Introduction to Medical Immunology

711 Pages·1998·8.871 MB·English

by  Gabriel Virella

Page i
Introduction to Medical Immunology
Fourth Edition
Edited by
Gabriel Virella
Medical University of South Carolina
Charleston, South Carolina
MARCEL DEKKER, INC.
NEW YORK • BASEL • HONG KONG
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Library of Congress Cataloging-in-Publication Data
Introduction to medical immunology / edited by Gabriel Virella. — 4th ed.
p. cm.
Includes bibliographical references and index.
ISBN 0-8247-9897-X (hardcover : alk. paper)
1. Clinical immunology. 2. Immunology. I. Virella, Gabriel.
[DNLM: 1. Immunity. 2. Immunologic Diseases. QW 504 I6286 1997]
RC582.I59 1997
616.07'9—dc21
DNLM/DLC
for Library of Congress
97-22373
CIP
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PREFACE
Ten years after the publication of the first edition of Introduction to Medical Immunology, the ideal immunology
textbook continues to be a very elusive target. The discipline continues to grow at a brisk pace, and the concepts tend to
become obsolete as quickly as we put them in writing. It is very true of immunology that the more we know, the greater
our ignorance. This represents the challenge that makes teaching immunology so exceptional and writing immunology
textbooks such a daunting task.
The fourth edition of Introduction to Medical Immunology retains the features that make this textbook unique—
particularly, its emphasis on the clinical application of immunology—but represents a significant departure from the
earlier editions. Most changes have resulted from our strong conviction that this textbook is not written to impress our
peers with extraordinary insights or revolutionary knowledge, but rather to be helpful to medical students and young
professionals who need an introduction to the field. The requirements that we tried to fulfill were sometimes difficult to
conciliate. The text needs to be updated and relatively complete, but not overwhelming. The scientific basis of
immunology needs to be clearly conveyed without allowing the detail to obscure the concept. The application to
medicine needs to be transparently obvious, but without unnecessary exaggeration. The text must present a reasonably
general and succinct overview, while covering areas that appear likely to have a strong impact in the foreseeable future.
The book needs to stimulate students to seek more information and to develop their own “thinking” without being
merely a model of theoretical dreams (and nightmares).
In what is probably not an entirely successful attempt to fulfill some of these goals, we have extensively revised the
book, added significant new concepts, and deleted areas that were clearly obsolete. The clinical sections are peppered
with cases in order to provide a solid link between the discussion of concrete problems presented by patients with
diseases of immunological basis and the relevant immunological principles. More significantly, the book has been
rewritten in an outline format. This format allows us to keep the conceptual approach while facilitating the
understanding of a reader facing the complexities of immunology with very little background. Of necessity, the book
emphasizes that which is well understood, as clearly as we can present it, and we try to promote a general understanding
of the discipline at the end of the twentieth century. It is not, and never will be, a finished work. We are certain that we
will always wish we could add here and revise there. But we hope that this new edition will be even more successful in
focusing the
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attention of our readers toward an intrinsically fascinating discipline that seeks understanding of fundamental biological
knowledge that has direct impact on the diagnosis and treatment of a variety of conditions in which the immune system
plays a key role.
GABRIEL VIRELLA, M.D., PH.D.
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CONTENTS
Preface iii
Contributors ix
Part I. Basic Immunology
1. Introduction 1
Gabriel Virella
2. Cells and Tissues Involved in the Immune Response 11
Gabriel Virella and Jean-Michel Goust
3. Major Histocompatibility Complex 31
Jean-Michel Goust
4. The Induction of an Immune Response: Antigens, Lymphocytes, and Accessory 49
Cells
Gabriel Virella and Barbara E. Bierer
5. Immunoglobulin Structure 75
