Lecture 11: Practical applications of immunology ; vaccinations Edith Porter, M.D. 1 Major applications of immunology ▪ Vaccines ▪ ▪ ▪ ▪ ▪ Immunological memory Types of adaptive immunity Types of vaccines Development of new vaccines Safety of vaccines ▪ Generation of antibodies for research and diagnostic ▪ Anti-sera ▪ Monoclonal antibodies ▪ Diagnostic immunology ▪ Precipitation and agglutination reactions ▪ Complement fixation ▪ ELISA, western blot, immunofluorescence 2 Once lymphocytes have encountered their specific antigen they undergo clonal expansion Some of these cells develop further into memory cells Can circulate for many years Upon re-contact with the same antigen they quickly proliferate and resume effector function B cells: antibody production T cells: cytokine production (TH, Treg) and cytotoxicity (CTL) Instead of requiring 10 – 14 days for a full response measurable effects appear within 2 days 3 Primary Response Secondary Response IgM is always the first antibody IgG follows IgM IgG level does not go back to baseline Re-exposure to the same antigen will lead to an augmented and accelerated immune response, increased IgG response and with higher residual antibody levels Presence of antibodies is not equivalent to sickness 4 Vaccines do not always target B cells and antibodies but some target T cells. 5 Artificially acquired Active immunity Naturally acquired Active immunity Resulting from Injection of Ag Long Lasting (vaccination) infection Passive immunity Transplacental Short Lasting Passive immunity Injection of Ab Colostrum Vaccines: toxoid, killed microorganisms, live attenuated microorganisms 6 1) What type of immunity results from vaccination? A) Innate immunity B) Naturally acquired active immunity C) Naturally acquired passive immunity D) Artificially acquired active immunity E) Artificially acquired passive immunity 3) What type of immunity results from recovery from mumps? A) Innate immunity B) Naturally acquired active immunity C) Naturally acquired passive immunity D) Artificially acquired active immunity E) Artificially acquired passive immunity 15) The antibodies found in mucus, saliva, and tears are A) IgG. B) IgM. C) IgA. D) IgD. E) IgE. 26) The best definition antibody is A) A serum protein. B) A protein that inactivates or kills an antigen. C) A protein made in response to an antigen that can combine with that antigen. D) An immunoglobulin. E) A protein that combines with a protein or carbohydrate. 7 Induce active immune response with a related or inactivated agent that does not cause major disease Induce cross-reactive antibodies or T cells Herd immunity is sufficient to prevent epidemic diseases Must weigh the benefit of protection versus the danger of vaccine associated disease 8 Attenuated whole agent vaccines Live, weakened microbes Generated through long term culture Mimic most closely actual infection Caution: danger of backmutation to a virulent form Dangerous for immunocompromised patients! Inactivated whole agent vaccines Toxoid 9 Subunit or acellular vaccines Use of antigenic subunit that triggers an immune response. Inherent safer as it cannot reproduce in the host Conjugated vaccine Combine as antigen poorly immunogenic material (e.g. capsules) with an immunogenic protein Nucleic acid vaccines (DNA vaccines) Introduce genes for protein targets into the host Host will express the protein and mount an immune response to this foreign protein 10 Classical Bacterial culture (Animal extract) Cell culture Embryonated eggs New Developments Recombinant vaccines Plants Influenza virus grown in embryonated eggs 11 Improve effectiveness of vaccines/immunizations by providing costimulatory signals for T and B cells In humans ▪ Alum ▪ Oil based substance MF59 and virosomes In animals ▪ Freund’s complete adjuvants ▪ Mycobacterium extract 12 Diphtheria: Purified diphtheria toxoid Pertussis: Acellular fragments of B. pertussis or antigenic acellular fragments Tetanus: Purified tetanus toxoid Meningococcal meningitis: Purified polysaccharide from N. meningitidis Haemophilus influenzae type b meningitis: Polysaccharides conjugated with protein Pneumococcal conjugate vaccine: S. pneumoniae antigens conjugated with protein 13 Influenza: Inactivated or attenuated virus Measles: Attenuated virus Mumps: Attenuated virus Rubella: Attenuated virus Chickenpox: Attenuated virus Poliomyelitis: Inactivated virus Hepatitis B: Antigenic fragments (recombinant) Smallpox: Live vaccinia virus Rabies: Inactivated virus Hepatitis A: Inactivated virus Human papilloma virus: Antigenic fragments Selected patients 14 15 Re-administration of vaccine to boost immune defense ( ) Increased antibody production Increased memory cell development Time 16 17 HIV Malaria Tuberculosis Cholera 18 Safety Sometimes illness follows vaccination ▪ Risk benefit analysis Autism had been linked to vaccination ▪ Most recent studies conclude that there is no link but instead a genetic disposition Weaning protection Bordetella pertussis 19 Patients antibodies indicate that patient had contact with the agent before “serology” Commercial antibodies used to detect patient antigen In research Detection of antigen Purification 20 Study of reactions between antibodies and antigens Globulins Serum proteins Gamma () globulin Serum fraction containing Antibodies (immunoglobulin) Antiserum Generic term for serum when it contains specific Ab Polyclonal Monoclonal antibodies 21 Prepare antigen Inoculate animal with antigen and adjuvants Administer several boosts Draw blood and let it coagulate Remove cells by centrifugation and collect supernatant = serum with high titers of specific antibodies 22 23 Precipitation Agglutination Hemagglutination Fluorescent-antibody technique ELISA 24 Involve soluble antigens and antibodies Upon cross linking a visible interlocking molecular aggregate is formed (lattice) Only in equivalence zone precipitates are formed Example Ouchterlony 25 26 Involve particulate antigens and antibodies IgM are most efficient Direct agglutination Antibodies against large cellular antigens Indirect agglutination Antibodies against soluble antigen adsorbed to a particle or erythrocytes 27 Relates to the concentration of antibodies against a particular antigen Gives a guide to how active the patient’s immune response is. 28 29 30 Labeled Specific Antibody To detect difficult to grow pathogens (e.g. Legionella) 31 Specific Primary Antibody Labeled Secondary Antibody Figure 18.10b 32 To detect Ag To detect Ab 33 34 Vaccination (against disease) and immunizations (for antibody production) require administration of attenuated or inactivated antigen Ab:Ag reaction is the fundamental reaction in immunology Precipitation: ab--soluble ag Agglutination: ab--particulate ag Presence of antibodies does not mean illness High titer means high concentration of ab 35 4) In an agglutination test, eight serial dilutions to determine antibody titer were set up: tube #1 contained a 1:2 dilution; tube #2, a 1:4, etc. If tube #6 is the last tube showing agglutination, what is the antibody titer? A) 6 B) 1:6 C) 64 D) 1:32 E) 32 15) What type of vaccine is live measles virus? A) Conjugated vaccine B) Subunit vaccine C) Nucleic acid vaccine D) Attenuated whole-agent vaccine E) Toxoid vaccine 16) A test used to identify antibodies against Treponema pallidum in a patient is the A) Direct fluorescent-antibody test. B) Indirect fluorescent-antibody test. C) Direct agglutination test. D) Direct ELISA test. E) Hemagglutination-inhibition test. 13) What type of vaccine involves host synthesis of viral antigens? A) Conjugated vaccine B) Subunit vaccine C) Nucleic acid vaccine D) Attenuated whole-agent vaccine E) Toxoid vaccine 36