CELL-MEDIATED IMMUNE RESPONSES

PHYSIOLOGY OF IMMUNITY
involves the following series of events that culminate in B cell or T cell activation (or both ) and response
to the introduction of a foreign into the circulation :
processing of the foreign entity by a macrophage or B cell
recognition of this foreign entity by specific , preformed receptors on certain B cells and T cells
proliferation of these B cells and T cells , as stimulated by soluble signals(interleukins ) between
macrophages , B cells and T cells
blast transformation and a series of mitotic divisions leading to the generation (from B cells ) of plasma
cells that produce immunoglobulins and ( from T cells ) of sensitized T cells all capable of interacting
with the original foreign stimulus

T-dependent antigens
are proteins; they stimulate all
five classes of immunoglobulins
and can elicit an anamnestic
(secondary-booster) response

T-independent antigens
molecules have a large,
repetitive structure, which
is sufficient to activate B
cells directly to make
antibody without the
participation of T-cell help

T cells
-mature in the thymus
-are involved in helpingB cells become antibody-producing plasma cells
-have specific receptors (T cell receptors) on their surface for antigen recognition
-are involved in cell mediated immunity
-participate in suppresion of the immune response
-are the predominant 95% lymphocytes in the circulation
-are found in the paracortical and interffolicular areas of the lymph nodes and spleen

The morphology of lymph nodes. A, This

schematic diagram shows the structural
organization and blood flow in a lymph node. B,
This light micrograph shows a cross section of a
lymph node with numerous follicles in the cortex,
some of which contain lightly stained central
areas (germinal centers), and the central medulla.

CD (cluster of differentiation) markers

arise on T cells during maturation in the thymus
appear on T cells in the following sequence:CD2(T11); CD3(T3); CD4(T4); CD8(T8)
CD2
is the earliest T cell marker
is the sheep red blood cell (SRBC) receptor
is present on virtually every peripheral T cell
CD3
is intimately associated with TCR
CD4
is present mainly on helper T cells
is involved in interaction with class II human leukocyte antigens (HLAs)
CD8
is present mainly on cytotoxic T cells
recognizes class I HLAs

Ontogeny of T cells
occurs as stem cells flow through the thymic cortex , into the medulla and then out into the general
circulation
begins in the thymic cortex with the appearance of CD2 , followed by appearance of CD3 (with TCR), then
with concomitant expression of CD4 and CD8
in the thymic medulla consists of a loss of marker to produce two populations of cells one CD2 +
,CD3+,TCR+, CD4+ (65%); and the other CD2+ ,CD3+,TCR+, CD8+ (35%)-that are then released into the
peripheral circulation
is the time when both positive selection and negative selection occur

Positive selection of thymocytes

occur in the cortical region of the thymus during the maturation process and involves the interaction of
immature thymocytes with cortical epithelial cells , which bear major histocompatibility complex (MHC)
selects those cels whose TCR binds with self MHC molecules on the epithelial cells
the thymocytes that do not bind with self MHC molecules die by apoptosis
results in cells that are self MHC restricted
Negative selection of thymocytes
occurs in the medulla of the thymus and involves immature thymocytes that have survived positive
selection
involves interaction of these thymocytes with dendritic cells and macrophages that bear self MHC
molecules and self antigens
thymocytes that have receptors for self antigen in the presence of self MHC molecules will die by
apoptosis
results in thymocytes that are both self MHC restricted and self tolerant

Cell-mediated immunity
the arm of the adaptive immune response
role is to combat infections by intracellular microbes
is mediated by T lymphocytes
Microbes are ingested by phagocytes as part of the early defense mechanisms of
innate immunity,

some of these microbes have evolved to resist the microbicidal activities of

phagocytes
many pathogenic intracellular bacteria and protozoa are able to survive, and even
replicate in the vesicles of phagocytes
Some of these phagocytosed microbes may enter the cytoplasm of infected cells and
multiply in this compartment, using the nutrients of the infected cells
Cytoplasmic microbes are protected from microbicidal mechanisms, because these
mechanisms are confined to vesicular compartments (where they cannot damage the host
cells).

