Image shows a health professional administering a vaccine to a child. The childs mother is holding them.

Image shows a diagram labeling the major arteries of the body. Some of these include the carotid artery which provides blood to the neck and head, the brachiocephalic artery which supplies blood to the arms and head, the renal artery supplying blood to the kidneys, the mesenteric arteries supplying blood to the intestines, the femoral arteries supplying blood to the legs.

Image shows a two part diagram of inflammatory response. The first pane shows an initial injury to the skin and introduction of pathogens to deeper tissues. Mast cells release clouds of histamines into the tissue.
In the second pane, the capillaries have become more porous, due to the histamines. Leukocytes are squeezing out of the capillary into the injured tissue, where they will phagocytize any pathogens they come across.

Image shows a diagram of the process of hemodialysis. Blood is removed from the patient from a location on the arm. Blood enters the hemodialysis apparatus and is run through dialyser to clean wastes from the blood. There are mechanisms to maintain blood tonicity and pressure, to prevent clotting, and ensure no air enters the bloodstream. The cleaned blood is returned to the patient in their arm, proximal to the place where the blood was first removed.

Image shows a photo of a young man.

Image shows the sequence of events leading to an allergic reaction. The text reads: The first time an allergy prone person runs across an allergen such as ragweed, he or she makes large amounts of ragweed antibody. These antibodies attach themselves to mast cells. The second time that person has a brush with ragweed, the primed mast cells release granules and powerful chemical mediators such as histamine and cytokines into the environment. These chemical mediators cause the typical symptoms of allergies.

 

Twenty-six-year-old Hakeem wasn’t feeling well. He was more tired than usual, dragging through his workdays despite going to bed earlier, and napping on the weekends. He didn’t have much of an appetite, and had started losing weight. When he pressed on the side of his neck, like the doctor is doing in Figure 17.1.1, he noticed an unusual lump.

Hakeem went to his doctor, who performed a physical exam and determined that the lump was a swollen lymph node. Lymph nodes are part of the immune system, and they will often become enlarged when the body is fighting off an infection. Dr. Hayes thinks that the swollen lymph node and fatigue could be signs of a viral or bacterial infection, although he is concerned about Hakeem’s lack of appetite and weight loss. All of those symptoms combined can indicate a type of cancer called lymphoma. An infection, however, is a more likely cause, particularly in a young person like Hakeem. Dr. Hayes prescribes an antibiotic in case Hakeem has a bacterial infection, and advises him to return in a few weeks if his lymph node does not shrink, or if he is not feeling better.

Hakeem returns a few weeks later. He is not feeling better and his lymph node is still enlarged. Dr. Hayes is concerned, and orders a biopsy of the enlarged lymph node. A lymph node biopsy for suspected lymphoma often involves the surgical removal of all or part of a lymph node. This helps to determine whether the tissue contains cancerous cells.

The initial results of the biopsy indicate that Hakeem does have lymphoma. Although lymphoma is more common in older people, young adults and even children can get this disease. There are many types of lymphoma, with the two main types being Hodgkin's lymphoma and non-Hodgkin's lymphoma. Non-Hodgkin lymphoma (NHL), in turn, has many subtypes. The subtype depends on several factors, including which cell types are affected. Some subtypes of NHL, for example, affect immune system cells called B cells, while others affect different immune system cells called T cells.

Dr. Hayes explains to Hakeem that it is important to determine which type of lymphoma he has, in order to choose the best course of treatment. Hakeem’s biopsied tissue will be further examined and tested to see which cell types are affected, as well as which specific cell-surface proteins — called antigens — are present. This should help identify his specific type of lymphoma.

As you read this chapter, you will learn about the functions of the immune system, and the specific roles that its cells and organs — such as B and T cells and lymph nodes — play in defending the body. At the end of this chapter, you will learn what type of lymphoma Hakeem has and what some of his treatment options are, including treatments that make use of the biochemistry of the immune system to fight cancer with the immune system itself.

Attributions

Figure 17.1.1

Lymph nodes/Is it a Cold or the Flu  by Lee Health on Vimeo is used under Vimeo's Terms of Service (https://vimeo.com/terms#licenses).

Figure 17.1.2

mitchell-luo-ymo_yC_N_2o-unsplash [photo] by Mitchell Luo on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 17.1.3

Lymph node biopsy by US Army Africa on Flickr is used under a  CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/) license.

References

Mayo Clinic Staff. (n.d.). Hodgkin's lymphoma [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/hodgkins-lymphoma/symptoms-causes/syc-20352646

Mayo Clinic Staff. (n.d.). Non-Hodgkin's lymphoma [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/non-hodgkins-lymphoma/symptoms-causes/syc-20375680

 

 

Image shows a diagram of the human body outlining the effects of anaphylaxis and where they occur in the body. These include: swelling of the tissues around the eyes, runny nose, swelling of lips, tongue and/or throat, fast or slow heartrate, low blood pressure, skin hives and itchiness, pelvic pain, lightheadedness, loss of consciousness, confusion, headache, anxiety, shortness of breath, wheezing, hoarseness, painful swallowing, cough, cramps and abdominal pains, diarrhea, vomiting, and loss of bladder control

A testable proposed explanation for a phenomenon.

