DASAR DASAR SISTIM PERTAHANAN

TUBUH = SISTEM IMUN

(IMUNOLOGI DASAR)

Prof. DR. dr. Harijono Kariosentono,SpKK

Topics:
1. Introduction and overview of Immunology
2. The Element of Immune System
3. Antibody and Lymphocyte structure
4. The Role of MHC in Immune Response
5. Immunity in Defence and Disease:
6. -Immunity to Fungi and Parasites
7. -Immunity to bacteria and Viruses
8. Complement System
10. The Effector Mechanism of Immune Response
11. Diseases cause by Immune Responses:
- Hypersensitivity
- Autoimmunity
- Immunodeficiencies
12. Immunity to Tumors
13. Immuno-prophylaxis and immuno therapy
14. Laboratory Techniques in Immunology &
Immunohematology
 INTRODUCTTION:
 Immunology is the study of immunity
 Understanding how the body distinguish
between what is “self” and what is “nonself”
 Historically, immunity meant protection
from disease and more spcifically infectious
disease 
 The ancient Chinese : custom of making children
resistant to smallpox by inhale powders made from
skin lesions patient recovering of the disease
 IMMUNITY

IMMUNE SYSTEM
Cells & molecules responsible for immunity

IMMUNE RESPONS
Collective and coordinated response to the introduction of foreign
substances
 I
IV
ANTIGEN
Protective
(Immune physiology)
III
IMMUNE
RESPONSE
V

Tissue injury / Disease

(Immunopathology)
II
IMMUNE 1. Hypersensitivity
SYSTEM
2. Autoimmune
3. Immunodeficiency
 SISTIM IMUN  RESPONS IMUN
 Definisi : Mekanisme tubuh (kolektif dan
terkoordinir) untuk mempertahankan keutuhan
tubuh , sebagai perlindungan terhadap bahaya
yang dapat ditimbulkan oleh berbagai bahan
asing (antigen) dalam lingkungan hidup.
 Fungsi : 1. proteksi
2. homeostasis
 Imunofisiologi gangguan imunopatologi:
1. hipersensitif (=alergi)
2. imunodefisiensi
3. otoimun
 Pembagian :
 I. Sistim Imun non spesifik
(innate immunity) : memberikan respon langsung
terhadap antigen, sebagai pertahanan tubuh yang telah
ada dan berfungsi sejak lahir.
A. Pertahanan fisik / mekanik :
Kulit, selaput lendir, silia, batuk, bersin
B. Pertahanan Biokimiawi :
Asam lambung, Lisozim, enzim, Laktoferin, dll.
C. Pertahanan Humoral :
komplemen, Interferon, C Reaktif protein.
D. Pertahanan Seluler :
Fagosit, Makrofag, Sel NK.
 Immunity :
- Innate immunity
/non-specific/ natural
- Acquired immunity
/specific/ adaptive immunity
IMMUNITY
Defence against microbes mediated by early reaction ( < 12
hours) of innate immunity  later responses of adaptive
immunity
INNATE ( = natural, native ) IMMUNITY :
☻ Used by the host to immediately defend itself
Consist of mechanisme that exist before infection,
since an indiv is born
☻ Rapid responses to microbes, short lived & have no
memory
☻ React in essentially the same way to repeated infect,
☻ Early / first line of defence mechanism against
microbes,
 The components of Innate Immunity

1. Physical and chemical barriers : skin & mucosal epithel,

antimicrobial substance produced at epithelial surface
2. Phagocytes cells : monocytes/macrophages (MØ), PMN
leucocytes ; Dendritric cell(DCs); NK cells; KC ;Eosinophil.
PMN : the earliest phagocytes cells to be recruited
3. Blood proteins : members of complement system, mediator of
inflamation, antimicrobial peptides, CRP
4. Cytokines  regulate an coordinate many of activities of the
cells of Innate Immunity
The pathogenicity of microbes related to
their ability to resist the mechanism of
Innate Immunity

Antigen : foreign substances induce immune

responses or targets of the such responses
Resp. Imun Non Spesifik = (SPTB)
 a. Komponen Sel :
- Sel Fagosit (DC, PMN, M & Monosit) :
- non-spec recognition & + Ag (Mikroorg)
“primitive system’ “Killed”
~ first line of defense

- NK Cells mengenal perubahan pada :