Gabriel Virella and An-Chuan Wang
6. Biosynthesis, Metabolism, and Biological Properties of Immunoglobulins 91
Gabriel Virella and An-Chuan Wang
7. Genetics of Immunoglobulins 105
Janardan P. Pandey
8. Antigen-Antibody Reactions 121
Gabriel Virella
9. The Complement System 137
Robert J. Boackle
10. Lymphocyte Ontogeny and Membrane Markers 163
Jean-Michel Goust and Anne L. Jackson
11. Cell-Mediated Immunity 187
Jean-Michel Goust and Barbara E. Bierer
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12. The Humoral Immune Response and Its Induction by Active Immunization 217
Gabriel Virella
13. Infections and Immunity 239
Gabriel Virella
Part II. Diagnostic Immunology
14. Immunoserology 259
Gabriel Virella
15. Diagnostic Evaluation of Humoral Immunity 283
Gabriel Virella
16. Diagnostic Evaluation of Lymphocyte Functions and Cell-Mediated Immunity 297
Gabriel Virella and Jean-Michel Goust
17. Diagnostic Evaluation of Phagocytic Function 317
Gabriel Virella
Part III. Clinical Immunology
18. Tolerance and Autoimmunity 335
Jean-Michel Goust, George C. Tsokos, and Gabriel Virella
19. Organ-Specific Autoimmune Diseases 363
Christian C. Patrick, Jean-Michel Goust, and Gabriel Virella
20. Systemic Lupus Erythematosus 383
Jean-Michel Goust and George C. Tsokos
21. Rheumatoid Arthritis 399
Jean-Michel Goust
22. Hypersensitivity Reactions 417
Gabriel Virella
23. IgE-Mediated (Immediate) Hypersensitivity 433
Jean-Michel Goust and Albert F. Finn, Jr.
24. Immunohematology 453
Gabriel Virella and Mary Ann Spivey
25. Immune Complex Diseases 475
Gabriel Virella and George C. Tsokos
26. Immune System Modulators 495
Jean-Michel Goust, Henry C. Stevenson-Perez, and Gabriel Virella
27. Transplantation Immunology 517
Gabriel Virella and Jonathan S. Bromberg
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28. Tumor Immunology 535
Henry C. Stevenson-Perez and Kwong-Y. Tsang
29. Malignancies of the Immune System 553
Gabriel Virella and Jean-Michel Goust
30. Immunodeficiency Diseases 579
Gabriel Virella
Index 621
Page ix
CONTRIBUTORS
Barbara E. Bierer, M.D. Associate Professor of Medicine, Department of Pediatric Oncology, Dana Farber Cancer
Institute, Boston, Massachusetts
Robert J. Boackle, Ph.D. Professor and Director of Oral Biology and Professor of Immunology, Division of
Stomatology, Medical University of South Carolina, Charleston, South Carolina
Jonathan S. Bromberg, M.D., Ph.D. Associate Professor of Surgery, Microbiology, and Immunology, Department of
General Surgery, Transplant Division, University of Michigan Hospitals, Ann Arbor, Michigan
Albert F. Finn, Jr., M.D. Clinical Assistant Professor, Departments of Medicine, Microbiology and Immunology,
Medical University of South Carolina, Charleston, South Carolina
Jean-Michel Goust, M.D. Professor of Immunology, Department of Microbiology and Immunology, Medical
University of South Carolina, Charleston, South Carolina
Anne L. Jackson, Ph.D. Consultant, Ridgefield, Washington
Janardan P. Pandey, Ph.D. Professor, Department of Microbiology and Immunology, Medical University of South
Carolina, Charleston, South Carolina
Christian C. Patrick, M.D., Ph.D. Director of Academic Programs and Associate Member, Department of Infectious
Diseases and Pathology and Laboratory Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
Mary Ann Spivey, M.H.S., M.T. (A.S.C.P.), S.B.B. Department of Pathology-Laboratory Medicine, Transfusion
Medicine Section, Medical University of South Carolina, Charleston, South Carolina
Henry C. Stevenson-Perez, M.D. Senior Investigator, Biologics Evaluation Section, Investigational Drug Branch,
National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Kwong-Y. Tsang, Ph.D. Senior Scientist, Laboratory of Tumor Immunology and Biology, National Cancer Institute,
National Institutes of Health, Bethesda, Maryland
George C. Tsokos, M.D. Professor, Department of Medicine, Uniformed Services University of Health Sciences,
Bethesda, Maryland, and Department of Clinical Investigations, Walter Reed Army Medical Center, Washington, D.C.
Gabriel Virella, M.D., Ph.D. Professor and Vice Chairman of Education, Department of Microbiology and
Immunology, Medical University of South Carolina, Charleston, South Carolina.
An-Chuan Wang, Ph.D. Professor, Department of Microbiology and Immunology, Medical University of South
Carolina, Charleston, South Carolina