Viruses
may bind to receptors on a wide variety of cells and are able to infect and replicate in
the cytoplasm of these cells
these cells often do not possess intrinsic mechanisms for destroying the viruses
the elimination of microbes that are able to live in phagocytic vesicles or in the cytoplasm
of infected cells is the main function of the T cell arm of adaptive immunity
CD4+ helper T lymphocytes also help B cells to produce antibodies
a common feature of all these reactions is that to perform their functions T lymphocytes
have to interact with other cells, (phagocytes, infected host cells, B lymphocytes)
recall that the specificity of T cells for peptides displayed by major histocompatibility
complex (MHC) molecules ensures that the T cells can see and respond to only antigens
associated with other cells

Phases of T Cell Responses

The responses of T lymphocytes to cell-associated microbial antigens
naive T lymphocytes
recirculate through peripheral lymphoid organs searching for
foreign protein antigens
express antigen receptors and other molecules that make up the
machinery of antigen recognition
naive lymphocytes are incapable of performing the effector
functions required for eliminating microbes

Phases of T Cell Responses

To perform these functions, the naive T cells have to differentiate into

effector cells, process is initiated by antigen recognition
The protein antigens of microbes are transported from the portals of entry
of the microbes to the same peripheral lymphoid organs through which naive
T cells recirculate
In these organs, the antigens are processed and displayed by MHC molecules
on dendritic cells, the antigen-presenting cells (APCs) that are the most
efficient stimulators of naive T cells
naive T lymphocytes first encounter protein antigens in the peripheral
lymphoid organs
At the same time as the T cells are seeing antigen, they receive additional
signals in the form of microbial products or molecules expressed by APCs in
response to innate immune reactions to the microbes

Steps in the activation of T lymphocytes. Naive T cells recognize major histocompatibility complex (MHC)associated peptide antigens displayed on antigen-presenting cells (APCs) and other signals (not shown). The T cells
respond by producing cytokines, such as IL-2, and expressing receptors for these cytokines, leading to an autocrine
pathway of cell proliferation. The result is clonal expansion of the T cells. Some of the progeny differentiate into
effector cells, which serve various functions in cell-mediated immunity, and memory cells, which survive for long
periods. CTL, cytotoxic T lymphocyte; IL-2, interleukin-2; IL-2R, interleukin-2 receptor.

Role of Innate Immunity in Stimulating Adaptive Immune Responses

The two-signal requirement for lymphocyte activation.

Antigen recognition by lymphocytes provides signal 1 for the activation of the lymphocytes,
and components of microbes or substances produced during innate immune responses to
microbes provide signal 2.
The lymphocytes could be T cells or B cells. By convention, the major second signals for T
cells are called costimulators because they function together with antigens to stimulate the
cells.

Antigen Recognition and Costimulation

The initiation of T cell responses
requires multiple receptors on the T
cells recognizing ligands on APCs:
the TCR recognizes MHC-associated
peptide antigens
CD4 or CD8 co-receptors recognize the
MHC molecules
adhesion molecules strengthen the
binding of T cells to APCs, and
receptors for costimulators recognize
second signals provided by the APCs
The molecules other than antigen
receptors that are involved in T cell
responses to antigens sometimes are
called accessory molecules of T
lymphocytes.
accessory molecules ;
two categories: signaling and adhesion
Different accessory molecules bind to
different ligands, and each of these
interactions plays a distinct and
complementary role in the process of T
cell activation
APC, antigen-presenting cell; ICAM-1, intercellular adhesion
molecule-1; LFA-1, leukocyte function-associated antigen-1;
MHC, major histocompatibility complex; TCR, T cell receptor;
VLA, very late antigen

The T cell receptor for antigen (the TCR) and the CD4 or CD8 co-receptor together
recognize the complex of peptide antigens and MHC molecules on APCs, and this
recognition provides the first, or initiating, signal for T cell activation

Antigen recognition and signal transduction during T

cell activation. Different T cell molecules recognize
antigen and deliver the signal to the interior of the cell
as a result of antigen recognition
two or more TCRs need to be cross-linked to initiate
signals, but only a single TCR is shown for simplicity
The figure illustrates a CD4+ T cell; the same
interactions are involved in the activation of CD8+ T
cells, except that the co-receptor is CD8 and the TCR
recognizes a peptide-class I MHC complex. APC,
antigen-presenting cell; MHC, major histocompatibility
complex; TCR, T cell receptor.
The TCR
recognizes antigens,
it is not able to transmit biochemical signals to the
interior of the cell.
is noncovalently associated with a complex of three
proteins that make up CD3 and with a homodimer of
another signaling protein called the chain

Regulation of integrin avidity

Integrins are present in a low-affinity state in resting T cells
Chemokines produced by APCs and signals induced by the TCR when it recognizes antigen both
act on integrins and lead to their clustering and to conformational changes that increase the
affinity of the integrins for their ligands
As a result, the integrins bind with high avidity to their ligands on APCs and thus promote T cell
activation. APC, antigen-presenting cell; TCR, T cell receptor.

