OPHTHALMIC PATHOLOGY

An immune response is a sequence of cellular and molecular events designed to protect the host from offending stimulus, eg. a pathogenic organism, toxic substance, cellular debris, or neoplastic cell. Two broad categories: adaptive and innate. Adaptive immunity, also called specific or acquired immunity, can be conceptualized as "user programmable." Adaptive responses react to specific environmental stimuli with a stimulus-specific immunologic response. Innate immune responses, also called natural immunity, are "factory preprogrammed." All individuals are endowed with a genetically predetermined set of responses to a wide range of noxious environmental stimuli. Different stimuli can often trigger the same responses.

Adaptive immunity is a host response set by a specific environmental antigen. An antigen usually represents an alien substance completely foreign to the organism, and the immune system must generate a specific receptor against it that must recognize a unique molecular structure in the antigen for which no specific preexisting receptor was present. The organism defends itself by the following steps: Recognizing the unique foreign antigenic substance as distinguished from self. Processing the unique antigen with receptors newly created by specialized tissues. Generating unique antigen-specific immunologic effector cells (T and B lymphocytes) and unique antigen-specific soluble effector molecules (such as antibodies), which function to remove antigenic substance from the organism

The adaptive immune system is not genetically predetermined but evolves as an ongoing way for an individual's T and B lymphocytes to continually generate new antigen receptors through recombination, rearrangement, and mutation of the germline genetic structure. This creates a vast repertoire of novel antigen receptor molecules that vary tremendously among individuals within a given species.

Innate immunity is a pattern recognition response to : Identify various offensive stimuli in an antigen-independent manner Respond in a stereotyped, preprogrammed fashion determined by the preexistence of receptors for the stimulus. Generate generic() biochemical mediators and cytokines that recruit nonspecific effector cells, especially macrophages and neutrophils, to remove the offending stimulus in a nonspecific manner(ie. phagocytosis or enzymatic degradation). The stimuli of innate immunity interact with receptors that have been genetically predetermined by evolution to recognize and respond to molecular motifs on triggering stimuli. These motifs often include a specific amino acid sequence, certain lipoproteins, certain phospholipids, or other specific molecular patterns.

The receptors of innate immunity are identical among all individuals within a species. The innate immune response to acute infection is the classic example of this process.

Receptor activation Both responses use receptors present on white blood cells to recognize offending stimuli, but the recognition receptors are fundamentally different. Inflammatory or noninflammatory responses Both responses can trigger inflammation, but they usually operate at a subclinical level so that the individual is unaware of the response. Nonspecific effector cells and molecules Although only the adaptive immune response employs T and B lymphocytes as antigen-specific effector cells, both forms of immunity use neutrophils, eosinophils, and monocytes as nonspecific effector cells and the same chemical mediators as amplification systems.

Triggering stimuli Adaptive immunity is triggered by an antigen, usually in the form of a protein, although carbohydrates or lipids can sometimes be antigenic. Innate immunity is triggered by bacterial toxins and cell debris, often in the form of carbohydrate, phospholipid, and other nonprotein molecules. Recognition receptors The antigen receptors of adaptive immunity, such as antibody molecules and T-cell antigen receptor molecules, are specific for each antigen, recognizing unique molecular regions of an antigen called epitopes. The receptors used by innate immunity, such as scavenging receptors or toxin receptors, recognize conserved molecular patterns or motifs shared among various triggering stimuli. Time of onset after triggering Because adaptive immune responses are acquired, they require recognition, processing, and effector phases that need several days for activation. Innate immunity is preprogrammed, requiring only the direct activation of a cellular receptor to initiate an effector response within hours.

Memory Adaptive immune responses demonstrate memory, so that on second exposure to the same antigen, the release of effectors is more vigorous and rapid than during the original response. Innate responses are genetically preprogrammed to react stereotypically to each encounter. Specificity Adaptive immune responses demonstrate specificity for each unique offending antigen. Innate responses do not.