Overview Cell-mediated immunity is the result of cooperation between innate and adaptive immunity to destroy virus infected cells before they can produce more virus damage pathogenic bacteria, fungi, and parasites eliminiate cancerous cells that lack normal cell surface proteins Cells involved in immunity can be divided into primary effector cells such as granulocytes macrophages CD8+ T-cells natural killer (NK) cells secondary support cells such as CD4+ helper T-cells dendritic cells Cell-mediated immunity can result from innate immune response activation of T-cells coordination of cells via cytokines Important Cytokines in Cellular Immunity Cytokines are key coordinators of the cellular immune response by promoting vascular changes near the site of inflammation recruiting of other target cells differentiation of target cells signaling to distant organs Cytokines can be secreted by a variety of cells including activated macrophages helper T-cells killer T-cells Important Cytokines in Cellular Immunity Cytokine Function Secreted by Interleukin-1 Causes fever and acute inflammation Activates endothelial expression of adhesion molecules Macrophages Interleukin-2 Stimulates growth and survival of T-cells and NK cells All T-cells Interleukin-3 Stimulates the growth and differentiation of bone marrow cells All T-cells Interleukin-4 Induces differentiation of helper T-cells into Th2 subtype cells Promotes growth of B-cells and enhances class switching to IgG and IgE Th2 cells Interleukin-5 Promotes growth and differentiation of B cells and eosinophils Promotes class switching to IgA Th2 cells Interleukin-6 Stimulates fever Causes increased production of acute phase proteins by liver Macrophages Interleukin-8 Stimulates chemotaxis by neutrophils to sites of infection Macrophages Interleukin-10 Decreases inflammatory response by inhibiting macrophages and dendritic cells Decreases expression of MHC molecules and Th1 cytokines Regulatory T-cells Interleukin-12 Promotes differentiation of T-cells into Th1 cells Activates killing by NK cells Macrophages Tumor necrosis factor-α Alters vascular endothelium to promote leakage Recruits diverse white blood cells to site of release Induce fever Macrophages Interferon-α/β Activates antiviral defense system of cells Down regulates protein synthesis Upregulates MHC expression for easy recognition of infected cells All cells Interferon-γ Activates macrophages to kill ingested organisms Promotes granuloma formation Increases MHC and antigen presentation by all cells Increases killing by NK cells Th1 cells Effector Mechanisms Macrophage and neutrophil killing depends upon oxygen-dependent mechanisms such as respiratory burst oxygen-independent mechanisms including hydrolytic enzymes that destroy peptides defensins that form holes in bacterial membranes lactoferrin that binds iron and denies it to bacteria lysozyme that cleaves bacterial peptidoglycan walls NK and cytotoxic CD8+ T-cell killing depends upon three mechanisms including exocytosis of cytotoxic granules containing granzymes that are apoptosis activating serine proteases perforin that makes a hole in membranes Fas ligand that directly signals target cells to undergo apoptosis cytokine signaling mainly through TNF pathways that also induce apoptosis Notably NK cells are inhibited by MHC complexes on the surface of cells
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Lab Values Blood Hematologic Cerebrospinal Sweat, Urine, and BMI Blood, Plasma, Serum Reference Range ALT 8-20 U/L Amylase, serum 25-125 U/L AST 8-20 U/L Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL Calcium, serum (Ca2+) 8.4-10.2 mg/dL Cholesterol, serum Rec: < 200 mg/dL Cortisol, serum 0800 h: 5-23 μg/dL //1600 h: 3-15 μg/dL 2000 h: ≤ 50% of 0800 h Creatine kinase, serum Male: 25-90 U/LFemale: 10-70 U/L Creatinine, serum 0.6-1.2 mg/dL Electrolytes, serum Sodium (Na+) 136-145 mEq/L Chloride (Cl-) 95-105 mEq/L Potassium (K+) 3.5-5.0 mEq/L Bicarbonate (HCO3-) 22-28 mEq/L Magnesium (Mg2+) 1.5-2.0 mEq/L Estriol, total, serum (in pregnancy) 24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL 28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL Ferritin, serum Male: 15-200 ng/mLFemale: 12-150 ng/mL Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL Female: premenopause: 4-30 mIU/mL midcycle peak: 10-90 mIU/mL postmenopause: 40-250 pH 7.35-7.45 PCO2 33-45 mmHg PO2 75-105 mmHg Glucose, serum Fasting: 70-110 mg/dL2-h postprandial:<120 mg/dL Growth hormone - arginine stimulation Fasting: <5 ng/mLProvocative stimuli: > 7ng/mL Immunoglobulins, serum IgA 76-390 