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02 Human Health and Disease

1. Introduction :
Health :
(i) Old view about health (i.e. Good humor hypothesis of health):
• Asserted by : Early Greeks like Hippocrates as well as Indian Ayurveda system of medicine.
• Health : State of body and mind, where there was balance of certain ‘humors’.

Early Greeks like Hippocrates

• Persons with ‘black bile’ belonged to hot personality and would have fevers. This idea was arrived
at by pure reflective thought.

Pitta
Blood

Yellow Body Phlegm Body

bile Kapha Vata

Black bile

4 humors 3 dosha
Indian Ayurveda system of medicine

• Disproved by : The discovery of blood circulation by William Harvey using experimental method
and the demonstration of normal body temperature in persons with black bile using thermometer.

(ii) Modern view about health:

• Health ≠ absence of disease or physical fitness
• Health: State of complete physical, mental and social well-being

Mind / Mental state

Influences through neural system and endocrine system

Immune system
maintains

Health

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(iii) Health is affected by:
(i) Genetic disorders : Deficiencies with which a child is born and deficiencies / defects which
the child inherits from parents from birth
(ii) Infections
(iii) Life style :
• Food and water we take
• Rest and exercise we give to our bodies
• Habits that we have or lack
• e.g. Drug and alcohol abuse also affect our health adversely.

(iv) Benefits of being healthy:

• Efficiency at work  → Productivity  → Economic prosperity
• Longevity 
• Infant and maternal mortality 

(v) Very important to maintain good health:

 Balanced diet  Personal hygiene  Regular exercise

Yoga : Yoga has been practised since time immemorial to achieve physical and mental health.

(vi) Necessary for achieving good health:

• Awareness about diseases and their effect on different bodily functions.
• Vaccination (immunisation) against infectious diseases.
• Proper disposal of wastes.
• Control of vectors.
• Maintenance of hygienic food and water resources.

Disease:
• Functioning of one or more organs or systems of the body is adversely affected.
• Characterised by various signs and symptoms.

2. Classification of diseases :
• Diseases can be broadly grouped into infectious and non-infectious :

Diseases

Congenital diseases Acquired diseases

Infectious/Communicable Non-infectious/Non-communicable
(spread from one (will not spread from one
person to another person) person to another person)

Contagious Non-contagious
(by direct contact) (by indirect contact)

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3. Common Diseases in Humans :
Introduction to common diseases in humans
Pathogens :
• Pathogens are disease causing organisms (belonging to bacteria, viruses, fungi, protozoans,
helminths, etc.).
• Most parasites are therefore pathogens as they cause harm to the host by living in (or on) them.
• Pathogens have to adapt to life within the environment of the host.
e.g. The pathogens that enter the gut must know a way of surviving in the stomach at low pH and
resisting the various digestive enzymes.
How do pathogens create their pathogenicity inside our body?
Entry of pathogen into our body by various means

Multiplication of pathogen and interference with
normal vital activity of our body

Morphological and functional damage to our body
Examples of infectious diseases in humans :
Type of disease Examples
Bacterial Typhoid, Pneumonia, Dysentery, Plague, Diphtheria, Tuberculosis,
Whooping cough (Pertussis), Cholera, Leprosy, etc.
Viral Common cold, Dengue, Chikungunya, Polio or Poliomyelitis, Influenza,
Measles, Chicken pox, Mumps, Rabies, SARS (Severe Acute Respiratory
Syndrome), Swine flu, Covid 19, etc.
Protozoan Malaria, Amoebiasis (Amoebic dysentery), etc.
Helminthic Ascariasis, Elephantiasis (Filariasis), etc.
Fungal Ringworms, etc.

Bacterial Symptoms &

S.No. Pathogen
Diseases Pathogenicity
(1) Typhoid fever Salmonella typhi • Enters small intestine through contaminated
food and water and migrate to other organs
through blood
• Sustained high fever (39-40°C)
• Weakness, constipation, stomach pain
• Headache, loss of appetite
• In severe cases intestinal perforation, death
• Widal test
• Mary Mallon, Nicknamed- Typhoid Mary
(Carrier of typhoid)

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(2) Pneumonia Streptococcus • By droplet or aerosol infection or use of
pneumoniae glass or utensils of infected person
Haemophilus • Infects alveoli of the lungs
influenzae • Alveoli get filled with fluid leading to severe
problem in respiration
• Fever with chills, cough & headache
• In severe cases lips and nails turns gray to bluish
in colour
(3) Dysentery Shigella • Abdominal pain
(Shigellosis) dysenteriae • Blood & mucus in the stool
• Transmits through faecal oral route
(4) Plague Yersinia pestis • High fever, headache
(Black death) Parasite of • Enlargement of axillary lymph nodes
Xenopsylla cheopis • Pneumonic (lungs)…… septa between alveoli
(Rat flea) rupture
• Septicemic (blood poisoning)… Black Death
(5) Diphtheria Corynebacterium • High grade fever, affects throat
diphtheriae • Causes suffocation (Investigation : Schick test)
(6) Tetanus (Lock Clostridium tetani • Sustained contraction of body muscles,
jaw) spasms, lock jaw, unconsciousness,
opisthotonus & Risus Sardonicus - Stretching of
facial muscles & neck-back muscles.

S.No. Viral Diseases Pathogen Symptoms & Pathogenicity

(1) Common cold Rhino viruses • One of the most infectious human ailments
(Group of viruses) • Transmits through droplet resulting from
(ss RNA) cough, sneeze etc.
• Infect nose and respiratory passage but not
the lungs
• Nasal congestion and discharge, sore throat,
hoarseness, cough, headache, tiredness
(2) Chikun-gunya Chikungunya • Fever, joint pain, Lymphoadenopathy
virus (ss-RNA) (enlargement of lymph nodes)
(Vector :- Aedes-
ageypti mosquito)
(3) Dengue fever or Flavi-arbo virus • Fever, severe-frontal-headache, muscle &
Break-bone- (Vector :- Aedes- joint pain
fever ageypti mosquito) • Bleeding from nose, mouth, gums
(4) Hepatitis-B HBV (ds DNA) • Severe liver damage, jaundice
• Recombinant DNA-vaccine
• Transmits-through parenteral and sexual-
route
• Can cross placenta

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Common diseases in humans protozoan diseases :
Malaria:
Pathogen :
• Plasmodium (a tiny protozoan)
• Different species of Plasmodium (P. vivax, P. malariae and P. falciparum) are responsible for
different types of malaria.
• Of these, malignant malaria caused by Plasmodium falciparum is the most serious one and can even
be fatal.
Symptoms : Fever and Chills

Stages in the life cycle of Plasmodium :

• It requires two hosts – human and mosquito – to complete its life cycle.
• The female Anopheles mosquito is the vector (transmitting agent) too.
When the mosquito
bites another human,
sporozoites are
injected with bite
Mature infective stages
(sporozoites) escape from
gut and migrate
to the mosquito
salivary glands

Sporozoites

Salivary glands Parasites (sporozoites)

reach the liver through
blood
Mosquito
Fertilization and Host
development take place
in the mosquito's gut The parasite reproduces
Asexually in liver cells,
bursting the cell and
Human releasing into the blood
Host
Female mosquito takes
up gametocytes with Gametocytes
blood meal
Female

Parasites reproduce asexually

Male In red blood cells, bursting
the red blood cells and causing
Sexual stages (gametocytes) cycles of fever and other
develop in red blood cells symptoms.
Released parasites infect
Stages in the life cycle of Plasmodium new red blood cells.

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SOME PROTOZOANAL DISEASE
Protozoanal
Pathogen Symptoms & Pathogenicity
Disease
(1) Amoebiasis Entamoeba • Parasite in large intestine
(Amoebic histolytica • Constipation, abdominal pain and cramps
dysentery) • Stools with excess mucus and blood clots
• Houseflies acts as mechanical carriers
• Spreads through contaminated food and water

SOME HELMINTHIC DISEASES

Helminthic Disease Pathogen Symptoms & Pathogenicity
(1) Ascariasis Ascaris • Intestinal parasite
(Common Round • Internal bleeding, muscular pain, fever,
worm) anemia, blockage of the intestinal passage
• Eggs of the parasite excreted along with the
faeces of infected person which contaminate
soil, water, plants
(2) Elephantiasis Wuchereria • Slowly developing chronic inflammation of
(Filariasis) (W. bancrofti and the organs in which they live for many years
W. malayi) (Usually the lymphatic vessels of the
(Filarial worm) lower limbs)
• Genital organs are also often affected,
resulting gross deformities
• Transmitted to a healthy person through the
bite by the female mosquito vectors

SOME FUNGAL DISEASE

Fungal Disease Pathogen Symptoms & Pathogenicity
(1) Ringworms Microsporum • One of the most common infectious disease
Trichophyton & • Appearance of dry, scaly lesions on various
Epidermophyton parts of the body such as skin, nails and scalp.
• These lesions are accompanied by intense
itching
• Heat and moisture help these fungi to grow,
which makes them thrive in skin folds such as
those in the groin or between the toes
• Generally acquired from soil or by using
towels, clothes or even the comb of infected
individuals
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Diagram showing inflammation

Diagram showing ringworm
in one of the lower limbs due to
affected area of the skin
elephantiasis

4. Prevention and Control of Infectious Diseases :

(1) Prevention and control of food/water borne diseases such as typhoid, amoebiasis and
ascariasis, etc.
Maintenance of personal and public hygiene :
• Measures for personal hygiene
• Keeping the body clean
• Consumption of clean drinking water, food, vegetables, fruits, etc.
• Measures for public hygiene
• Proper disposal of waste and excreta
• Periodic cleaning and disinfection of water reservoirs, pools, cesspools and tanks
• Observing standard practices of hygiene in public catering

(2) Prevention and control of air borne diseases such as pneumonia and common cold, etc.
• In addition to the previous measures, close contact with the infected persons or their belongings
should be avoided.