ROLE OF COSTIMULATION IN T CELL ACTIVATION

The full activation of T cells is dependent on the recognition of costimulators on APCs
The role of costimulation in T cell
activation
Resting APCs, which have not been
exposed to microbes or adjuvants, may
present peptide antigens, but they do
not express costimulators and are
unable to activate naive T cells
T cells that recognize antigen without
costimulation may become unresponsive
to subsequent exposure to antigen;
this state of unresponsiveness is called
anergy
Microbes, and cytokines produced
during innate immune responses to
microbes, induce the expression of
costimulators, such as B7 molecules, on
the APCs
The B7 costimulators are recognized
by the CD28 receptor on naive T cells,
providing "signal 2"; in conjunction with
antigen recognition ("signal 1"), this
recognition initiates T cell responses.
APC, antigen-presenting cell; IL,
interleukin

Cross-presentation of microbial antigens from infected cells by professional antigenpresenting cells (APCs)
Cells infected with intracellular microbes, such as viruses, are ingested (captured) by
professional APCs, and the antigens of the infectious microbes are broken down and presented in
association with the major histocompatibility complex (MHC) molecules of the APCs. T cells
recognize the microbial antigens and co-stimulators expressed on the APCs, and the T cells are
activated. In most cases, the term cross-presentation (or cross-priming) is applied to CD8+ T
cells-cytotoxic T lymphocytes (CTLs)-recognizing class I MHC-associated antigens (as shown);
the same cross-presenting APC may display class II MHC-associated antigens from the microbe
for recognition by CD4+ helper T cells.

Biochemical Pathways of T Cell Activation

On recognition of antigens and costimulators, T cells express proteins that are involved in
proliferation, differentiation, and effector functions of the cells
Naive T cells that have not encountered antigen (so-called resting cells) have a low level of protein
synthesis
Within minutes of antigen recognition, new gene transcription and protein synthesis are seen in the
activated T cells
Signal transduction pathways in T lymphocytes
Antigen recognition by T cells induces early signaling events,
which include tyrosine phosphorylation of molecules of the
TCR complex and the recruitment of adapter proteins to the
site of T cell antigen recognition
These early events lead to the activation of several
biochemical intermediates, which in turn activate
transcription factors that stimulate transcription of genes
whose products mediate the responses of the T cells
The possible effects of costimulation on these signaling
pathways are not shown. PLC1 refers to the 1 isoform of
phosphatidylinositol-specific phospholipase C
AP-1, activating protein-1; APC, antigen-presenting cell;
GTP/GDP, guanosine triphosphate/guanosine diphosphate;
ITAM, immunoreceptor tyrosine-based activation motif;
NFAT, nuclear factor of activated T cells; PKC, protein kinase
C; TCR, T cell receptor.

The role of interleukin-2 (IL-2) and

IL-2 receptors in T cell proliferation
Naive T cells express the low-affinity
IL-2 receptor (IL-2R) complex, made
up of the and c chains (c designates
the common chain-so called because it
is a component of the receptors for
several cytokines)
On activation by antigen recognition
and costimulation, the cells produce IL2 and express the chain of the IL-2R,
which associates with the and c
chains to form the high-affinity IL-2
receptor. Binding of IL-2 to its
receptor initiates proliferation of the
T cells that recognized the antigen.
APC, antigen-presenting cell.

The molecules involved in the

effector functions of CD4+
helper T cells. CD4+ T cells that
have differentiated into
effector cells express CD40L
and secrete cytokines. CD40L
binds to CD40 on macrophages
or B lymphocytes, and cytokines
bind to their receptors on the
same cells. The combination of
signals delivered by CD40 and
cytokine receptors activates
macrophages in cell-mediated
immunity (A) and activates B
cells to produce antibodies in
humoral immune responses (B).
IL, interleukin.

