1. Objectives – Adaptive Immunity
To understand the importance of both the innate and adaptive immune system in controlling pathogens
To understand the function/role of Th1 versus Th2 versus Th17
To understand the architecture of the secondary lymphoid tissue and the role that various regions play in the adaptive response.
To understand why different pathogens require a different adaptive response.

2. Review
Adaptive immunity – requires innate, but infections that get by innate will overwhelm host if adaptive is not present.
Role of adhesion molecules to get cells in correct place.

3. Review
Th1 vs Th2 vs Th17 has taught us that appropriate response is important if host is to control disease
Leprosy/Leishmania example
Erythroblastosis fetalis example
Autoimmune disease (MS/RA) example
Much effort is directed at understanding what controls Th1,Th2 or Th17– so that this can be done clinically.

4. Objectives -- Memory
To understand how memory is important for species survival
List the components important in maintaining memory.
Define original antigenic sin and what it means to the immune response to a pathogen.

5. Review -- continued
The memory component of the adaptive immune response is important both from an evolutionary point of view as well as clinical.
Survival of species and allows survivors to treat those who have disease
Vaccination requires memory
Memory means faster response with higher affinity Ab – meaning response to lower pathogen levels.

6. Concept of “Original Antigenic Sin”
Primary response is prevented when secondary response is available.
Can work to disadvantage in situations where pathogen is highly mutatable e.g. influenza virus.
New and highly immunogenic epitopes go unused.

7. Objectives—Failure of Bodies Defenses
List methods that pathogens can use to subvert the immune system.
To understand how the immune system can actually contribute to the disease.

8. Review -- continued
Pathogens have developed “tricks” to get around memory – altered coats, high mutation rates, going into cytoplasm, special vesicle, coating with serum proteins, make cytokine like molecules – are just some examples.
Disease can result from too much IR – bacterial sepsis example.

9. Review -- continued
Inherited immunodeficiencies give great advantages to pathogen – though severity of condition depends upon what is lost.
Understand treatment options for condition
Some can cause few problems
B cell (antibody only) – IVIg –
wheras SCID or lack of innate immunity – BM transplant.

10. Spectrum of Immunodeficiency Diseases
Type of Infections
DEFICIENCY Bacterial Viral Fungal Protozoan
Antibody deficiency
T cell/Combined
Complement
Phagocytic

11. Treatment of Immune Disorders
Disease Therapy
Antibody Deficiency Immunoglobulins (IVIG)
SCID BMT
Enzyme Therapy
Interleukin-2 infusion
Gene therapy (ADA)
WASP BMT
CGD Interferon-
LAD BMT
BMT = Bone Marrow Transplantation

12. Review -- continued
Vaccines – a triumph of immunology! Started with Jenner and observation that cowpox protected against smallpox.
Attenuated now used—especially for viruses as stimulates a protective response much like virulent agent.
Success can essentially eliminate disease.
Historically – vaccines stimulate the antibody response – new research aims to stimulate the CTL more effectively.