(3) Prevention and control of diseases such as malaria and filariasis, etc. that are transmitted
through insect vectors
To control or eliminate the vectors and their breeding places, which can be achieved by :
• Avoiding stagnation of water in and around residential areas
• Regular cleaning of household coolers
• Use of mosquito nets
• Introducing fishes like Gambusia in ponds that feed on mosquito larvae
• Spraying of insecticides in ditches, drainage areas and swamps, etc
• Providing doors and windows with wire mesh to prevent the entry of mosquitoes
Such precautions have become more important especially in the light of recent widespread incidences of
the vector-borne (Aedes mosquitoes) diseases like dengue and chikungunya in many parts of India.
The advancements made in biological science which have armed us to effectively deal with many
infectious diseases
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• Discovery of antibiotics and various other drugs has also enabled us to effectively treat infectious
diseases.
• The use of vaccines and immunisation programmes have enabled us to completely eradicate a
deadly disease like smallpox, and to control other infectious diseases like polio, diphtheria,
pneumonia and tetanus to a large extent.
• Biotechnology is at the verge of making available newer and safer vaccines.

BEGINNER’S BOX-1 ACQUIRED DISORDERS, IMMUNITY

1. Health includes :-
(1) Complete physical well being (2) Complete mental well being
(3) Complete social well being (4) All of the above
2. Who asserted good humor hypothesis?
(1) Hippocrates (2) Indian Ayurveda system
(3) William Harvey (4) Both (1) and (2)
3. Good humor hypothesis was disproved by demonstration of normal body temperature in persons
with –
(1) Blood (2) Phlegm (3) Yellow bile (4) Black bile
4. Health is affected by –
(1) Food and water we take (2) Rest and exercise we give to our bodies
(3) Habits that we have or lack (4) All of the above
5. Which of the following is incorrect in context of diseases?
(1) Functioning of one or more organs is adversely affected
(2) Characterised by appearance of various signs and symptoms
(3) Broadly grouped into infectious and non-infectious
(4) AIDS is one of the non-infectious diseases
6. Disease causing organisms are called –
(1) Parasites (2) Vectors (3) Pathogens (4) Carriers
7. Lips and finger nails may turn gray to bluish in colour in severe cases of –
(1) Typhoid (2) Pneumonia (3) Dysentery (4) Common cold
8. The malignant malaria is caused by :-
(1) P. vivax (2) P. malaria (3) P. falciparum (4) All
9. The fungi causing ringworm disease are :-
(1) Microsporum (2) Trichophyton (3) Epidermophyton (4) All of the above
10. Pick wrong one out :-
(1) Elephantiasis – Wuchereria
(2) Amoebic dysentery – Entamoeba histolytica
(3) Infective stage of Plasmodium for human – Sporozoite
(4) Pneumonia – Salmonella typhi
11. Which of the following is a non-infectious disease?
(1) Common cold (2) Cancer (3) Malaria (4) Cholera
12. "Fluid filled alveoli" are feature of :-
(1) Amoebiasis (2) Pneumonia (3) Ascariasis (4) Typhoid
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13. Sexual stages in the life cycle of Plasmodium are developed in –
(1) Liver of human (2) Red blood cells of human
(3) Gut of mosquito (4) Salivary gland of mosquito
14. The vector for pathogen of malaria is –
(1) Male Anopheles mosquito (2) Female Anopheles mosquito
(3) Aedes mosquito (4) Culex mosquito
15. Which of the following is a protozoan dysentery?
(1) Malaria (2) Shigellosis (3) Amoebiasis (4) Diphtheria

5. Immunity :
(1) Immunity : Resistance of the body against a pathogen or disease.
(2) Antigen or Agglutinogen : Substance which stimulates the production of antibodies.
(3) Antibody or Agglutinin : It is a complex glycoprotein secreted by B-lymphocytes in
response to an antigen.
(4) Antiserum : Serum of any animal which contains the antibody for a specific antigen is called
antiserum.
(5) Venom (poison) : Toxic substances secreted by animals and some insects.
(6) Agglutination : Antigen antibody reaction is called agglutination and study of antigen-
antibody reaction is called serology.

Immunity

Innate (Non-specific) Acquired (Specific)

Active Passive

Natural Artificial induced by Natural Artificial

eg. infection eg. vaccination eg. IgG (Placenta) eg. Antiserum
IgA (Colostrum) ATS, ADS

• Overall ability of the host to fight the disease-causing organisms or resistance of the body against
a disease is called immunity.
• Immunity is conferred by the immune system.

Classification of immunity :
• Immunity is of two types :
Innate Immunity Acquired Immunity
• Pathogen non-specific type of defence • Pathogen specific type of defence
• Present at the time of birth (Inborn/ Congenital) • Acquired during life (Adaptive)
• Not characterised by memory • Characterised by memory
• Found in plants and animals both • Found in higher vertebrates only
• It includes monocytes, neutrophils, NK cells and • It includes T-lymphocytes and
macrophages B-lymphocytes
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Innate immunity:
• Innate immunity is accomplished by providing different types of barriers to the entry of the foreign
agents into our body.
• Innate immunity consists of four types of barriers :
(1) Physical barriers
(2) Physiological barriers
(3) Cellular barriers
(4) Cytokine barriers

(1) Physical barriers of innate immunity

Following structures are included in these barriers :
(A) Skin
• Skin on our body is the main barrier which prevents entry of the micro-organisms into our body.
• Outermost layer of skin (Stratum corneum) is dead, so the bacteria do not grow or enter into it.
• pH of skin is acidic (3-5) in nature, destroys the bacteria.

(B) Mucosa
• Mucus coating of epithelium lining of the respiratory, gastrointestinal and urogenital tracts also
act as physical barriers for microbes entering our body.
• Mucosa contain mucosal cells and cilia.
• Mucous secreted by mucosal cells and cilia help in trapping and propelling the microbes
respectively.

(2) Physiological barriers of innate immunity

• Fever, acidic pH of various body parts (like oral cavity, stomach and vagina) and secretions
containing lysozyme enzyme (like tears, sebum) are included in this type of barrier.
• Acid in the stomach, saliva in the mouth, tears from eyes all prevent microbial growth.
• Some physiological processes of body create adverse environment for growth of bacteria.

(3) Cellular barrier of innate immunity

There is involvement of two types of cells :
(A) Phagocytic Cells
• These cells perform phagocytosis.
• Examples of phagocytic cells are :
• In blood : Polymorpho-nuclear leukocytes (PMNL- neutrophils), Monocytes
• In tissues : Macrophages
Note : Monocytes are liberated at the site of infection and later converted into macrophages.

(B) Non-Phagocytic Cells

• These cells do not perform phagocytosis.
• Example of non-phagocytic cells is Natural Killer cell or NK cell.
• NK cell kills abnormal cell by creating perforin lined pores in the plasma membrane. Water
enters through these pores causing swelling and bursting of the abnormal cell.

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(4) Cytokine barrier of innate immunity
• It includes interferons.
• Interferons are antiviral proteins, secreted by virus infected cells.
• Interferons are chemically glycoproteins, each molecule consisting of 270 amino acids.
• Interferons protect non-infected cells from further viral infection by stimulating the adjacent
normal cells to produce Translational Inhibiting Protein (T.I.P.).
• Interferons are not virus specific, but are species specific.
• α-interferon is given to AIDS patients to treat Kaposi sarcoma, it acts as Biological Response
Modifier.
• -interferon is given for slow progression of multiple sclerosis (an auto immune disorder)
• -interferon is secreted by certain lymphocytes like NK cells and T- Killer cells.
• Now a days, interferons are produced by genetic engineering also.

Inflammation : Local response of living mammalian tissue to injury due to any agent. It is the body's
defence reaction in order to eliminate or limit the spread of infectious agent.
Inflammation is characterised by –
• Redness (Rubor/Erythema) – due to vasodilation.
• Heat (Calor) – metabolic reactions proceed more rapidly.
• Swelling (Tumor) – due to increased permeability of blood vessels.
• Pain (Dolor) – results from injury to neurons and chemicals released by damaged cells
(e.g. prostaglandins).

(A) Acquired Immunity :

• Acquired immunity was evolved in higher vertebrates.

Characteristics:
• Specificity : Pathogen specific type of defence
• Diversity : Recognition of vast variety of pathogens (antigens)
• Discrimination between self cells & foreign organisms (e.g. pathogens/foreign molecules) : Present
• Memory : Present

3R’s of acquired immunity:

Recognition – Response – Remember

Immune responses and role of memory:

Encounter of body with Immune Onset and intensity of
a pathogen (antigen) response by body immune response
First Primary (PIR) Slow and low
Secondary / Rapid and high (due to memory of first
Subsequent
Anamnestic (SIR) encounter of body with same pathogen)

• Low intensity of immune system : Antibody concentration = Low

• High intensity of immune system : Antibody concentration = High
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• Booster/Anamnestic
• Highly intensified

Y Axis
• Rapid
Concentration of antibodies SIR

• Weak
in blood

• Low intensified
• Slow

PIR

X Axis
Time Period
First exposure Second exposure
with an antigen with same antigen

(B) Cells of Acquired Immunity :

• The primary and secondary B-Cell Receptor T-Cell Receptor
immune responses are carried out (BCR) (TCR)
with the help of two special types
of lymphocytes present in our
blood, i.e., B-lymphocytes and T-
lymphocytes.
• The B-lymphocytes produce an
army of proteins in response to
pathogens into our blood to fight
with them. These proteins are
B-Lymphocyte T-Lymphocyte
called antibodies.
• The T-cells themselves do not secrete antibodies but help B cells to produce them.

