T I P S , T R I C K S &

The Immune System Game

TECHNIQUES 

K i r s t e n A . W o r k , M e l i s s a A. G i b b s,
E r i c h J. F r i e d ma n

Abstract game will teach them about the basic components and actions of the
specific immune response (only the key immune cells of each system
We describe a card game that helps introductory biology students understand
are included in this simulation), as well as emphasize the similarities
the basics of the immune response to pathogens. Students simulate the steps of
in the immune responses to viruses and bacteria. The game is also
the immune response with cards that represent the pathogens and the cells and
­molecules mobilized by the immune system. In the process, they learn the similar-
useful as a pre-exam review of material covered during lecture.
ities and differences between the immune responses to viral and bacterial patho-
To play the game, students can work alone or in groups of two or
gens and why the primary and secondary responses differ. three, and they should be able to complete all four simulations within
1 hour. Some students may kill off the pathogen before their specific
Key Words: Immune system; card game; pathogen. immune system is fully functional, and a few others may find their
immune systems quickly overwhelmed (death or at least in need of
medical attention), while most students will activate a normal, robust
Biological literacy is a commonly desired goal of biological educa- immune response that eventually overwhelms the pathogen. If time
tion; however, there are multiple levels of biological literacy that permits, students can reset and restart the game if they immediately
represent different levels of mastery of mate- kill or are killed by the pathogen. If class time is
rial (Uno  &  Bybee, 1994). A student who is limited, those exceptions can illustrate varying
nominally literate may recognize terms but A student who is degrees of response of the immune system to
have major misconceptions. A student who nominally literate may pathogens.
is functionally literate may have memorized Each kit contains all of the materials
terms and processes but cannot explain pro- recognize terms but have needed to model both the primary and sec-
cesses in his or her own words. A structurally ondary responses to both viral and bacterial
literate student, on the other hand, has a con- major misconceptions. pathogens. After completing the exercise, pre-
ceptual knowledge of biological processes that sentation of a review sheet can reinforce the
includes an understanding of how these processes proceed (Uno & concepts presented in the game. See the Appendix for game cards
Bybee, 1994). Subjects such as the immune system are of interest and review sheets.
to many students but are sufficiently complicated – with many cells
with different functions activated at different times during an immune
JJ  Materials for Each Kit
response – that structural literacy and self-efficacy eludes many or
most students in introductory biology courses. • Playing cards printed on different colors of card stock (plus
Here, we describe a game designed to simulate a simplified some extras)
human immune response to bacteria and viruses. The immune • Body bag (paper lunch bag with body outline attached)
system is often given short shrift in the typical introductory biology
• Coin
courses, so we created a game that students can play either during or
outside of class. The game simulates a simplified immune response • Paperclip (to attach a memory cell to the body bag)
to viral and bacterial infections (both primary and secondary expo- • Snack-size Ziploc bags to keep each type of playing card
sures). Before playing the game, students should be familiar with the organized
concepts of innate and adaptive (specific) immune responses, but the • Gallon Ziploc bag for storing each kit

The American Biology Teacher, Vol. 77, No. 5, pages 382–390. ISSN 0002-7685, electronic ISSN 1938-4211. ©2015 by National Association of Biology Teachers. All rights reserved.
Request permission to photocopy or reproduce article content at the University of California Press’s Rights and Permissions Web site at www.ucpressjournals.com/reprintinfo.asp.
DOI: 10.1525/abt.2015.77.5.11

