Chapter 11 – Immunity

A. Defence against disease

1. External defence system
Humans have a variety of mechanisms that protect us against diseases. If we are healthy, we have
physical, chemical and cellular defences that prevent pathogens from entering the body.
From epithelia that creates an airway barrier, to hydrochloric acid that kills many bacteria or blood
clotting that prevent blood loss and entry of pathogens through the skin.

2. Internal defence system

If pathogens enter the body, the white blood recognizes and destroys them.
White blood cells are part of the immune system and recognize pathogens by the distinctive
molecules covering the pathogen surface. Some of these molecules are proteins, glycoproteins,
glycolipids and polysaccharides although Some pathogens can produce toxins and waste materials.
Any pathogen foreign to the body is called an antigen

There are 2 types of blood cells, Phagocytes and Lymphocytes. Before looking at those 2 types in
detail, there is also to look at the immune response in humans which with an example would
introduce further important features like the ability to distinguish between the self, and non-self
and the production of antibodies (which are glycoprotein that acts against specific antigens).

Everyone has molecules on the cells that are not found in any other organisms, which are often
called cell surface antigens. Although cell surface antigens do not stimulate the production of
antibodies until they enter another body. A good example is the ABO blood group system. You
would have a specific carbohydrate chain on the glycolipids and glycoprotein on your red blood
cells if you are in group A which are not found if you are in blood group B. if A blood enters a body
with blood type B then the immune system will recognize it as an antigen and produce antibodies
against it. But if the blood type is the same then the body the immune system will recognize it as
self and no antibodies are produced.

The response of lymphocytes to the presence of foreign antigens is known as an immune response.
Lymphocytes would respond by producing antibodies, while others respond by killing cells that had
been infected by the pathogens.

Antigen adalah zat yang dapat merangsang sistem kekebalan tubuh untuk menghasilkan antibodi
sebagai bentuk perlawanan.

Antibodi adalah zat kimia yang beredar di aliran darah dan termasuk dalam bagian dari sistem
imunitas atau kekebalan tubuh. Antibodi memiliki fungsi penting bagi tubuh, yaitu sebagai benteng
pertahanan terhadap virus, bakteri, dan zat beracun yang menjadi penyebab penyakit.

Inkompatibilitas ABO adalah kondisi ketika seseorang menerima tipe golongan darah yang
berbeda dalam prosedur transfusi darah. Hal ini dapat memicu reaksi sistem kekebalan tubuh
sehingga menimbulkan gejala seperti demam, mual, hingga sesak napas.

3. What is the strongest antibiotic?

Your immune system:
 Able to eliminate basically anything
 Able to remember dangerous pathogens
  Able to adopt to the pathogen
 Able to protect the most important person (you)

B. Cells of the immune system

1. Phagocytes
What are they?
Phagocytes are produced throughout life in the bone marrow. They are stored there before being
distributed around the body in the blood. They are scavengers, removing any dead cells as well as
invasive microorganisms.

How many are there?

Neutrophils are kind of phagocyte and form about 60% of the white cells in the blood.
Macrophages are larger than neutrophils and tend to be found in organs such as lungs, liver, and
others. After made in the bone marrow, they travel in the blood as monocytes.

2. Phagocytosis
A TEM of two neutrophils that have ingested several Staphylococcus bacteria. At the top right side,
one bacterium is just about to be engulfed

Stages of Phagocytosis

3. Lymphocytes
What are lymphocytes?
 Lymphocytes are smaller than phagocytes
 They have a large nucleus that fills most of the cell
 They are produced in the bone marrow before birth
 There are two types of lymphocytes (with different modes of action)
 2 Types of Lymphocytes

B-Cells T-Cells
Attack invaders outside the cells Attack infected cells
Stay in the bone marrow until they are mature Leave the bone marrow to the thymus where
and then spread throughout the body, they mature
concentrating mainly in the lymph nodes and
the spleen

When lymphocytes are mature, they circulate between the blood

and the lymph ensuring that they are well distributed throughout
the body so that they can encounter pathogens and also meet with
each other

4. Maturation of B-Lymphocytes

B-lymphocytes (B cells) remain in the bone marrow until

they are mature and then spread through the body.
During the process of maturation:
B cells gain specific cell surface receptors called B cell
receptors (BCRs).
Once mature, each type of B-lymphocyte cell can make
one type of antibody molecule.
At this stage, the antibody molecules do not leave the
B-lymphocyte cell but remain in the cell surface
membrane.