Cells of Acquired Immunity

Antigen Presenting Cells (APCs) Lymphocytes

e.g. • Macrophages

T-Lymphocytes B-Lymphocytes

• T-Helper • B-Plasma
• T-Killer/Cytotoxic • B-Memory
• T-Regulatory/Suppressor
• T-Memory
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Mechanism of acquired immunity :

T-Helper Cells B-Cells Production of AMIS

+ antibodies
Lymphokines
APC’s + (Interleukins)
+
T-Killer Cells Secretion of perforins
& Lymphotoxins EMIS

Lines of Defence :
• First line of defence : Skin, Mucous membrane
• Second line of defence : Neutrophils, Monocytes, Macrophage, Interferon, Fever.
• Third line of defence : Specific immunity by T- and B-lymphocytes

Antigen (Ag):
• Antigen is the substance which stimulates antibodies production.
• Most of antigens are proteins.
• Each antigen molecule has different antigenic determinant sites (epitopes), which are recognised
by antibodies or B/T lymphocytes.

(C) Antibody (Ab)/ Immunoglobulin (Ig) :

• Antibody is a complex glycoprotein molecule, secreted by plasma B lymphocytes.
• Each antibody molecule has four polypeptide chains, two small called light chains and two longer
called heavy chains, held together by interchain disulphide bonds in shape of Y.
• It is represented as H2L2.

Variable region of the

Heavy chain
Antigen

Fab

Light chain Variable region of

oo the light chain Antigenic determinant
oo
Hinge Constant region or Epitope
oo
oo

Disulphide bond of light chain

Fc Heavy chain Antigen binding site
or Paratope
oo
oo

Heavy chain Light chain

COO– COO–

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Different types (classes) of antibodies are produced in our body :
1. IgG antibody
• Most abundant
• About 75% of total antibodies in blood
• Can cross placenta
• Provides natural passive acquired immunity to foetus

2. IgA antibody
• Second most abundant (about 10%)
• Dimer antibody
• Secretory antibody
• Present in saliva, tears, sweat, mucus
• Protects mucosal lining (inhaled pathogen)
• Also present in colostrum (Natural passive acquired immunity to infants)

3. IgD antibody
• Fixed or surface antibody
• Acts as B cell receptor (BCR)

4. IgE antibody
• Present in very small quantity (0.05%)
• Involved in allergy (type 1 hypersensitivity)
• Stimulates mast cells and basophils
• Also protects from parasitic infections

5. IgM antibody
• Pentamer antibody
• Largest antibody
• Millionaire or heaviest antibody (M.W. = 9,60,000)
• Oldest antibody
• First antibody formed by foetus by the age of 5 months against
congenital infections during intrauterine life.

Different functions of antibodies are :

1. Agglutination
• Antibody is attached with the antigen, present on the surface of pathogen and in turn destroy
the pathogen by cell lysis.
2. Opsonisation
• Coating of bacteria (Ag) with opsonin antibody (IgG and IgM) facilitates the phagocytes cells
and these antibodies or opsonins promote phagocytosis by combination with antigen.
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3. Neutralisation
• Antibodies neutralize the viruses or toxin of bacteria by attaching with them.

(D) Immune System in the Body :

Immune System
4 components

Lymphoid Organs Lymphoid Tissues Cells Soluble Molecules

e.g. MALT (like antibodies)

Primary Secondary (Lymphocytes), etc

T Lymphocytes B Lymphocytes

Examples of lymphoid organs:

Lymphoid Organs
Lymph nodes

Primary (PLO) Secondary (SLO) Thymus

▪ Bone Marrow ▪ Lymph nodes
▪ Thymus ▪ Spleen
▪ Tonsils
▪ Peyer’s patches of Lymphatic vessels
small intestine (ileum)
▪ Appendix
Diagrammatic representation
of Thymus and Lymph nodes

Bone Marrow:
• Main lymphoid organ where all blood cells including lymphocytes are produced

Thymus:
• A lobed organ located near the heart and beneath the breastbone.
• Quite large at the time of birth but keeps reducing in size with age and by the time
puberty is attained it reduces to a very small size

Note : Both bone-marrow and thymus provide micro-environments for the development and
maturation of T-lymphocytes.

Spleen:
• A large bean shaped organ
• Mainly contains lymphocytes and phagocytes
• Acts as a filter of the blood by trapping blood-borne microorganisms
• Also has a large reservoir of erythrocytes
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Lymph nodes:
• Small solid structures located at different points along the lymphatic
system.
• Serve to trap the micro-organisms or other antigens, which happen to
get into the lymph and tissue fluid.

MALT:
• MALT= Mucosa Associated Lymphoid Tissue
• It is lymphoid tissue located within the lining of the major tracts (respiratory, digestive and
urogenital tracts).
• It constitutes about 50 per cent of the lymphoid tissue in human body.

Pathogen (Antigen)

Interaction with

T-cells or B-cells
Proliferation (Mitotic division)

Effector cells Memory cells

(Short lived) (Long lived)

Primary Immune Response Secondary Immune Response

Note : Effector B cells are also known as Plasma B cells.

Bone Marrow Thymus Secondary Lymphoid Organs

Interaction of mature
Stem Cells lymphocytes with trapped
Maturation antigen
&
Origin
Proliferation of
lymphocytes
Immature Antigen Sensitive Effector & Memory
Lymphocytes T Lymphocytes T Lymphocytes

Maturation

Antigen Sensitive Effector & Memory

B Lymphocytes B Lymphocytes

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Origin, maturation and proliferation of B Lymphocytes

Origin

Immature Lymphocytes
Stem cells of Bone Marrow (Receptor for antigen : absent)

Maturation
(In bone marrow)

Immature Lymphocytes Antigen sensitive B-lymphocytes

(Receptor for antigen : absent) (Receptor for antigen : present)

Interaction of mature
lymphocytes with trapped
antigen Plasma B Lymphocytes
&
Proliferation of lymphocytes

Antigen sensitive B-lymphocytes

(Receptor for antigen : present) Memory B Lymphocytes

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Types of Acquired Immunity:
1. On the basis of involvement of type of lymphocytes :

Acquired Immunity

Humoral Immunity Cellular Immunity

{AMI=Antibody Mediated Immunity} {CMI=Cell Mediated Immunity}

Involvement of B Lymphocytes Involvement of T Lymphocytes
Responsible for graft rejection

2. On the basis of participation of immune system of host :

Acquired Immunity

Active Immunity Passive Immunity

• Active participation of immune system of host • No participation of immune system of host

• Antibodies are produced against living/dead • Readymade antibodies are received by/
microbes or other proteins administered to host
• Slow response • Quick response
• Immunological memory- Present • Immunological memory- Absent
• Serves no purpose in immuno-deficient host • Applicable in immuno-deficient host
• Used for prophylaxis to increase body resistance • Used for treatment of acute infection

Examples of Active and Passive Immunity

Acquired Immunity

Active Immunity Passive Immunity

Natural Artificial Natural Artificial

e.g. Natural e.g. Vaccines e.g. ▪ IgG antibodies (Placenta) e.g. ▪ Anti Serums
infections ▪ IgA antibodies (Colostrum) ▪ Anti Venoms