- sel tumor “destroy”
- sel yang terinfeksi virus (sel lisis)
Produksi :
Sitokin proinflamasi - amplifikasi resp. Inflamasi
(TNF-, IL 1 & IL-6) - mempengaruhi SPTA
- signal ke CNS reaksi sistemik
b. Komponen Humoral :
- Lisozym
- Komplemen
- Interferon
II. Sistim
Imun Spesifik (adaptive immunity):
 kemampuan untuk mengenal Ag
 sehingga terjadi proses sensitisasi
(pengenalan) sel-sel imunkompeten.
- Sistem imun spesifik hanya dapat
menghancurkan benda asing yang telah
dikenali dengan lebih cepat.
- Dapat bekerja sendiri tanpa sistem
imun non spesifik, tapi dapat terjadi pula
kerjasama antibodi-komplemen-
fagosit dan antara Sel T dengan Makrofag.
 ADAPTIVE IMMUNITY
( Spesific, Acquired Immunity)
☻ A response to infection and adapts to the infection
An ability to “remember” and respond more
vigorously to repeated exposures to the same microbe 
have memory
☻ Spesifics to microbes or macromol (non microbial Ag),
even closely related  have specificity
☻ ”Acquired” it by experience, are long lasting
☻ Component:- T lymphocytes and Antibodies produced
by B cells
- APC (in epidermis =LC, and dermal: DC)
Cellular component of Adaptive Immun
System
1. Lymphocytes :
- B lymphocytes
- T lymphocytes : - helper T cells (Th)
- cytolytic T cells (CTLs)
- NK cells (Natural Killer) against virus and intracellular
micr (in IIR)

2. Accessory cells : -MNC (phagocytes), dendritic cells, and

several other cells function as accessory cells

3. Effector cells : activated lymph, phagocytes, & other

leucocytes
 Cardinal Features of Adaptive
Immun Response
1. Specificity: IR are specific for distict Ag, elicit spec response

2. Diversity: capable recognizing a wide variety of Ag.

-Mammalian immun system can discrminate 109 - 1011 Ag
(lymphocyte repertoire)

3. Memory: enhanced responses to re-exposures to same

microbes.

4. Specialized response : special ways to different types of micr.

-Response optimal for defence against diff type of micr.
Cardinal Features …

5. Self-limitation : Ab levels decline with time

after each immunization
 homeostasis (returning to its resting
basal state)
6. Non reaction to self : ability to discriminate
between self and non-self =foreign Ag.
Eliminate nonself Ag while not reacting
harmfully to self substance.
 immunologic unresponsive = tolerance
The Link between Innate and Adaptive
respons :
1.IIR to microbes stimulates AIR and
influences the nature of adaptive
response
2.AIR use many of the effector mech of
innate immunity to eliminate microbes
 Types of
Adaptive Immune Responses

Humoral Immunity Cell-mediated Immunity

TIPE SISTIM IMUN ADAPTIV
A.Imunitas Humoral
Yang berperan : Limfosit B.(berasal dari Bursa
Fabricius)  Berkembang jadi sel Plasma, untuk
membentuk antibodi.
Antibodi : molekul sebagai pertahanan terhadap
virus, bakteri (ekstraseluler) dan menetralisir
toksin
B.Imunitas Seluler
Yang berperan: sel T (dibentuk dalam sumsum tulang,
diferensiasi dan proliferasi pada Tymus).
Sebagai pertahanan terhadap bakteri (Intraseluler),
virus, jamur, parasit & keganasan.
 1. HUMORAL IMMUNITY

Mediated by molecules in the blood, called ANTIBODY

(Ab) produced by B lymphocytes

☻ recognize specifically microbial Ag 

neutralize the infectivity  elimination (by
effectors mech)
☻Defence mech against extracellular
microbes and Could be transferred to
naive indiv as adoptive transfer

Substance bound Ab
Ab Induce  production of Ab
Ag
2. CELL – MEDIATED IMMUNITY

☻ Mediated by T cells
☻ Defence mech to intracell microbial ( virus & some bact )
☻  Promotes destruction of microbial residen in cell
☻  phagocytes or  lysis of infective cells
☻ Can be transferred to naive individu with T cells from
immunizes indiv
Clinically measure immunity by detect reaction when re exposed
to substance  sensitized / unsensitized
Active acquired by respond
to Ag
Cellular immunity
Passive
Transfer of cells
 Adaptive Immune Response Process

Ag recocnation

Lymphocytes active  proliferating & differentiating

Memory cells Effector cells

Re-exposure  response increase Eliminate Ag

Immune Phases of Adaptive Response

Recocnation phase

Activation phase

Effector phase

Decline (homeostasis)

☻ Memory
….>
RESPON IMUN:
 I. ALAMI (“ innate Immunity”/ natural)
* Non Spesifik, lini terdepan dari sist prthanan tubuh
* Bawaan sejak lahir
* seluler : Sel-sel fagosit
Humoral : Sist. Enzim, Komplemen,
Interferon .
 II.ADAPTIF (“Adaptive Immunity”)
* Spesifitas & Memory, second line of defence
* Seluler : Sel Limfosit, + APC
Humoral : Ig A, Ig G, Ig M, Ig D & Ig E.
PARADIGMA IMUNOFISIOLOGI
 SISTIM IMUN FUNGSI :
1. Pertahanan
2. Homeostasis
3. Perondaan
Imunopatologi :
1. Hipersensitif (alergi)
2. Imunodefisiensi
3. Autoimun
Kulit ~ Organ Imunologik
(oleh karena Mampu respon
imun)