5. Antibody Production
Lymphocytes → Plasma Cell

Only one of these B-cells has an antibody receptor that is specific

to the shape of the antigen that has entered the body.
The selected B-cell divided by mitosis, some of the daughter cells
develop into plasma cells, others into memory cells.
Plasma cells secrete antibodies that specifically combine with the
antigen that has entered the body
6. Antibodies
Antibodies are all globular glycoproteins with
quaternary structure.
They form the group of plasma proteins called
immunoglobulins.
Note: Each clone of B cells makes antibody
molecules all with the same variable regions
which are complementary in shape to one
antigen.

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7. T-lymphocytes
T cells are activated when they recognise this
antigen on another cell of the host or when a
macrophage exposes the pathogen’s surface
molecules or an invaded body cell similarly
displaying the antigen on its cell surface
membrane. This is known as antigen
presentation.
Clonal selection and clonal expansion
There are 2 main types of T cell:
 T-helper cells
 T-killer cells (also known as T-cytotoxic cells)
a. T-helper cells
 Releases cytokines (cell-signalling molecules) that
 Stimulates B cells - to divide, develop into plasma cells and secrete antibodies.
 Stimulates macrophages - to carry out phagocytosis
 Stimulates T-killer cells - to divide and to differentiate by producing vacuoles full of toxins
 Forms memory T-helper cells

b. T-killer cells
 Functions:
1) Recognises the antigens
2) attach themselves to the surface of infected cells
3) punches holes in cell surface membrane of infected body cell
4) secrete toxic substances such as hydrogen peroxide, killing the body cells and the pathogen
inside.
 Forms memory T-killer cells

9700/2022/OCTOBER/NOVEMBER/13

Ans: C
Option A - not true for either of the lymphocytes
Option B - not true for either of the lymphocytes
Option D - true for only T lymphocytes

9700/13/M/J/22/40

Ans: B
 9700/12/M/J/22/40

Ans: C

9700/11/M/J/22/40

Ans: D

C. Active & passive immunity

1. Active immunity
Immunity gained when an antigen enters the body, an immune response occurs and antibodies
are produced by plasma cell (makes their own antibodies).
How it works?
Lymphocytes are activated by antigens on the surface of pathogens that have invaded the body.
When B cells encounter a pathogen, as well as differentiating into antibody-producing plasma
cells, they create memory cells. Memory cells are a type of B cell produced following the
primary infection that can recognize the pathogen. They are typically long-lived, some surviving
for decades, reactivating if the same pathogen invades again.

Types of Active Immunity

1) Natural Active Immunity
 Immunity gained by being infected by a pathogen. Acquired from exposure to the disease
organism through infection with the actual disease.
  Example: Natural immunity happens after you get infected by a germ and your immune system
responds by making antibodies to it. The infection could make you sick. But if you’re exposed to
that germ in the future, your body’s defenses spot it and fight back with antibodies. This makes
you less likely to get infected again.

2) Artificial Active Immunity

 Immunity gained by putting antigens into the body, either by injection or mouth.
 Example: Vaccination, it confers artificial active immunity without the development of
symptoms of the disease. Its functions is to stimulate active immunity against one or several
diseases.
NOTE: Both natural and artificial active immunity, the antibody concentrations in the blood change.

B&T Cell
 It takes time for enough B and T cells to be produced to give an effective defence. If a person
infected with a fatal disease such as tetanus, a more immediate defence than that provided by
active immunity is needed for survival. So people with get injection of antitoxin to kill tetanus
toxin. The antibodies are collected from blood donors who have recently been vaccinated
against tetanus.
 Antitoxin provides immediate protection, but only temporary since antibodies are not
produced by the body’s own B cells therefore it is non-self. They are removed from the
circulation by phagocytes in the liver and spleen.

2. Passive immunity
The temporary immunity gained without there being an immune response. It is when the
person has not produce the antibodies themselves but it is created outside of the individual’s
body.
 Does not require previous exposure to a disease agent (either through infection or
vaccination)
 Takes effect immediately
 Normally does not last long (up to a few months)
Passive immunity is generally short-lived as the supply of antibodies is not being replenished as
they would be in someone whose own immune system was generating them.

Types of Passive Immunity

1) Natural Passive Immunity
 The immunity gained by a fetus when maternal antibodies cross the placenta or the immunity
gained by an infant from breast milk.
 The immune system of a newborn infant is not as effective as that of a child or an adult.
However, infants are not entirely unprotected against pathogens, because antibodies from their
mother cross the placenta during
pregnancy and remain in the infant
for several months.
 Colostrum, the thick yellowish fluid produced by mother’s breasts for the first four or five days
after giving birth. It contains a type of antibody known as IgA.