3 82 The american biology teacher volume 77, No. 5, May 2015

 Instructions for Students
JJ   pathogen (cover the pathogen with the macrophage card, and
then add two macrophages to the body bag to represent the
The object of the game is to eliminate an infectious agent from your movement of that macrophage to the lymph nodes and activa-
body by removing all of the pathogen. At the completion of this tion of macrophages there). If you get tails, the macrophage
game, you should be able to can’t see your pathogen and returns to the body bag.
• identify the cells involved in the immune system from 3. If the macrophage eats the pathogen, it presents the patho-
diagrams; gen’s antigens to the immune system. The antigen will also will
attract TH cells (add two TH cards to the body bag to repre-
• put the steps of immune system response in the appropriate
sent the increased density of these cells in the vicinity of the
order;
infection).
• distinguish between primary and secondary immune responses;
4. Continue drawing until you get a TH card and place it on the
and
macrophage–pathogen stack to represent the maturation of the
• describe why an infected person will feel sick shortly after infec- TH cell.
tion and why this feeling of sickness will dissipate.
5. Primary Infection: Activated TH cells will activate B cells
In most cases, when a new infectious agent gets into your (add two B cells to the body bag to simulate the proliferation
body, the bacteria or viruses are never able to proliferate because of cells that occurs during activation). Continue drawing until
the phagocytic cells of your innate immune system recognize and you get a B cell (place it on the TH cell stack to represent the
destroy many common benign pathogens before you can get sick. activation of naive B cells by TH cells). (Continue to step 6.)
This innate response is not very specific and cannot protect us from
OR
all pathogens, but it can activate the adaptive immune system when
a more powerful immune response is needed. When the infectious Secondary Infection: After a TH cell binds to the macrophage,
agent is able to proliferate, the cells (T & B) and proteins (antibodies) it will activate the memory B cell you clipped to the body bag
during the primary infection. The memory B cells immediately
of the adaptive immune system efficiently distinguish between self
proliferate and produce antibodies. (Skip to step 7.)
and nonself (the infectious agent) cells and mount an immune attack
directed specifically at that particular infectious agent. The adaptive 6. Once the B cells have been activated, your immune system
immune response is, however, relatively slow to develop the first time needs 14 days (14 draws from the body bag, during which
a particular infectious agent is detected (the primary response). After you continue to follow the rules governing pathogen and mac-
detection of the infectious agent, it takes time to develop a specific rophage behavior; steps 1 and 2) to produce antibodies and
response that has mobilized a sufficient number of antibodies and memory B cells (be sure to clip a B cell to the body bag for use
during the secondary infection).
immune cells; during that time, the infectious agent can proliferate
and make you sick. Eventually, your specific immune response to 7. Place an antibody on every exposed pathogen on your
that specific infectious agent will trigger the production of antibodies desk. Any pathogens that are subsequently drawn from
that help your immune system fight off the pathogen. Additionally, the body bag after the antibodies have been produced will
in the process of making antibodies, your adaptive immune system also bind to an antibody and will not be able to reproduce
will have made memory cells that will allow you to mount a rapid (antibodies interfere with basic pathogen functions, such as
immune response the next time you are exposed to the infectious reproduction).
agent (secondary infection). This response typically happens so fast 8. Continue drawing from the body bag until you have drawn
that the infectious agent cannot proliferate, and usually you do not enough macrophages to kill all of the pathogens (remember
get sick. that once the pathogen binds to an antibody, macrophages will
always find the antibody-labeled pathogen; no need for a coin
For a Bacterial Infection flip).
Add the bacterial starter kit to your body bag (Table 1). At this point, 9. Once the pathogens on your desk have been consumed, count
there are four types of cards in the body bag: (1) three pathogens, and record the ratio of pathogens to white blood cells (WBCs)
(2) one macrophage, (3) one B cell, and (4) one helper T cell. The in the body bag.
body bag represents your body, and the playing cards are the immune 10. Return the cards to their bags. After you have modeled the
cells and infectious agents that are circulating in your body and doing primary infection, run a secondary infection.
battle. 11. How do the pathogen: WBC ratios compare between the pri-
mary and secondary infections?
For a Primary Bacterial Infection
Teachers: Because of the 2-week (14 draws) interval between acti-
1. Draw a card from the body bag. If you draw a bacterial pathogen, vating B cells and the production of antibodies, students should
put it on your desk and add another to your body bag (it has find (on average) that during primary infections, the pathogens are
replicated). If you draw a Helper T cell or a B cell, return the more likely to overwhelm the immune system (increased pathogens,
card to the body bag; those cells cannot recognize or act against decreased WBCs), while the rapid response of the secondary response
a pathogen without first having the antigens presented to them should overwhelm the pathogens with WBCs (decreased pathogens,
by a macrophage. Draw again from the body bag. increased WBCs).
2. If you draw a macrophage and have a pathogen on your desk, 12. What is the relationship between the innate and adaptive
flip a coin. If you get heads, the macrophage finds and eats a immune systems?

The american biology teacher The Immune System Game 383

Table 1. Bacterial starter kit.
Bacterial Pathogen
Bacterial pathogens represent the infection. The surface of these cells is covered with unique
antigens, which the immune system can recognize as “nonself”. Although macrophages can
recognize pathogens as “nonself” and consume them as part of the innate immune response,
the pathogen’s antigens must be presented to the immune system before an adaptive immune
response can be initiated.