mg/dL IgE 0-380 IU/mL IgG 650-1500 mg/dL IgM 40-345 mg/dL Iron 50-170 μg/dL Lactate dehydrogenase, serum 45-90 U/L Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL Female: follicular phase: 5-30 mIU/mL midcycle: 75-150 mIU/mL postmenopause 30-200 mIU/mL Osmolality, serum 275-295 mOsmol/kd H2O Parathyroid hormone, serume, N-terminal 230-630 pg/mL Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L Phosphorus (inorganic), serum 3.0-4.5 mg/dL Prolactin, serum (hPRL) < 20 ng/mL Proteins, serum Total (recumbent) 6.0-7.8 g/dL Albumin 3.5-5.5 g/dL Globulin 2.3-3.5 g/dL Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h Thyroxine (T4), serum 5-12 μg/dL Triglycerides, serum 35-160 mg/dL Triiodothyronine (T3), serum (RIA) 115-190 ng/dL Triiodothyronine (T3) resin uptake 25%-35% Urea nitrogen, serum 7-18 mg/dL Uric acid, serum 3.0-8.2 mg/dL Hematologic Reference Range Bleeding time 2-7 minutes Erythrocyte count Male: 4.3-5.9 million/mm3Female: 3.5-5.5 million mm3 Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/hFemale: 0-20 mm/h Hematocrit Male: 41%-53%Female: 36%-46% Hemoglobin A1c ≤ 6 % Hemoglobin, blood Male: 13.5-17.5 g/dLFemale: 12.0-16.0 g/dL Hemoglobin, plasma 1-4 mg/dL Leukocyte count and differential Leukocyte count 4,500-11,000/mm3 Segmented neutrophils 54%-62% Bands 3%-5% Eosinophils 1%-3% Basophils 0%-0.75% Lymphocytes 25%-33% Monocytes 3%-7% Mean corpuscular hemoglobin 25.4-34.6 pg/cell Mean corpuscular hemoglobin concentration 31%-36% Hb/cell Mean corpuscular volume 80-100 μm3 Partial thromboplastin time (activated) 25-40 seconds Platelet count 150,000-400,000/mm3 Prothrombin time 11-15 seconds Reticulocyte count 0.5%-1.5% of red cells Thrombin time < 2 seconds deviation from control Volume Plasma Male: 25-43 mL/kgFemale: 28-45 mL/kg Red cell Male: 20-36 mL/kgFemale: 19-31 mL/kg Cerebrospinal Fluid Reference Range Cell count 0-5/mm3 Chloride 118-132 mEq/L Gamma globulin 3%-12% total proteins Glucose 40-70 mg/dL Pressure 70-180 mm H2O Proteins, total < 40 mg/dL Sweat Reference Range Chloride 0-35 mmol/L Urine Calcium 100-300 mg/24 h Chloride Varies with intake Creatinine clearance Male: 97-137 mL/minFemale: 88-128 mL/min Estriol, total (in pregnancy) 30 wks 6-18 mg/24 h 35 wks 9-28 mg/24 h 40 wks 13-42 mg/24 h 17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 hFemale: 2.0-8.0 mg/24 h 17-Ketosteroids, total Male: 8-20 mg/24 hFemale: 6-15 mg/24 h Osmolality 50-1400 mOsmol/kg H2O Oxalate 8-40 μg/mL Potassium Varies with diet Proteins, total < 150 mg/24 h Sodium Varies with diet Uric acid Varies with diet Body Mass Index (BMI) Adult: 19-25 kg/m2 Calculator ( ) xy AC 7 8 9 ÷ 4 5 6 × 1 2 3 - 0 . = + Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.IM.21) A 55-year-old Caucasian male presents for a routine colonoscopy. A polyp is found in the patient's transverse colon and is found to be cancerous on histological evaluation. Upon examination, it is found that these cancerous cells have decreased MHC class I expression on their surface. Which immune system cell is most capable of killing these tumor cells? Review Topic QID: 100442 1 Natural killer cells 56% (10/18) 2 B-cells 0% (0/18) 3 Macrophages 6% (1/18) 4 Eosinophils 0% (0/18) 5 Cytotoxic T-cells 39% (7/18) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (M1.IM.72) A 3-year-old recent immigrant is diagnosed with primary tuberculosis. Her body produces T cells that do not have IL-12 receptors on their surface, and she is noted to have impaired development of Th1 T-helper cells. Which of the following cytokines would benefit this patient? Review Topic QID: 100493 1 IL-4 15% (8/55) 2 IL-17 0% (0/55) 3 IL-22 4% (2/55) 4 Interferon-gamma 78% (43/55) 5 TGF-beta 0% (0/55) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (M1.IM.46) A 48-year-old immigrant from Vietnam presents with fever, weight loss, a persistent cough, and malaise. His symptoms began three months ago and have worsened over time. On exam, he is afebrile with BP 140/80, HR 78/minute, and RR 14/min. A sample of the patient's sputum is shown in Figure A, and chest radiograph is shown in Figure B. Which cell type is responsible for the formation of the granuloma? Review Topic QID: 100467 FIGURES: A B 1 Neutrophils 7% (4/58) 2 TH2 lymphocyte 22% (13/58) 3 CD8 T cell 16% (9/58) 4 TH1 lymphocyte 48% (28/58) 5 Natural killer cells 3% (2/58) M1 Select Answer to see Preferred Response PREFERRED RESPONSE 4 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Cell-Mediated Immunity Immunology - Cell-Mediated Immunity - Treatment Consult This video describes cell-mediated immunity. 2/16/2015 70 views