2) Artificial Passive Immunity

 The immunity gained by injecting antibodies. It is produced by antitoxins because the antibodies
have not entered the body by a natural process. They have come from another person who has
encountered the antigen.
 Example: Antibodies received from a medicine (gamma globulin injection or infusion)

Active Immunity Passive Immunity

Antibodies Produce inside the body Introduced from outside of the body
Result from  Direct infection  Mother to baby transfer through
 Vaccination placenta
 Breast milk
Takes effect Over time (typically weeks) Immediately
Length of efficiency Long-term to lifelong Short-term
Generates memory cell? ✓ ✕

9700/11/May/June 2020 #39

Ans: C

9700/13/May/June 2020 #39

Ans: B
3. Vaccines
Vaccine is a preparation containing antigens which is used to stimulate an immune response
artificially.
Vaccines may contain:
 A living microorganism
 A dead microorganism
 An attenuated organism
 Toxoid
 Surface antigens
Ways to take vaccines:
 Injection into a vein or the muscle.
Example → Covid-19
 Taken orally by mouth
Example→ Polio
Some vaccines are highly effective, and one injection may give a lifetime protection.
Less effective vaccines need booster injections to stimulate secondary responses that give
enhanced protection.
It is good to take booster injections if you are likely to be exposed to the disease.

4. Herd Immunity
vaccinating a large proportion of the population; provides
protection for those not immunized as transmission of a
pathogen is reduced.
This activity is very important because when most of the
population are immune to a specific disease, it is unlikely that
the pathogen will be transmitted to those who do not have
immunity for whatever reason.
Vaccination programmes for the diseases on the WHO schedule
should always attempt to achieve nearly 100% coverage to achieve good herd immunity.

9700/11/0N/2019/40

Ans: C
5. Vaccination Programmes
The WHO recommends a schedule of vaccinations that is adapted
by health authorities across the world to their own circumstances.
 Vaccination Schedules
 A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be
either recommended or compulsory, depending on the country of residence.
 For Example:
Children receive the first MMR vaccine for measles, mumps and rubella at about nine
months of age and a second dose at any time after a minimum interval of four weeks

6. Ring Immunity

Vaccinating all those people in contact with a

specific disease to prevent transmission in the
immediate area.
Ensuring that people living in the area where
an outbreak has occurred provide a “zone of
immunity.

7. Injection & Oral Vaccine

Injection Oral Vaccine

Immunity gained when an antigen enters the The temporary immunity gained without there
body, an immune response occurs and being an immune response. It is when the
antibodies are produced by plasma cells. person has not produce the antibodies
 themselves
How it works?
Lymphocytes are activated by antigens on the
surface of pathogens that have invaded the
body.

8. Monoclonal Antibodies
Monoclonal Antibodies (or mAbs) are artificially produced antibodies produced from a single B
cell clone; The hybridoma method is a method used to make monoclonal antibodies.
Hybridoma
Cells produced from fusing plasma cells and cancer cells. Hybridoma cells divide by mitosis and
secrete antibodies.

Hybridoma method
The hybridoma method involves injecting mice
with an antigen that stimulates the production of
antibody-producing plasma cells.
Isolated plasma cells from the mice are fused
with immortal tumour cells, which result in
hybridoma cells.
Monoclonal antibodies have multiple
applications; diagnostics, treatment, food safety
testing and pregnancy testing.

Examples of mAbs
Trastuzumab
Used as a treatment for some breast cancers.
Ipilimumab
Used as treatment for melanoma, a type skin cancer.
Infliximab
Treatment for rheumatoid arthritis.
Rituximab
Used to control B-lymphocytes.

Using monoclonal antibodies in treatment

 The antibodies produced by mice, rabbits or other laboratory animals, trigger an immune
response when introduced into humans as they are foreign (non-self).
 This is overcome by:
1) Altering genes that code for polypeptide chains of antibodies into human sequences.
2) Changing the type/position of sugar groups into human antibodies.

 Examples of using monoclonal antibodies in treatment:

  Used in cancer therapy by marking
cancerous cells for their destruction or
binding to protein produced by T cells that
reduces immune response.
 Controls over/inappropriate production of
B cells, preventing leukaemia and
autoimmune diseases.

Command Words
No Command word What it means
.
1. Assess Make an informed judgement
2. Calculate Work out from given facts, figures or information
3. Comment Give an informed opinion
4. Compare Identify/comment on similarities and/or differences
5. Contrast Identify/comment on differences
6. Define Give precise meaning
7. Describe State the points of a topic / give characteristic and main features
8. Discuss Write about issue(s) or topic(s) in depth in a structured way
9. Explain Set out purposes or reasons / make the relationships between things evident /
provide why and/or how and support with relevant evidence
10. Give Produce an answer from a given source or recall/memory
11. Identify Name/select/recognise
12. Outline Set out main points
13. Predict Suggest what may happen based on available information
14. Sketch Make a simple drawing showing the key features
15. State Express in clear terms
16. Suggest Apply knowledge and understanding to situations where there are a range of
valid responses in order to make proposals / put forward considerations