White Blood Cells

Macrophages are part of the innate immune response. They are phagocytic cells that recognize
the pathogens as “nonself,” eat the pathogens, and present the pathogen’s antigens to the
immune system (activating the adaptive immune system). Until the adaptive immune system
is activated by the macrophage-presented antigens and starts making antibodies (humoral
response), the macrophages may or may not find the pathogens. Once a macrophage has
consumed a pathogen, it migrates to the lymph nodes, presents the antigens to T and B white
blood cells, and secretes cytokines. Helper T cells are activated by the cytokines and begin
to proliferate, producing their own cytokines, which in turn induces proliferation of more
macrophages.
Helper T cells (TH) are part of the adaptive immune system. They are activated by macrophage
cytokines. Activated TH cells proliferate and then produce cytokines that activate B cells. TH cells
also produce cytokines that induce proliferation of macrophages.

B cells are part of the adaptive immune system. They make antibodies for immediate use and
memory cells, which are stored for future use. After B cells are activated, it takes 14 days for them
to produce specific antibodies that will target the invading pathogen. B cells are inactive until
a macrophage has consumed one of the pathogens, TH cells have been activated, and TH cells
activate the B cells.

Antibodies are part of the adaptive immune system. They are proteins that label pathogens and
interfere with cellular function, making it easy for macrophages to find them.

Teachers: The innate immune system activates the adaptive immune system game and simplicity, only the dendritic cell will serve as the antigen-
when the phagocytic cells present antigens to the inactive adaptive immune presenting cell, and T C cells as the primary destroyer of infected
system in the lymph nodes. cells.

For a Viral Infection For an Initial Viral Infection

Add the viral starter kit to your body bag (Table 2). At this point,
there are five types of cards in the viral body bag: (1) three virus- 1. Draw a card from the body bag.
infected cells, (2) one dendritic cell, (3) one cytotoxic T cell, (4) one 2. If you draw a virus-infected cell, lay the card on your desk and
helper T cell, and (5) one B cell. The body bag represents your body, add one virus-infected cell to the body bag (to represent the
and the playing cards are the immune cells and infectious agents that virus reproducing).
are circulating in your body and doing battle. 3. If you draw any WBC before you have any virus-infected
Teachers: Although T C and dendritic cells both can destroy virus- cells on your desk, return the WBC to the body bag (the WBCs
infected cells during the immune response, for the purposes of this can’t act until there is an infection).

3 84 The american biology teacher volume 77, No. 5, May 2015

Table 2. Viral starter kit.
Virus-infected Cell
A viral pathogen is represented by a virus-infected cell, which contains many individual viruses;
if it ruptures, it will spread those viruses to healthy cells and infect them. The infected cells
bear antigens that identify the cell to the immune system as “nonself,” but the immune system
still needs to be activated in the lymph nodes by an antigen-presenting cell (the phagocytic
dendritic cell).

White Blood Cells

Dendritic Cells are part of the innate immune system. They are phagocytic cells that behave a
lot like the macrophages in the bacterial immune response, in that they detect and consume
pathogens, travel to the lymph nodes, and present the pathogen’s antigens. The physical
interaction between the antigens the dendritic cell is presenting, inactive TH and TC cells, and the
cytokines the dendritic cell produces activate the TH and TC cells.

Cytotoxic T cells (TC) are part of the adaptive immune system. They are primarily responsible for
binding to and destroying virus-infected cells. TC cells are activated and begin proliferating after
physical interaction with antigen-presenting dendritic cell and dendritic cell cytokines. They are
also activated by TH cells. When TC cells proliferate and produce cytokines, they will also activate
TH cells.

Helper T cells (TH) are part of the adaptive immune system. Once activated, TH cells will use their
own cytokines to activate B cells and more TC cells.

B cells are part of the adaptive immune system. They make antibodies and memory cells. After
B cells are activated by TH cytokines, it takes 14 days for them to produce antibodies that will
specifically target the virus-infected cell. B cells can’t act until a dendritic cell has consumed one
of the virus-infected cells and a TH cell has been activated.

Antibodies are proteins that interfere with cellular function and label virus-infected cells for
destruction by TC cells.

