASSAYS
FLOWCYTOMETRY AND CELL SORTING
(FLOURECENCE ACTIVATED CELL SORTER)
STRUCTUR ANALYSIS AND EXPRESION GEN

ANTIGEN-ANTIBODY
INTERACTIONS
A. Precipitation Reaction in Gels
a. Immuno-double diffusion
b. Immunoelectrophoresis
c. Single Radialimmunodiffusion
d. Countercurrent electrophoresis
e. Rocket electrophoresis

B. Haemaglutination
C. Complement Fixation
D. Immunofluorescence
a. Direct
b. Indirect
c. Indirect Complement Amplified

E. Radioimmunoassay
(RIA)
F. Enzyme-Linked Immunosorbent
Assay (ELISA)
G. Radioallergosorbent test
(RAST)
H. Radioimmunosorbent test
(RIST)
I. Immunoblotting

2
ISOLATION OF
PURE ANTIBODIES

3
ASSAY FOR
COMPLEMENT

ISOLATION OF
LYMPHOCYTE
POPULATIONS

* Lymphocyte Separation
on Ficoll Isopaque
* Isolation of Lymphocyte
Sub-populations-rosetting
* Isolation of Lymphocyte
Sub-population-panning

EFFECTOR CELL
ASSAY

* Plaque forming cell assay-I

* Plaque forming cell assay-II

a. Indirect plaques
b. Direct plaques
c. Reversed plaques
* The lymphocyte stimulation test
* Cytotoxicity assay by chromium
release.

FLOWCYTOMETRY
AND CELL SORTING

STRUCTUR ANALYSIS
AND EXPRESION GEN

A. Precipitation Reaction in Gels

Immuno - double diffusion - II

Single Radial Immunodiffusion

Countercurrent electrophoresis
and
Rocket Electrophoresis

HAEMAGLUTINATION

COMPLEMENT FIXATION TEST

DIRECT AND INDIRECT

IMMUNOFLUORESCENCE

ENZYME-LINKED IMMUNOSORBENT ASSAY

RADIOIMMUNOASSAY (RIA)

RADIOALLERGOSORBENT TEST
(RAST)

RADIOIMMUNOSORBENT TEST
(RIST)

IMMUNOBLOTTING

ISOLATION OF PURE ANTIBODIES

( Affinity Chromatography)

MONOCLONAL ANTIBODY
PRODUCTION

ASSAY FOR COMPLEMENT

COMPONENT

LYMPHOCYTE SEPARATION ON FICOLL ISOPAQUE

ISOLATION OF LYMPHOCYTE
SUBPOPULATIONS ROSETTING

ISOLATION OF LYMPHOCYTE
SUBPOPULATIONS PANNING

T CELL LINES

PLAQUE FORMING CELL ASSAY. I

PLAQUE FORMING CELL ASSAY. II

LYMPHOCYTE STIMULATION TEST

CYTOTOXICITY ASSAY BY CHROMIUM RELEASE

Chemotactic fn test

Non
specific
immune
response
test

Leukocyte
function
test

Immunologic
competence
test

Swallowing fn test
Intracellular killing
fn test

Quantitative

Lymph. T &B count

Lymph. T subsetcount

Qualitative

a) Lymphocyte
transformation test
b) DNA synth. rate test
c) Mixed culture reaction
d) Cytotoxicity test
e) Lymphocyte
production test

Specific
immune
response
test
Immuno
diagnostics

IMUNOSEROLOGIC

TUMOR
MARKER

a)
b)
c)
d)
e)

Typhoid
Streptococcus
Syphilis
Gonococcus
Hepatitis A, B, C, D, E, G

* CEA
* AFP
* HCG
* Ca 19-9 * Ca 125 * MCA

* PSA * TPS
* Cyfra 21.1