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BEGINNER’S BOX-2 IMMUNITY

1. The light chain and heavy chain of antibody are joined with the help of :-
(1) H–H bond (2) S–S bond (3) Ionic bond (4) Phosphodiester bond
2. Colostrum is rich in :-
(1) IgA (2) IgG (3) IgE (4) IgM
3. Fever, pH and body secretions are included in which of the following barrier :-
(1) Physical (2) Cellular (3) Cytokine (4) Physiological
4. Which of the following are the properties of acquired immunity ?
(1) Specificity (2) Diversity
(3) Immunological memory (4) All of the above
5. Which of the following is true about immunity?
(1) It is overall ability of the host to fight the disease causing organisms
(2) It is resistance of the body against a disease
(3) It is conferred by immune system
(4) All of the above
6. Innate immunity is –
(1) Pathogen non-specific type of defence
(2) Present at the time of birth
(3) Not characterised by memory
(4) All of the above
7. Acquired immunity is not –
(1) Pathogen specific type of defence (2) Present at the time of birth
(3) Characterised by memory (4) All of the above
8. Which of the following barriers of innate immunity includes skin on our body?
(1) Physical barriers (2) Physiological barriers
(3) Cellular barriers (4) Cytokine barriers
9. Physiological barriers do not include –
(1) Acid in the stomach
(2) Saliva in the mouth
(3) Tears from eyes
(4) Mucus coating of the epithelium lining different tracts
10. Natural killer cells are a type of –
(1) Erythrocytes (2) Monocytes (3) Lymphocytes (4) Thrombocytes
11. Interferons are included in –
(1) Physical barriers of innate immunity
(2) Physiological barriers of innate immunity
(3) Cellular barriers of innate immunity
(4) Cytokine barriers of innate immunity
12. Interferons –
(1) Are secreted by non-infected cells (2) Protect virus infected cells
(3) Are lipids in nature (4) None of the above
13. Acquired immunity is present in –
(1) Lower vertebratesjdo (2) Higher vertebrates
(3) All vertebrates (4) No vertebrate
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14. Which of the following is not a characteristic of acquired immunity?
(1) It is a pathogen specific type of defence
(2) Only few certain pathogens can be recognised by it.
(3) Discrimination between self cells and foreign organisms is present in it.
(4) It has immunological memory.
15. Which of the following is an example of antigen presenting cells?
(1) T-Killer lymphocyte (2) T-Helper lymphocyte
(3) Macrophage (4) Natural Killer cell
16. Which of the following classes of antibodies can cross placenta?
(1) IgG (2) IgA (3) IgM (4) IgD
17. Which of the following is/are not secondary lymphoid structure(s)?
(1) Spleen (2) Lymph nodes (3) Bone marrow (4) Tonsils
18. Which of the following organs provide micro-environments for the development and maturation
of T-lymphocytes?
(1) Bone marrow (2) Thymus (3) Both (1) and (2) (4) None of the above
19. MALT constitutes about …….. per cent of the lymphoid tissue in human body. Which one of the
following options is correct to fill in the blank?
(1) 20 (2) 50 (3) 80 (4) 99
20. Immature lymphocytes are –
(1) Lymphocytes on which receptors for antigens are absent
(2) Antigen sensitive lymphocytes
(3) Effector cells
(4) Memory cells

6. Immunisation :
Immunisation

Active Immunisation or Vaccination Passive Immunisation

(A) Active Immunisation/Vaccination :

• It is to provide (acquired) immunity artificially for a particular infection/disease by administration
of vaccine.
• It provides prophylaxis for a particular infection/disease.

Vaccine :
• It is a preparation of weakened/inactivated pathogen, pathogenic exotoxins without toxicity or
antigenic proteins of pathogen.
• Vaccines are taken orally or by injection to provide immunity for that pathogen.
• Edward Jenner, 1796 (Father of immunity) noticed that milkmaid did not suffer from small pox
but they had scabs of cow pox. He transport the material from sore of milkmaid who was suffering
from cow pox to the young boy of 8 year old. After sometime he injected live small pox material
into that boy. But symptoms of disease did not appear. He tried this procedure on other person and
got success. He gave the term vaccination for this process.
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• Louis Pasture : He discovered the process of inactivating the pathogen & prepared vaccines for
Chicken cholera, Anthrax & Rabies.
• Von Behring : He discovered the process of passive immunization and prepared the
antidiphtherial serum (ADS) by injecting diphtheria antigen into sheep. Von Behring is known as
'Father of passive immunization'.

Principle of Vaccination :
• Principle of vaccination is based on memory of immune system of host.

First encounter of body with antigens

Introduction of vaccine (only antigens ; no pathogenicity/toxicity)
into the body

Primary immune response

Slow recognition of antigens ;
Production of low concentration of antibodies by immune system of
host against these antigens & generation of memory B- and T- cells

In future

Subsequent encounter of body with ‘same’ antigens

(Actual infection)

Secondary immune response

Quick recognition of antigens; massive production of antibodies

by immune system of host against these antigens
{due to memory of immune system of host}

Types of Vaccines :
• There are 4 different types of vaccines available :
Live Vaccine
Complete pathogen : after attenuation / Natural

Killed Vaccine
Vaccine
Complete pathogen : after inactivation

Toxoids Vaccine
Pathogenic exotoxins without toxicity i.e. toxoids

Recombinant Antigen Vaccine

Antigenic proteins of pathogens
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Examples of Different Types of Vaccines :
1. Live (Natural/Atteneuated) Vaccines :
• Small Pox
• Rota virus
• BCG (Bacillus Calmette Guerin) : for tuberculosis
• OPV (Oral Polio Vaccine; Sabin type 1)
• MMR (Measles, Mumps, Rubella), etc.

2. Killed (Inactivated) Vaccines : 3. Toxoid Vaccines :

• IPV (Inactivated Polio Vaccine) / Salk Polio • Tetanus (TT)
• Whooping cough (Pertussis) • Diphtheria (DT)
• TAB : for typhoid • Botulism, etc.
• Rabies
• Influenza 4. Recombinant Antigen Vaccines :
• Pneumonia • Hepatitis B
• Cholera, etc.

Recombinant
Live vaccines Killed Vaccines Toxoids Vaccines
Antigen Vaccines
(Natural/Attenuated) (Inactivated) (Subunit Vaccine)
(Subunit Vaccine)
• Small pox • Salk polio (IPV) • Tetanus (TT) • Hepatitis-B
• Rota virus • Whooping cough • Diphtheria (DT)
• BCG (Bacillus Calmette (Pertussis) • Botulism
Guerin) • TAB for Typhoid
• OPV (Oral Polio Vaccine, • Rabies
Sabin Type 1) • Influenza
• MMR (Measles, Mumps, • Pneumonia
Rubella) • Cholera

Hepatitis B vaccine

Hepatitis B vaccine has been produced from transgenic yeast with the help of
recombinant DNA technology.
Isolation of antigenic gene Insertion into

Ds DNA

Hepatitis B Virus
Transgenic fungus (Yeast)

Restriction Endonuclease Enzyme Antigenic proteins are isolated

and used as vaccine

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(B) Passive Immunisation :
• It is to provide immunity by administration of readymade antibodies (like antiserum, antivenom,
antitoxin etc.).
• It provides treatment for an acute infection, snake bite, etc.
• There is no role of memory of immune system of host in passive immunisation.
• Common examples of antiserums are:
✓ ATS = Anti Tetanus Serum
✓ ADS = Anti Diphtherial Serum
✓ ARS = Anti Rabies Serum, etc.

7. Transplantation :
• Graft = Transplanted tissue/organ
• Very often, when some human organs like heart, eye, liver, kidney fail
to function satisfactorily, transplantation is the only remedy to enable
the patient to live a normal life.
A suitable donor? Why is it that the organs cannot be taken from just
anybody?
• The body is able to differentiate ‘self’ and ‘nonself’. Grafts from just
any source an animal, another primate, or any human beings cannot
be made since the grafts would be rejected sooner or later.
• The cell-mediated immune response is responsible for the graft rejection.
• Tissue matching, blood group matching are essential before undertaking any graft/transplant and
even after this the patient has to take immuno- suppressants (e.g. Cyclosporin A, obtained from
Trichoderma polysporum fungus) all his/her life.

Tissue matching/HLA or MHC Antigen matching :

MHC/HLA Complex
(Group of genes present on 6th chromosomes)
Haplotype

MHC Antigen/HLA
(Membrane Protein)
present on cell membrane

MHC-I MHC-II

present on almost all present only on APCs (Antigen presenting cells)

cells except RBCs (Macrophages, B-cells, Dendritic cells)
*MHC = Major Histocompatibility Complex | *HLA = Human Leucocyte Antigen
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Types of Tissue Grafting :
1. Autograft 2. Isograft (Syngraft)

3. Allograft 4. Heterograft (xenograft)

Successful graft order

Self > Identical twins > Siblings > Parents > Unrelated donors

BEGINNER’S BOX-3 GRAFTING AND VACCINES

1. Vaccine is included in :-
(1) Natural passive acquired immunity
(2) Natural active acquired immunity
(3) Artificial active acquired immunity
(4) Artificial passive acquired immunity
2. MHC–II is present on :-
(1) Macrophage (2) B-lymphocytes (3) Dendritic cells (4) All of the above
3. Tissue matching is required in which of the following :-
(1) Homograft (2) Autograft (3) Allograft (4) Both (1) and (3)
4. 'BCG' vaccine is example of :-
(1) Killed vaccine (2) Live attenuated vaccine
(3) Toxoid (4) All of the above
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5. Which type of immunity is responsible for rejection of graft ?
(1) Innate immunity (2) Humoral immunity
(3) Antibody mediated immunity (4) Cell mediated immunity
6. HLA genes are present on –
(1) Chromosome 6 (2) Chromosome 8
(3) Chromosome 3 (4) Chromosome 12
7. Which of the following organs can be transplanted?
(1) Heart, Liver (2) Eye, Liver
(3) Pancreas, Lung (4) All of the above
8. Grafting from a donor of same specie but with non-identical genetic constitution to the recipient
is called ___________.
(1) autograft (2) Isograft
(3) allograft (4) heterograft
9. Principle of vaccination is based on –
(1) memory of immune system of host (2) memory of immune system of pathogen
(3) innate immune system (4) All of the above
10. Passive immunisation includes _________.
(1) Anti-tetanus serum (ATS) (2) Anti-diphtherial serum (ADS)
(3) Anti-rabies serum (ARS) (4) All of the above

8. Immune System Disorders :

(1) Allergies :
• When someone has gone to a new place and suddenly he/she started sneezing, wheezing for no
explained reason, and when he/she went away, his/her symptoms disappeared. What did this
happen to his/her?
• Allergy : Exaggerated (hypersensitive) response of the immune system to certain antigens present
in environment.
• The substances to which such an immune response is produced are called allergens. Common
examples of allergens are mites in dust, pollens, animal dander, etc.
• Symptoms of allergic reactions : Sneezing, watery eyes, running nose and difficulty in breathing, etc.
Production
Allergen B- Cell Antibodies (IgE)

IgE Receptor
Mast Cell Allergen
Or
Basophil

Sensitised cell
• Histamine
Secretion • Serotonin
• Heparin, etc.
The Stages of Allergic Reaction
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• The antibodies produced to these are of IgE type.
• Allergy is due to the release of chemicals like histamine and serotonin from the mast cells.
• The use of drugs like anti-histamine, adrenalin and steroids quickly reduce the symptoms of allergy.
• For determining the cause of allergy, the patient is exposed to or injected with very small doses of
possible allergens, and the reactions studied.