4. If you draw a dendritic cell and have infected cells on your and bind to the infected cell and then activate B cells using
desk, flip a coin. If you get tails, the dendritic cell can’t find cytokines (represent the activation of the TH cell by covering
your infected cell and returns to the body bag. If you get heads, the dendritic stack with the TH cell, and then add two B cell
the dendritic cell finds and consumes the virus-infected cell cards to the body bag to represent activation of B cells by the
(represent this by covering the infected cell with the dendritic TH cells). If you already had a memory B cell clipped to your
cell) and moves to the lymph nodes, where TC and TH cells are body bag, you can immediately initiate a secondary immune
activated by dendritic cell cytokines. response.
5. If you then draw a TH cell after a dendritic cell binds the 6. Primary infection: When you draw a B cell, this represents full
infected cell, because it is now activated, it will first recognize activation of a primary immune response. Your newly activated

The american biology teacher The Immune System Game 385

 B cells need time to produce antibodies (14 days), so you must 10. How do the infected cell:WBC ratios compare between the pri-
draw from the body bag 14 more times, and continue to follow mary and secondary infections? Why?
the original rules for pathogen reproduction. Teachers: Because of the 2-week (14 draws) interval between activating
OR B cells and the production of antibodies, students should find (on average)
Secondary infection: The memory B cells immediately pro- that during primary infections, the pathogens are more likely to over-
duce antibodies (get the antibody bag from your kit and place whelm the immune system (increased pathogens, decreased WBCs),
an antibody on every exposed infected cell on your desk). Any while the rapid response of the secondary response should overwhelm the
infected cell you draw from the body bag after the antibodies pathogens with WBCs (decreased pathogens, increased WBCs).
have been produced will also bind to an antibody from your
antibody bag and will not be able to reproduce.
7. Continue drawing cards from the body bag until you have Reference
drawn enough TC cells to kill each of the virus-infected Uno, G.E. & Bybee, R.W. (1994). Understanding the dimensions of biological
cells. literacy. BioScience, 44, 553–557.
8. Once all of the virus-infected cells have been consumed, count
and record the ratio of virus-infected cells to WBCs in the body
MELISSA GIBBS and KIRSTEN WORK are Associate Professors of Biology, and
bag.
ERICH FRIEDMAN is an Associate Professor of Math and Computer Science,
9. Return cards to their bags and reset the game. After you have all at Stetson University, 421 N. Woodland Blvd., DeLand, FL 32723; e-mail:
modeled the primary infection, run a secondary infection. [email protected]; [email protected]; [email protected].

Appendix
Immune System Game Playing Cards
Print out each different type of card on colored cardstock. The number in parentheses is the number of cards you are likely to need
per kit.

Antibodies (30)

B-cells (4)

3 86 The american biology teacher volume 77, No. 5, May 2015

 Helper T-cells (4)

Virus-infected cells (40)

Cytotoxic T-cells (40)

Phagocytes (40)

The american biology teacher The Immune System Game 387

 Bacterial pathogens (40)

Body outline to tape to the outside of the Body Bag

3 88 The american biology teacher volume 77, No. 5, May 2015

 Bacterial Invasion

Primary infection
A pathogen enters the body

Macrophage finds and consumes the pathogen

Macrophage travels to lymph nodes, presents antigens to immune system & produces cytokines

Macrophages proliferate & cytokines activate TH

TH cells produce cytokines

Naive B cells activated Macrophages proliferate

B cells proliferate

After 14 days, B cells proliferate

B cells make memory B cells B cells make antibodies

Antibodies label pathogens

Macrophages find & consume labeled pathogens

*** For a secondary infection, memory B cells are activated instead of naive cells,
and there is no 14-day waiting period; memory B cells will immediately produce antibodies

The american biology teacher The Immune System Game 389

 Viral Invasion

Primary infection

Cell is infected with a virus

Infected cell is consumed by a dendritic cell

Dendritic cell travels to lymph nodes, presents antigens to immune system & produces cytokines

TH or Tc cells are activated by dendritic cell cytokines

TH cells proliferate & produce cytokines Tc cells proliferate and produce cytokines
activating more Tc activating more TH

TH cell cytokines activate naive B cells

After 14 days, B cells proliferate,

B cells make memory B cells B cells make antibodies

Antibodies interfere with viral functions Tc cells find &

and label cells for destruction by Tc destroy labeled
infected cells

** For a secondary infection, memory B cells are activated instead of naive cells, and
there is no 14-day waiting period; memory B cells will immediately produce antibodies

3 90 The american biology teacher volume 77, No. 5, May 2015

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