Salt : - Sel Langerhans (LC)

- Keratinosit
- Limfosit (Immunocompetence)
- Sel Endotel pembuluh darah
Antigen :
 Setiap bahan dapat menimbulkan respon imun
spesifik
 Dapat mengikat komponen hasil respon imun
spesifik, seperti Ab / Epitop
 Hapten adalah determinan Ag dengan BM rendah,
dapat menjadi Ag setelah berikatan dengan carier
(BM Tinggi) Ag

IL-2
IL-1
MǾ Th
IL-2

Ig
SP
 Antibodi :
 Protein yang disebut Imunogloobulin (Ig)
 Mempunyai spesifitas dan aktivitas biologik
 Dibentuk sel plasma karena proliferasi sel B
akibat kontak dengan antigen
 Ab spesifik dapat berikatan dengan Ag yang
merangsang pembentukannya.
 Terdapat 5 klas antibodi tergantung struktur kimia
rantai berat yaitu : Ig g – IgM-IgA-IgD-IgE
 Dapat mengikat komplemen secara tidak spesifik
 Dapat mengikat permukaan mastosit, sehingga
terjadi pelepasan histamin.
Immunoglobulin (Antibodi).
 Ada 5 klas Ig :
 1. Ig.M : Pertama kali dibentuk pada waktu
 kontak dengan Antigen yang masuk kedalam
 membran Sitoplasma.
 2. Ig.G : Terbanyak dalam Sirkulasi Darah
 3. Ig.A : Berada pada Mukosa
- Usus dan Bronchus
- Air Liur
- Air mata
 4. Ig.E :Berperan pada respon alergi, melawan
 Infeksi cacing
 5. Ig. D : Fungsi belum jelas
Antigen – Antibodi Kompleks :
1. Menetralisir Toksin
2. Mengaglusinasi Microorganisme Mudah di
Fagositir

Reaksi Hipersensitivitas = Alergi

Merupakan respon imun yang patologik. Akibat
respon imun yang berlebihan sehingga menimbulkan
kerusakan jaringan tubuh.
Gell dan Coombs membagi 4 tipe reaksi:
 I. Tipe 1 :
- Disebut reaksi cepat / Rx anafilaksis / alergi
- Timbul segera setelah terpapar alergen
- Melalui mekanisme IgE, ada beberapa tahap:
A. Fase sensitisasi :
Pembentukan IgE sampai diikat oleh reseptor
spesifik pada permukaan Mastosit dan Basofil
B. Fase aktivasi – paparan dengan Ag Spesifik,
Mastosit, alami degranulasi.
C. Fase efektor, terjadi respon kompleks (Anafilaksis)
Sebagai efek bahan yang dilepas oleh Mastosit
dengan aktifitas farmakologik.
- Reaksi berupa wheal & flare/eritema dan edema.
- Pada asthma bronkhial, rhinitis & Urtikaria dan
dermatitis atopik.
• II. Tipe II
Disebut juga reaksi sitotoksik, terbentuk IgG dan IgM
yang dapat mengaktifkan Sel K.
Antigen terletak pada permukaan sel . Ikatan Ab-Ag
mengaktifkan komplemen, memudahkan fagositosis dan
mengalami lisis dari sel.
Pada destruksi eritosit akibat reaksi transfusi, anemia
hemolitik, reaksi obat dan kerusakan jaringan pada
penyakit auto imun.
III. Tipe III :
Disebut reaksi kompleks Imun
Terjadi bila komplek Ab-Ag berada disirkulasi darah
dan ditemukan dalam jaringan / dinding pembuluh
darah & mengaktifkan komplemen,
Ab disini IgG&IgM mengaktifkan komplemen
melepas MAF melepas enzim merusak jaringan
sekitar.
Ag dapat berasal dari kuman patogen, spora jamur /
jaringan sendiri.
Bentuk reaksi tipe III :
1. Reaksi Arthus
2. Reaksi serum sickness

Reaksi Tipe III terdapat pada :

a. Good Pasteur sindrom perdarahan paru dan
glomerulus
b. Rheumatic fever
c. Arthritis rheumatoid
d. Infeksi lain seperti malaria, lepra dan virus
e. Penyakit akibat kerja seperti pada Farmers lung.
Paparan jerami menimbulkan radang paru
ok terbentuk IgG spesifik komplek Ag-Ab
pada paru
IV. Tipe IV :
Disebut juga reaksi Hipersensitivitas lambat
respon sel T yang tersensitisasi terhadap Ag ttt.
Limposit T Limfokin. (MIF atau MAF)
aktivasi makrofag kerusakan jaringan.
Ag : Jaringan asing, virus,mycobact. Protein &
bahan kimia.
Reaksi ini perlu waktu 1-2 minggu untuk
meningkatkan klon sel T spesisifik untuk Ag ttt.