Common examples of allergies :

(A) Bronchial asthma :
• It is an allergy of lower respiratory tract (lungs).
It is characterised by :
• Spasm of the smooth muscles present in the walls of the bronchi and bronchiole
• Secretion of excess amount of mucous by mucous membranes on the wall of the air passage, etc.
Symptoms :
• Coughing
• Difficulty in breathing mainly during expiration (Wheezing)
Prevention and care :
• To avoid exposure to the foreign substance or allergens
• Antibiotic therapy for removing the infection, and use of bronchodilator drugs as well as inhalers
for symptomatic relief

(B) Hay fever :

• It is an allergy of mainly mucosa of eyes and upper respiratory passage.
• It is mainly due to pollen grains.

(C) Anaphylactic shock :

• It is generalised or most severe form of allergy.
• It involves almost all tissues of the body.
• It occurs within few minutes of entry of an allergen such as penicillin into blood.
• Histamine released from mast cells causes marked dilation of all arteries, therefore a large amount
of fluid is passed from blood to the tissues and there is a drastic fall in blood pressure.
• Drastic fall in blood pressure may lead to unconsciousness and even death.
More and more children in metro cities of India suffer from allergies and asthma. Why?

(2) Auto Immunity :

• Sometimes, due to genetic and other unknown
reasons, the body attacks self-cells. This results
in damage to the body and is called auto-
immune disease.
Rheumatoid arthritis which affects many
people in our society is an auto-immune
disease.

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(1) (2)

(3) (4) (5)

• It is due to formation of rheumatoid factor (IgM/IgG antibodies).
• The primary symptom of rheumatoid arthritis is inflammation of synovial membrane and pain due
to pressure exerted by increased synovial fluid. If it is left untreated, finally the joint becomes
immovable.
• Treatment of pain and inflammation is heat therapy and physiotherapy. Joint replacement is done
in extreme cases.
Other examples of auto-immune disorders are :
• Myasthenia gravis
• Pernicious anaemia
• Insulin Dependent Diabetes Mellitus (IDDM)/ Type 1 Diabetes
• Hashimoto disease
• Multiple Sclerosis.

(A) Myasthenia Gravis

• In this autoimmune disorder, antibodies are formed against acetylcholine (Ach) receptors present
on post synaptic membrane.
• It destroys acetylcholine receptors and causes depressed nerve conduction at neuromuscular
junction and decreased movements of muscles.
• Symptoms : Weakening and finally degeneration of skeletal muscles.

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(B) Pernicious Anaemia

• In this autoimmune disease, antibodies are formed against gastric oxyntic cells and Castle Intrinsic
Factor (CIF).
• Due to which vitamin B12 is not absorbed in the intestine and blood (RBC) formation is decreased.

(C) Insulin Dependent Diabetes Mellitus/Type 1 Diabetes

• In this autoimmune disease, antibodies are formed against β cells of pancreas.
• It destroys these cells and causes deficiency of insulin hormone in body.
• Symptoms : Hyperglycaemia, glycosuria, polyuria, polydipsia (excessive thirst), polyphagia
(increased hunger), etc.

(D) Hashimoto Disease

• In this autoimmune disease, antibodies are formed against thyroid gland.
• It destroys thyroid gland and causes deficiency of thyroid hormones i.e.
hypothyroidism.

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(E) Multiple Sclerosis
• In this autoimmune disease, antibodies are formed
against myelin sheath of nerve cells.
• It causes destruction of myelin sheath of nerve cells.
• Symptom : Neurological dysfunction.

(9) Immuno Deficiency Disorders :

Immunodeficiency Disorders

Primary/Congenital Secondary/Acquired
e.g. SCID e.g. AIDS

(A) Severe Combined Immuno Deficiency (SCID) :

• It is due to gene mutation involving deficiency of enzyme adenosine deaminase (ADA).
• This enzyme (ADA) is involved in maturation of B- and T-lymphocytes.
• Affected individual dies at an early age.
• Treatment : Gene therapy

(B) Acquired Immuno Deficiency Syndrome (AIDS) :

• In AIDS, its pathogen i.e. HIV attacks on T helper cells.
• It decreases count of T helper cells from 900 million per litre (normal count) to less than 200
million per litre.

AIDS :
• AIDS = Acquired Immuno Deficiency Syndrome
• Deficiency of immune system is acquired during the lifetime of an individual : AIDS is not a
congenital disease.
gp 120
• ‘Syndrome’ means a group gp41
of symptoms.
• AIDS was first reported in p24(Capsid) p17(matrix)
1981 and in the last twenty- ssRNA Integrase
five years or so, it has
spread all over the world Protease Reverse
killing more than 25 million transcriptase
persons.
• AIDS is caused by the
Human Immuno deficiency
Virus (HIV), a member of a Structure of HIV
group of viruses called
retrovirus, which have an envelope enclosing the RNA genome.
• In India, first case was reported in 1986 from Chennai.
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HIV

Envelope Core
Components
Protein Coat (P-17 & P-24)

Components
GP-120

GP-41 Genetic Material (ss-RNA)

Lipid Bilayer Enzymes

Reverse Transcriptase

Types
Integrase
Protease

Transmission of HIV-infection generally occurs :

1. Sexual route : by sexual contact with infected person
2. Parenteral route :
• By transfusion of contaminated blood and blood products
• By sharing infected needles as in the case of intravenous drug abusers

3. Tranplacental route : From infected mother to her foetus through

placenta
4. From infected mother to her infant by colostrum

Retro virus
People who are at high risk of getting viral RNA core
this infection includes :
viral protein virus infects
• Individuals who have multiple sexual normal cell
coat plasma
partners
• Individuals who required repeated membrane
Animal cell
blood transfusions
viral RNA is introduced into cell
• Drug addicts who take drugs
viral DNA is cytoplasm
intravenously produced by
reverse viral DNA incorporates
• Children born to an HIV infected
transcriptase into host genome
mother HIV/AIDS is not spread by
mere touch, physical contact, hugging, new viral RNA is
kissing, sharing meals, shaking hands, produced by
infected cell
mosquito bites, coughing, sneezing,
looking after AIDS patients; it New viruses are
spreads only through body fluids. produced
nucleus DNA

new viruses can infect

other cells
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Glycoprotein Viral envelope

(1) The envelope
glycoproteins enable
the virus to bind to Capsid
specific receptors
(not shown) on certain RAN (two
white blood cells. identical
strands)
Reverse
transcriptase HIV
(2) The virus fuses with the cell's plasma
membrane. The capsid proteins are removed,
releasing the viral proteins and RNA.

(3) Reverse transcriptase catalyzes

the synthesis of a DNA strand
complementary to the viral RNA.
HOST CELL
Viral
Reverse (4) Reverse
capsid
transcriptase transcriptase catalyzes
proteins
the synthesis of a
Viral RNA
second DNA strand
complementary to the
RNA-DNA first.
hybrid

(5) The double-stranded

DNA DNA is incorporated as a
provirus into the cell's
NUCLEUS DNA
Provirus
Chromosomal
(6) Proviral genes are
DNA
transcribed into RNA
RNA genome molecules, which serve
for the progeny as genomes for progeny
viruses viruses and as mRNAs
mRNA
for translation into viral
protein.

(7) The viral proteins include

capsid proteins and reverse
transcriptase (made in the
cytosol) and envelope
glycoproteins (made in the ER).

(9) Capsids are assembled (8) Vesicles transport the

around viral genomes and glycoproteins to the cell's
(10) New viruses, with viral reverse transcriptase plasma membrane.
envelope glycoproteins, bud from molecules.
the host cell.

AIDS :
HIV Entry First Symptom Death
(5-10 Years)
Asymptomatic Phase Symptomatic Phase

AIDS Related Complex Full Blown AIDS

(Mild form of AIDS) (Opportunistic
Infections)
(2-12 Weeks)
Window Period

HIV Entry Laboratory Diagnosis

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Note :
• Incubation period : Time interval between the entry of pathogen and appearance of symptoms
• Window period : Period between infection to the time when it can be laboratorically detected
• After getting into the body of the person, the virus enters into macrophages to produce virus
particles. The macrophages continue to produce virus and in this way acts like a HIV factory.
• Simultaneously, HIV enters into helper T-lymphocytes (TH), and produce progeny viruses. The
progeny viruses released in the blood attack other helper T-lymphocytes. This is repeated leading
to a progressive decrease in the number of helper T-lymphocytes in the body of the infected person.
• Infected cell can survive while viruses are being replicated and released.
• Due to progressive decrease in the number of helper T-lymphocytes (normal cell count is 900
million/litre), the person starts suffering :
• Initially from AIDS Related Complex (ARC) and finally from full blown AIDS.