The development and

characteristics of subsets of
CD4+ helper T lymphocytes.
A, A naive CD4+ T cell may
differentiate into subsets that
produce different cytokines and
perform different effector
functions.
B, The main differences between
TH1 and TH2 subsets of helper T
cells are summarized. Note that
many helper T cells are not readily
classified into these distinct and
polarized subsets. The chemokine
receptors are called CCR or CXCR
because they bind chemokines
classified into CC or CXC
chemokines based on whether key
cysteines are adjacent or
separated by one amino acid.
Different chemokine receptors
control the migration of different
types of cells. These, in
combination with the selectins,
determine whether TH1 or TH2
cells dominate in different
inflammatory reactions in various
tissues. GM-CSF, granulocytemacrophage colony-stimulating
factor; IFN, interferon; Ig,
immunoglobulin; IL, interleukin;
TNF, tumor necrosis factor.

The functions of TH1 cells. TH1 cells produce the

cytokine interferon- (IFN-), which activates
phagocytes to kill ingested microbes and stimulates
the production of antibodies that promote the
ingestion of microbes by the phagocytes. APC,
antigen-presenting cell

The functions of TH2 cells.

TH2 cells produce the cytokines
IL-4, which stimulates the
production of immunoglobulin E
(IgE) antibody, and IL-5, which
activates eosinophils. IgE
participates in the activation of
mast cells by protein antigens
and coats helminthes, and
eosinophils destroy the
helminthes
TH2 cells stimulate the
production of other antibody
isotypes that may neutralize
microbes and toxins but do not
opsonize microbes for
phagocytosis or activate
complement by the classical
pathway. APC, antigen-presenting
cell; IL, interleukin.

CONCLUSIONS
T lymphocytes are the cells of cell-mediated immunity, the arm of the adaptive immune system that
combats intracellular microbes, which may be microbes that are ingested by phagocytes and live within
these cells or microbes that infect nonphagocytic cells.
The responses of T lymphocytes consist of sequential phases:
recognition of cell-associated microbes by naive T cells
expansion of the antigen-specific clones by proliferation
differentiation of some of the progeny into effector cells and memory cells
T cells use their antigen receptors to recognize peptide antigens displayed by MHC molecules on
antigen-presenting cells (which accounts for the specificity of the ensuing response) and polymorphic
residues of the MHC molecules (accounting for the MHC restriction of T cell responses)
Antigen recognition by the TCR triggers signals that are delivered to the interior of the cells by
molecules associated with the TCR (the CD3 and chains) and by the co-receptors, CD4 and CD8, which
recognize class II and class I MHC molecules, respectively
The binding of T cells to APCs is enhanced by adhesion molecules, notably the integrins, whose affinity
for their ligands is increased by chemokines produced in response to microbes and by antigen
recognition by the TCR.

CONCLUSIONS
APCs exposed to microbes or to cytokines produced as part of the innate immune
reactions to microbes express costimulators that are recognized by receptors on T cells
and deliver necessary "second signals" for T cell activation
The biochemical signals triggered in T cells by antigen recognition and costimulation
result in the activation of various transcription factors that stimulate the expression of
genes encoding cytokines, cytokine receptors, and other molecules involved in T cell
responses
In response to antigen recognition and costimulation, T cells secrete cytokines, of which
some induce proliferation of the antigen-stimulated T cells and others mediate the
effector functions of T cells
CD4+ helper T cells may differentiate into subsets of effector cells that produce
restricted sets of cytokines and perform different functions
TH1 cells, which produce IFN-, activate phagocytes to eliminate ingested microbes,
and stimulate the production of opsonizing and complement-binding antibodies.
TH2 cells, which produce IL-4 and IL-5, stimulate IgE production and activate
eosinophils, which function mainly in defense against helminths.
TH17 cells, which produce IL-17, are implicated in several inflammatory diseases and
may play a role in defense against bacterial infections
CD8+ T cells recognize peptides of intracellular (cytoplasmic) protein antigens and may
require help from CD4+ T cells to differentiate into effector CTLs. The function of CTLs
is to kill cells producing cytoplasmic microbial antigens.