Immune dysfunction and clinical immunology


The immune system is a highly regulated and balanced system and when the balance is disturbed, disease can result.


Immunodeficiency disorders involve problems with the immune system that impair its ability to mount an appropriate defence. As a result, these are almost always associated with severe infections that persist, recur and/or lead to complications, making these disorders severely debilitating and even fatal. There are two types of immunodeficiency disorders: primary immunodeficiencies are typically present from birth, are generally hereditary and are relatively rare. Such an example is common variable immunodeficiency (CVID). Secondary immunodeficiencies generally develop later in life and may result following an infection, as is the case with AIDS following HIV infection.


Autoimmune diseases occur when the immune system attacks the body it is meant to protect. People suffering from autoimmune diseases have a defect that makes them unable to distinguish ‘self’ from ‘non-self’ or ‘foreign’ molecules. The principles of immunology have provided a wide variety of laboratory tests for the detection of autoimmune diseases. Autoimmune diseases may be described as ‘primary’ autoimmune diseases, like type-1 diabetes, which may be manifested from birth or during early life; or as ‘secondary’ autoimmune diseases, which manifest later in life due to various factors. Rheumatoid arthritis and multiple sclerosis are thought to belong to this type of autoimmunity. Also, autoimmune diseases can be localised, such as Crohn’s Disease affecting the GI tract, or systemic, such as systemic lupus erythematosus (SLE).


Allergies are hypersensitivity disorders that occur when the body’s immune system reacts against harmless foreign substances, resulting in damage to the body’s own tissues. Almost any substance can cause allergies (an allergen), but most commonly, allergies arise after eating certain types of food, such as peanuts, or from inhaling airborne substances, such as pollen, or dust. In allergic reactions, the body believes allergens are dangerous and immediately produces substances to attack them. This causes cells of the immune system to release potent chemicals like histamine, which causes inflammation and many of the symptoms associated with allergies. Immunology strives to understand what happens to the body during an allergic response and the factors responsible for causing them. This should lead to better methods of diagnosing, preventing and controlling allergic diseases.


Asthma is a debilitating and sometimes fatal disease of the airways. It generally occurs when the immune system responds to inhaled particles from the air, and can lead to thickening of the airways in patients over time. It is a major cause of illness and is particularly prevalent in children. In some cases it has an allergic component, however in a number of cases the origin is more complex and poorly understood.


Cancer is a disease of abnormal and uncontrolled cell growth and proliferation and is defined by a set of hallmarks, one of which is the capacity for cancer cells to avoid immune destruction. Cancer immunotherapy seeks to stimulate the immune system’s innate powers to fight cancerous tissue and has shown extraordinary promise as a new weapon in our arsenal against the disease. Other applications of immunological knowledge against cancer include the use of monoclonal antibodies (proteins that seek and directly bind to a specific target protein called an antigen. An example is Herceptin, which is a monoclonal antibody used to treat breast and stomach cancer). Moreover, a number of successful cancer vaccines have been developed, most notably the HPV vaccine.


Transplants involve transferring cells, tissues or organs from a donor to a recipient. The most formidable barrier to transplants is the immune system’s recognition of the transplanted organs as foreign. Understanding the mechanisms and clinical features of rejection is important in determining a diagnosis, advising treatment and is critical for developing new strategies and drugs to manage transplants and limit the risk of rejection.


Vaccines are agents that teach the body to recognise and defend itself against infections from harmful pathogens, such as bacteria, viruses and parasites. Vaccines provide a sneak ‘preview’ of a specific pathogen, which stimulates the body’s immune system to prepare itself in the event that infection occurs. Vaccines contain a harmless element of the infectious agent that stimulate the immune system to mount a response, beginning with the production of antibodies. Cells responsive to the vaccine proliferate both in order to manufacture antibodies specific to the provoking agent and also to form ‘memory cells’. Upon encountering the infectious agent a second time, these memory cells are quickly able to deal with the threat by producing sufficient quantities of antibody. Pathogens inside the body are eventually destroyed, thereby thwarting further infection. Several infectious diseases including smallpox, measles, mumps, rubella, diphtheria, tetanus, whooping cough, and polio are no longer a threat in India due to the successful application of vaccines.