AIDS Related Complex (ARC)

• Mild form of AIDS
• Symptoms : Bouts of fever, repeated episodes of diarrhoea, weight loss, prolonged cough, swollen
lymph nodes, night sweats (in more than 50% cases), etc.

Full blown AIDS

• Cell count of helper T-lymphocytes : Below 200 million/litre
• Patient becomes severely immunodeficient in this period, therefore starts suffering from
opportunistic infections (infections that could have been otherwise overcome) such as :
• Tuberculosis by Mycobacterium avium (bacterium)
• Candidiasis (ulcers of mouth and oesophagus) by Candida albicans (fungus)
• Pneumonia by Pneumocystis carinii (fungus)
• Kaposi sarcoma (cancer of skin and lymph nodes) by herpes virus
• Encephalitis by Toxoplasma gondii (protozoan)

Diagnosis :
• A widely used diagnostic test for AIDS is enzyme linked immuno-sorbent assay (ELISA), but it
is screening test only.
• Confirmatory test for AIDS is Western blot test.

Treatment :
1. Reverse Transcriptase Inhibitors
2. Integrase Inhibitors
3. Protease Inhibitors
4. HAART (Highly Active Anti Retroviral Therapy) or Cocktail Treatment :
• It includes both Reverse Transcriptase Inhibitors and Protease Inhibitors.
• Treatment of AIDS with anti-retroviral drugs is only partially effective. They can only prolong the
life of the patient but cannot prevent death, which is inevitable.

Prevention :
• As AIDS has no cure, prevention is the best option.
• HIV infection, more often, spreads due to conscious behaviour
patterns. The only excuse may be ignorance and it has been rightly
said – “don’t die of ignorance”.
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• In our country the National AIDS Control Organisation (NACO) and other non-governmental
organisation (NGOs) are doing a lot to educate people about AIDS.
• Infection with HIV or having AIDS is something that should not be hidden – since then, the infection
may spread to many more people.
• WHO has started a number of programmes to prevent the spreading of HIV infection.

Some such steps :

• Advocating safe sex and promoting regular check-ups for HIV in susceptible population
• Free distribution of condoms
• Making blood (from blood banks) safe from HIV
• Ensuring the use of only disposable needles and syringes in public and private hospitals and clinics
• Controlling drug abuse
• HIV/AIDS-infected people need help and sympathy instead of being shunned by society. Unless
society recognises it as a problem to be dealt with in a collective manner, the chances of wider
spread of the disease increase manifold.
Note : AIDS is a malady that can only be tackled, by the society and medical fraternity acting together, to
prevent the spread of the disease.

10. Cancer :
• Cancer : Uncontrolled, abnormal and excessive mitotic divisions of cells
• Study of cancer : Carcinology/Oncology
• Cancer is one of the most dreaded diseases of human beings.
• It is a major cause of death all over the globe. More than a million Indians suffer from cancer and a
large number of them die from it annually.
• The mechanisms that underlie development of cancer or oncogenic transformation of cells, its
treatment and control have been some of the most intense areas of research in biology and
medicine.

Types of Cancer :
Cancer

Carcinoma Sarcoma Blood Cancers

• Cancer of epithelial tissue • Cancer of connective
• Ectodermal & Endodermal tissue
origin • Mesodermal origin Lymphoma Leukemia
e.g. e.g. e.g. e.g.
✓ Skin Cancer ✓ Bone Cancer Burkitt’s Lymphoma Chronic Myelo-
✓ Lung Cancer ✓ Muscle Cancer (8 14) genous Leukemia
✓ Breast Cancer ✓ Lymph nodes (9 22)
✓ Prostate Cancer Cancer
✓ Cervical Cancer
✓ Oral Cancer
✓ Adenocarcinoma
(gland tumour)

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Mechanism of Cancer :
• In our body, cell growth and differentiation is highly controlled and regulated. In cancer cells, there
is breakdown of these regulatory mechanisms.
Cellular Oncogene (c-onc)
Or
Proto oncogene

Tumor Suppressor gene

Normal cell
• Tumour suppressor genes inhibit cellular proliferation.
Cellular Oncogene (c-onc) Cancer gene
Or Or
Proto oncogene Oncogene (v-onc)

Normal cell Tumour cell

• Several genes called cellular oncogenes (c-onc) or proto oncogenes have been identified in normal
cells which, when activated under certain conditions, could lead to oncogenic transformation of the cells.
Oncogenic Transformation
Normal cell Tumour cell
Induced by Carcinogens

Tumor Promoters :
• Agents that promote the proliferation of cells, which have already undergone genetic alternations
responsible for oncogenic transformation. These agents are called tumor promoters.
e.g. Some growth factors and hormones.

Tumor Promoter
Number of cells 
Normal cell

Tumour (Neoplasm)
Properties of Cancer cells :
• Normal cells show a property called contact inhibition by virtue of which contact with other cells
inhibits their uncontrolled growth. Cancer cells appears to have lost this property. As a result of
this, cancerous cells just continue to divide giving rise to masses of cells called tumors.
• Cancer cells are anchorage independent and insensitive to population density.
• Cancer cells are immortalised by the mechanism that maintains length of telomeres.
• Cancer cells are spread by invasion and metastasis.
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Tumors :
• Tumors are of two types: benign and malignant.
• Benign tumors normally remain confined to their original location and do not spread to other parts
of the body and cause little Primary
damage. tumor Extracellular
• The malignant tumors, on the matrix
other hand are a mass of Blood vessel
proliferating cells called
neoplastic or tumor cells. These Cancer cells invade
cells grow very rapidly, invading surrounding tissues Cancer cells are
and damaging the surrounding and vessels. transported by the
normal tissues. As these cells circulatory system
to distant sites.
actively divide and grow they also
starve the normal cells by
competing for vital nutrients.
• Cells sloughed from such tumors
reach distant sites through blood,
and wherever they get lodged in Cancer cells reinvade and
the body, they start a new tumor grow at new location.
there. This property called metastasis is the most feared property of malignant tumors.

Difference between benign tumour and malignant tumour :

Trait Benign Malignant

Tissue
Normal Disorganized
organization
Tumor boundary Well defined Poorly defined

Carcinogens :
• Cancer causing agents are known as carcinogens.
• There are 3 types of carcinogens :
(1) Physical agents
• Ionising radiations like X-rays and gamma rays and non-ionizing radiations like UV rays cause DNA
damage leading to neoplastic transformation.
• Sometimes, injury due to sharp teeth causes tongue cancer.
• Kashmiri people keep 'Kangri' close to skin that causes skin cancer and this skin cancer is called
kangri cancer.

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(2) Chemical agents
• The chemical carcinogens present in tobacco smoke have been identified as a
major cause of lung cancer.
• Tobacco chewing cause oral cancer.
• Combustion product of coal and pesticides, artificial flavour, sweeteners,
synthetic food, etc cause cancer.
• Hormonal imbalance or estrogen excess causes breast cancer.
• Urinary bladder cancer is common in dye workers.

(3) Biological agents

• It includes oncogenic viruses. Oncogenic viruses have genes called viral oncogenes.
e.g. Rous sarcoma virus, Hepatitis B & C viruses, Human papilloma virus, Epstein Barr virus, Herpes
virus, etc.

Cancer Detection and Diagnosis :

• Early detection of cancers is essential as it allows the disease to be treated successfully in many
cases.
• The techniques for cancer detection and diagnosis :
(1) Blood examination :
(a) Test for increased cell counts in case of leukemias
(b) Detection of the tumor markers in blood like :
• α-fetoprotein (AFP) for liver cancer
• PSA (prostate specific antigen) for prostate cancer
• alkaline phosphatase for bone metastasis

(2) Imaging (X-Ray, Sonography, CT Scan and MRI, etc.)

• These techniques are very useful to detect cancers of the internal organs.
• In X-rays scan and CT (Computed Tomography) scan, X-rays are used to generate, respectively, a
two dimensional (2D) and three dimensional (3D) image of the internals of an object.
• In sonography, high frequency sound waves (ultrasound) are used to produce dynamic visual
image of internal organs.
• In MRI (Magnetic Resonance Imaging), strong magnetic fields and non-ionising radiations are used
to accurately detect pathological and physiological changes in the living tissue.

(3) FNAC (fine needle aspiration cytology)

• Fluid is collected from cysts/tumors and examined for presence of cancer cells.

(4) Pap smear

• It is specially used for cervical carcinoma. In it, slide is prepared from cervical fluid.

(5) Biopsy and histopathological study

• In biopsy, a piece of the suspected tissue cut into thin sections is stained and examined under
microscope (histopathological studies) by a pathologist.
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(6) Modern techniques
• Antibodies against cancer-specific antigens are also used for detection of certain cancers.
• Techniques of molecular biology can be applied to detect genes in
individuals with inherited susceptibility to certain cancers. Identification
of such genes, which predispose an individual to certain cancers, may be
very helpful in prevention of cancers. Such individuals may be advised to
avoid exposure to particular carcinogens to which they are susceptible.
e.g. : Tobacco smoke in case of lung cancer

Treatment of Cancer :
• The common approaches for treatment of cancer are surgery, radiation therapy, chemotherapy and
immunotherapy.
(a) Surgery :
• Entire cancerous tissue and/or involved lymph nodes are removed.

(b) Radiotherapy :
• Tumor cells are irradiated lethally, taking proper care of the normal tissues surrounding the tumor
mass.

(c) Chemotherapy :
• Several chemotherapeutic drugs are used to kill cancerous cells. Some of these are specific for
particular tumors.
• Anti cancerous drugs inhibit synthesis of DNA in cancer cells stopping their cell cycle.
• Majority of drugs have side effects like hair loss, anemia, etc.
• Some popular anti cancerous drugs are :
✓ Vincristine and vinblastine (Source : Cantharanthus roseus or Vinca
rosea)
✓ Taxol (Source : Taxus baccata)

(d) Immunotherapy :
• Monoclonal antibodies
✓ They are designed to attach specific proteins in cancer cells.
✓ Their uses :
(i) To allow the immune system itself to destroy the cancer cells.
(ii) To deliver radiation directly to cancer cells.
(iii) Carry drugs directly to cancer cells.
• Cancer vaccine: Research is in progress to develop cancer vaccines.
• Tumor cells have been shown to avoid detection and destruction by immune system. Therefore,
the patients are given substances called biological response modifiers such as α-interferon which
activate their immune system and help in destroying the tumor.
• The common approaches for treatment of cancer are surgery, radiation therapy, chemotherapy and
immunotherapy.
• Most cancers are treated by combination of surgery, radiotherapy, chemotherapy and
immunotherapy.
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BEGINNER’S BOX-4 AIDS AND CANCER

1. Envelope of HIV is formed by :-

(1) P–24 (2) P–17 (3) ssRNA (4) GP–41, GP–120
2. ELISA test is used for the detection of :-
(1) HIV infection (2) Hepatitis–B (3) Both (1) and (2) (4) None of these above
3. AIDS is characterized by reduction in :
(1) Mast cells (2) Neutrophils (3) RBC (4) Helper T-cells
4. Which of the following gene is absent in a normal cell ?
(1) Proto-oncogene
(2) Tumor-suppressor gene
(3) Gene related to program cell death
(4) Oncogene
5. "Don't die of ignorance" is said for :-
(1) Cancer (2) AIDS (3) Malaria (4) Filaria
6. Which of the following statement is correct for SCID?
(1) This enzyme (ADA) is involved in maturation of B-lymphocytes only
(2) This enzyme (ADA) is involved in maturation of T-cells only
(3) Affected individual dies at an old age
(4) It is due to gene mutation involving deficiency of enzyme ADA (adenosine deaminase)
7. Nucleic acid in HIV is –
(1) ss RNA (2) ss DNA (3) ds RNA (4) ds DNA
8. Transmission of HIV occurs through.
(1) Transplacental route only (2) Sexual route only
(3) Parenteral route only (4) All of the above
9. Enzymes present in HIV is/are –
(1) Reverse transcriptase (2) Integrase
(3) Protease (4) All of the above
10. Which of the following act like HIV factory?
(1) Mast cell (2) Macrophage
(3) T-cell (4) B-cell
11. Opportunistic infections occur in HIV patient during –
(1) Window period (2) Incubation period
(3) ARC (4) Full down AIDS
12. Which of the following is not a carcinoma?
(1) Bone cancer (2) Skin cancer (3) Lung cancer (4) Cervical cancer
13. Tumour cell has –
(1) Active proto – oncogenes (2) Inactive proto – oncogene
(3) Inactive cellular oncogene (4) Tumour suppressor gene
14. Which of the following not a chemical carcinogen caused cancer?
(1) Kangri cancer (2) Lung cancer (3) Breast cancer (4) Oral cancer
15. Which of the following are oncogenic viruses?
(1) EB virus (2) Herpes virus (3) HPV (4) All of the above
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11. Drug Abuse :
Psychotropic Drugs
(Mood Altering)

Stimulants Depressant

Caffeine Cocaine Amphetamine Tranquilizers Sedative Hypnotic opioids

(Erythroxylum coca) (e.g. Phenothiazine, Benzodiazepine

& Barbiturates)

Morphine, Heroin Smack

Codeine (di-acetyl (Brown sugar)
morphine)

Psychedelic
(Vision producing drugs)

Hallucinogens

L.S.D. Datura Atropa belladona Cannabinoids

Charas/Hashish (Extract)

Marijuana (♀ Plant)
Bhang – Complete Shoot

Ganja - Inflorescence

When certain compounds are taken :

• For a purpose other than medicinal use or O
• In amounts/frequency that impairs one’s physical,
H3C N
physiological or psychological functions. NH
• Majority of these are obtained from flowering plants, H3C N
but some drugs are obtained from fungi. For e.g. LSD
CH3
(Lysergic acid Diethylamide) (Fruiting body of fungus
claviceps purpurea)

The drugs, which are commonly abused are :

(1) Opioids
Examples:
• Natural: Morphine
• Synthetic: Heroine (Diacetyl morphine) [White, odourless, bitter crystalline compound]
Source
• Morphine : Extracted from the latex of poppy plant Papaver somniferum
• Heroine : Obtained by acetylation of morphine
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Mode of intake
Generally by– Snorting, Injection

Mechanism of action
• Binding with specific opioid receptors present OH
in central nervous system and
gastrointestinal tract
O
Effects on body H
• Morphine : Very effective sedative and N–CH3
painkiller, and is very useful in patients who HO
have undergone surgery Papaver somniferum Morphine
• Heroine : A depressant and slows down body (Poppy plant)
functions

(2) Cannabinoids
Examples:
• Bhang
• Marijuana, Hashish, Charas and Ganja
Source
• Natural : Inflorescences of the cannabis plant Cannabis sativa
• Marijuana, Hashish, Charas and Ganja :
Flower tops, leaves and the resin of
cannabis plant are used in various
combinations for production
Mode of intake
• Generally by inhalation and oral
ingestion
Mechanism of action
Interacting with cannabinoid receptors Leaves of Skeletal structure of
present principally in the brain Cannabis sativa cannabinoid molecule
Effects on body
• Effects on cardiovascular system of the body
• Also being abused by some sports persons these days

(3) Coca alkaloids

Examples
• Cocaine, commonly called coke or crack
Source
• Coca plant Erythroxylum coca, native to South America.

Mode of intake – Usually by snorting

Mechanism of action
• Interference with the transport of the neuro-transmitter dopamine
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Interference of cocaine with transport of neuro-transmitter dopamine

Effects on body
• Potent stimulating action on central nervous system, producing a sense of euphoria and increased
energy.
• Excessive dosage causes hallucinations
• Several plants, fruits and seeds having hallucinogenic properties
have been used for hundreds of years in folk-medicine, religious
ceremonies and rituals all over the globe.
• Well-known plants with hallucinogenic properties are Atropa
belladona and Datura.
• Drugs like barbiturates, amphetamines, benzodiazepines, and
other similar drugs, that are normally used as medicines to help patients cope with mental illnesses
like depression and insomnia, are often abused.

12. Addiction and Dependence :

• The most important thing, which one fails to realise, is the inherent addictive nature of tobacco,
alcohol and drugs.
• Addiction : Psychological attachment to certain effects- such as euphoria and a temporary feeling
of well being- associated with drugs×.
• Dependence : The tendency of the body to manifest a characteristic and unpleasant withdrawal
syndrome if regular dose of drugs× is abruptly discontinued.

• Withdrawal Syndrome :
✓ Characterised by anxiety, shakiness, nausea and sweating, etc. which may be relieved when use
of drugs× is resumed again
✓ In some cases, withdrawal symptoms can be severe and even life threatening and the person
may need medical supervision.
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Frequent and repeated intake of drugs×

Addiction
(Due to inherent addictive nature of drugs×)

Intake of drugs× even when these are not needed or

their use becomes self destructive

Tolerance level of receptors present in body

(Receptors respond only to higher doses of drugs×)

Tolerance level of receptors present in body

(Receptors respond only to higher doses of drugs×)

Dependence

Intake of higher dose of drugs× No intake

more

(or intake of lower dose of drugs×)

Effects of drugs× : Continue

Withdrawal syndrome

(Vicious cycle)

Effects of Drug / Alcohol Abuse :

Immediate adverse effects of drugs and alcohol abuse :
• Reckless behaviour
• Vandalism
• Violence

Excessive doses of drugs may lead to :

• Coma
• Death due to respiratory failure, heart failure or cerebral haemorrhage
Note : A combination of drugs or their intake along with alcohol generally results in overdosing and even
deaths.

Most common warning signs of drug and alcohol abuse among youth include :
• Drop in academic performance
• Unexplained absence from school/college
• Lack of interest in personal hygiene
• Withdrawal
• Isolation
• Depression
• Fatigue
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• Aggressive and rebellious behaviour
• Deteriorating relationships with family and friends
• Loss of interest in hobbies
• Change in sleeping and eating habits
• Fluctuation in weight, appetite, etc.

Dependence leads to possible far-reaching implications of drug/alcohol abuse :

• Ignorance of all social norms by abuser in order to get sufficient
funds to satiate his/her needs, resulting in many social
adjustment problems
• Mental and financial distress to entire family and friends of
abuser etc
• The chronic use of drugs and alcohol damages nervous system and
liver (cirrhosis).
• Those who take drugs intravenously (direct injection into the vein
using a needle and syringe), are much more likely to acquire serious
infections like AIDS and Hepatitis B. Both AIDS and Hepatitis B
infections are chronic infections and ultimately fatal.
• The use of drugs and alcohol during pregnancy is also known to
adversely affect the foetus.

Certain sportspersons (mis)use :

• Narcotic analgesics
• Anabolic steroids
• Diuretics and certain hormones
• In sports to increase muscle strength and bulk and to promote aggressiveness and as a result
increase athletic performance.

The side-effects of the use of anabolic steroids in males include :

• Acne
• Increased aggressiveness
• Mood swings
• Depression
• Reduction of size of the testicles
• Decreased sperm production
• Potential for kidney and liver dysfunction
• Breast enlargement
• Premature baldness
• Enlargement of the prostate gland

The side-effects of the use of anabolic steroids in females include :

• Masculinisation (features like males)
• Increased aggressiveness
• Mood swings
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• Depression
• Abnormal menstrual cycles
• Excessive hair growth on the face and body
• Enlargement of clitoris
• Deepening of voice

Note : These side effects in males or females may be permanent with prolonged use.
• In the adolescent male or female, severe facial and body acne, and premature closure of the
growth centres of the long bones may result in stunted growth.

Prevention and Control of Drug/Alcohol Abuse :

• The age-old adage of ‘prevention is better than cure’ holds true here also.
• Measures particularly useful for prevention and control of alcohol and drugs abuse among
adolescents :
✓ Avoid undue peer pressure
✓ Education and counselling
✓ Seeking help from parents and peers
✓ Looking for danger signs
✓ Seeking professional and medical help

13. Alcohol Abuse :

• Ethyl alcohol is consumed as fermented beverages with low content of alcohol (like beer, wine, etc.)
and as distilled beverages with a relatively high alcohol percentage (like brandy, rum, whisky, gin, etc.).
• This alcohol is rapidly absorbed from the wall of stomach and enters the blood stream within
minutes of ingestion.
• In liver, alcohol is converted into a more toxic substance acetaldehyde.

Effects of alcohol abuse :

1. On liver :
• Alcoholic fatty liver
• Alcoholic cirrhosis
2. On brain :
• Depression
• The cerebrum part is affected first (The abuser loses judgement, self control and will power).
• And then cerebellum part is affected (control and coordination of the muscles of the abuser is
affected)
• Amnesia lass of memory
3. Lowering of blood sugar level (Hypoglycaemia)
4. Body resistance against diseases is reduced.
5. Impotency and Infertility
6. Foetal Alcohol Syndrome (FAS) (Due to heavy drinking by mother during pregnancy)
7. Oesophagitis and gastritis

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14. Tobacco Abuse :
• Tobacco has been used by human beings for more than 400 years.
• Tobacco is smoked, chewed or used as a snuff.
• Tobacco contains a large number of chemical substances including nicotine, an alkaloid.
• Nicotine stimulates adrenal gland to release adrenaline
and nor-adrenaline into blood circulation, both of
which raise blood pressure and increase heart rate.
• Smoking increases carbon monoxide (CO) content in
blood and reduces the concentration of haem bound
oxygen. This causes oxygen deficiency in the body. Health lungs Lung cancer
• Smoking also paves the way to hard drugs.
• Smoking is associated with increased incidence of :-
(i) Cancers of lung, urinary bladder and throat
(ii) Emphysema
(iii) Bronchitis

Alveolar
membranes
Break down
Normal alveoli Emphysema

Inflammation &
excess mucus
Normal bronchus Bronchitis
(iv) Coronary heart disease (Lumen of blood vessels become narrow)
(v) Intestinal ulcer.
• Tobacco chewing is associated with increased risk of cancer of the oral cavity.
• When one buys packets of cigarettes one cannot miss the statutory warning that is present on the
packing which warns against smoking and says how it is injurious to health.

15. Adolescence and Drug/Alcohol Abuse :

Adolescence :
• Both ‘a period’ and ‘a process’
• Period between 12-18 years of age
• During it, a child becomes mature in terms of his/her attitudes and beliefs for effective
participation in society.
• In other words, a bridge linking childhood and adulthood
• Accompanied by several biological and behavioural changes
• Thus, is a very vulnerable phase of mental and psychological development of an individual.

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Causes for motivation among adolescents/ youngsters towards tobacco, alcohol and drugs use :
Initially :
• Natural curiosity
• Need for adventure and excitement
• Experimentation
• Perception that it is ‘cool’ or progressive to smoke, use drugs or alcohol (television, movies,
newspapers, internet also help to promote this perception)
____________ (effects perceived as benefits) ____________
Later :
• To escape facing problems
• Due to stress from pressures to excel in academics or examinations and also
• Due to unstable or unsupportive family structures and peer pressure, etc.

BEGINNER’S BOX-5 DRUGS AND ALCOHOL ABUSE

1. Which of the following is included in cannabinoid ?

(1) Morphine (2) Heroin (3) Codeine (4) Charas
2. Receptors of opioids are present in :-
(1) CNS (2) GIT (3) Both (1) and (2) (4) Spleen
3. Which of the following is used as opioid analgesics ?
(1) Paracetamol, Aspirin (2) Morphine, Codeine
(3) Nimesulide, Penicillin (4) Ciprofloxacin, Ampicillin
4. Tabacco chewing is associated with increased risk of which cancer ?
(1) Oral cancer (2) Lung cancer
(3) Urinary bladder cancer (4) Prostate cancer
5. Drug extracted from latex of poppy plant Papaver somniferum is –
(1) Morphine (2) Heroine (3) Smack (4) All of the above
6. Organ system affected by opioids are –
(1) CNS (2) BVS (3) GIT (4) Both (1) and (3)
7. In liver, alcohol gets converted into more toxic substance –
(1) Acetaldehyde (2) Acetone
(3) Formaldehyde (4) Ketone
8. Adolescents get indulged in tobacco, alcohol and drugs due to –
(1) Peer pressure (2) Natural curosity
(3) Perception of cool and progressive (4) All of the above
9. Immediate adverse effect of drugs and alcohol abuse are –
(1) Reckless behaviour (2) Vandalism
(3) Violence (4) All of the above
10. Intra-venous drugs may lead to chronic and fatal injection like –
(1) AIDS (2) Hepatitis-B
(3) Both (1) and (2) (4) None of the above

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BEGINNER’S BOX ANSWERS KEY

Que. 1 2 3 4 5 6 7 8 9 10
Ans. 4 4 4 4 4 3 2 3 4 4
BEGINNER'S BOX-1
Que. 11 12 13 14 15
Ans. 2 2 2 2 3

Que. 1 2 3 4 5 6 7 8 9 10
Ans. 2 1 4 4 4 4 2 1 4 3
BEGINNER'S BOX-2
Que. 11 12 13 14 15 16 17 18 19 20
Ans. 4 4 2 2 3 1 3 3 2 1

Que. 1 2 3 4 5 6 7 8 9 10
BEGINNER'S BOX-3
Ans. 3 4 4 2 4 1 4 3 1 4

Que. 1 2 3 4 5 6 7 8 9 10
Ans. 4 3 4 4 2 4 1 4 4 2
BEGINNER'S BOX-4
Que. 11 12 13 14 15
Ans. 4 1 1 1 4

Que. 1 2 3 4 5 6 7 8 9 10
BEGINNER'S BOX-5
Ans. 4 3 2 1 4 4 1 4 4 3

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Immunity
(Ability of host to fight the disease-causing organism)

Innate immunity Acquired immunity

• Congenital • After birth
• Non-specific • Specific
• Consists of 4 types of barriers • Characterised by Memory
(i) Physical = Skin, Mucosa
(ii) Physiological = Saliva, Tear,
Gastric Juice Active Immunity Passive Immunity
(iii) Cellular = PMNL-neutrophils,
Monocytes, NK cells, Macrophage
(iv) Cytokine = Interferons Natural active Artificial active
immunity immunity
by infection by vaccine

Natural passive Artificial passive

immunity immunity
e.g. – IgG (placenta) e.g. Preformed
IgA (Colostrum) antibodies

Lymphoid organs
(Where origin, maturation and proliferation of lymphocytes occur)

Primary Lymphoid Organs Secondary Lymphoid Organs

(Bone-marrow, Thymus)
Spleen
Immature Antigen Lymph-nodes
lymphocytes sensitive Tonsils
lymphocytes Payer's patches
Appendix
MALT [50%]
Bone marrow : Main lymphoid organ (Mucosa Associated Lymphoid Tissues)

Provide site for interaction

of
lymphocytes with the
antigen

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Cancer
• One of the most dreaded disease of human beings.
• Develops due to Oncogenic transformation.

Oncogenic transformation
Proto-Oncogenes Oncogenes
(Normal cells) (Cancer cells)

Follow Do not follow contact inhibition

'Contact inhibition' phenomenon so, divide to form Tumor

Tumor

Benign (Non cancerous) Malignant (Cancerous)

Remains confined to origin site Show metastasis
(most feared property)

Neoplastic Invades
or surrounding
tumor cells tissues

Drugs

Opioids Cannabinoids Coca alkaloid

Opioid receptors are Receptors present in Brain,

present in CNS and GIT natural cannabinoids are Obtained from
e.g. Heroin and Morphine obtained from inflorescence Erythroxylum coca
of Cannabis sativa (native to S. America),
e.g. Cocaine/Coke/Crack,
• Diacetylmorphine • Extracted from e.g. Marijuana, Hashish,
Charas, Ganja it produces a sense of
• White • Latex of poppy
euphoria,
• Odourless plant
high dose causes
• Bitter • It is effective hallucination
• Crystalline sedativeand like Datura, Atropa
• Depressant painkiller, used for belladona
post surgical pain
Other abused drugs
• Barbiturates
• Amphetamines
• Benzodiazepines
• LSD [most potent
hallucinogen]

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