Image shows a diagram depicting the locations of the symptoms of Lupus. These include: low grade fever, photosensitivity, ulcers in the mouth and nose, muscle pain, joint pain, fatigue, loss of appetite, facial rash, inflammation of the lungs heart and kidneys, and poor circulation of the extremities.

Created by CK-12 Foundation/Adapted by Christine Miller

Case Study: Drink and Flush

“Wow, this line for the restroom is long!” Shae says to Talia, anxiously bobbing from side to side to ease the pressure in her bladder. Talia nods and says, “It’s always like this at parties. It’s the alcohol.”

Shae and Talia are 21-year-old college students at a party. They — along with the other party guests — have been drinking alcoholic beverages over the course of the evening. As the night goes on, the line for the restroom has gotten longer and longer. You may have noticed this phenomenon if you have been to places where large numbers of people are drinking alcohol, like at the ballpark in Figure 16.1.2.

Shae says, “I wonder why alcohol makes you have to pee?” Talia says she learned about this in her Human Biology class. She tells Shae that alcohol inhibits a hormone that helps you retain water. Instead of your body retaining water, you urinate more out. This could lead to dehydration, so she suggests that after their trip to the restroom, they start drinking water, instead of alcohol.

For people who drink occasionally or moderately, this effect of alcohol on the excretory system — the system that removes wastes such as urine — is usually temporary. However, in people who drink excessively, alcohol can have serious, long-term effects on the excretory system. Heavy drinking on a regular basis can cause liver and kidney disease.

As you will learn in this chapter, the liver and kidneys are important organs of the excretory system, and impairment of the functioning of these organs can cause serious health consequences. At the end of the chapter, you will learn which hormone Talia was referring to. You will also learn some of the ways alcohol can affect the excretory system — both after the occasional drink, and in cases of excessive alcohol use and abuse.

Created by: CK-12/Adapted by Christine Miller

Giving the Gift of Life

Did you ever donate blood? If you did, then you probably know that your blood type is an important factor in blood transfusions. People vary in the type of blood they inherit, and this determines which type(s) of blood they can safely receive in a transfusion. Do you know your blood type?

Blood is composed of cells suspended in a liquid called plasma. There are three types of cells in blood: red blood cells, which carry oxygen; white blood cells, which fight infections and other threats; and platelets, which are cell fragments that help blood clot. Blood type (or blood group) is a genetic characteristic associated with the presence or absence of certain molecules, called antigens, on the surface of red blood cells. These molecules may help maintain the integrity of the cell membrane, act as receptors, or have other biological functions. A blood group system refers to all of the gene(s), alleles, and possible genotypes and phenotypes that exist for a particular set of blood type antigens. Human blood group systems include the well-known ABO and Rhesus (Rh) systems, as well as at least 33 others that are less well known.

Antigens and Antibodies

Antigens — such as those on the red blood cells — are molecules that the immune system identifies as either self (produced by your own body) or non-self (not produced by your own body). Blood group antigens may be proteinsno post, carbohydrates, glycoproteins (proteins attached to chains of sugars), or glycolipids (lipids attached to chains of sugars), depending on the particular blood group system. If antigens are identified as non-self, the immune system responds by forming antibodies that are specific to the non-self antigens. Antibodies are large, Y-shaped proteins produced by the immune system that recognize and bind to non-self antigens. The analogy of a lock and key is often used to represent how an antibody and antigen fit together, as shown in the illustration below (Figure 6.5.2). When antibodies bind to antigens, it marks them for destruction by other immune system cells. Non-self antigens may enter your body on pathogens (such as bacteria or viruses), on foods, or on red blood cells in a blood transfusion from someone with a different blood type than your own. The last way is virtually impossible nowadays because of effective blood typing and screening protocols.

Genetics of Blood Type

An individual’s blood type depends on which alleles for a blood group system were inherited from their parents. Generally, blood type is controlled by alleles for a single gene, or for two or more very closely linked genes. Closely linked genes are almost always inherited together, because there is little or no recombination between them. Like other genetic traits, a person’s blood type is generally fixed for life, but there are rare instances in which blood type can change. This could happen, for example, if an individual receives a bone marrow transplant to treat a disease, such as leukemia. If the bone marrow comes from a donor who has a different blood type, the patient’s blood type may eventually convert to the donor’s blood type, because red blood cells are produced in bone marrow.

The ABO blood group system is the best known human blood group system. Antigens in this system are glycoproteins. These antigens are shown in the list below. There are four common blood types for the ABO system:

1. Type A, in which only the A antigen is present.
2. Type B, in which only the B antigen is present.
3. Type AB, in which both the A and B antigens are present.
4. Type O, in which neither the A nor the B antigen is present.

Genetics of the ABO System

The ABO blood group system is controlled by a single gene on chromosome 9. There are three common alleles for the gene, often represented by the letters A , B , and O. With three alleles, there are six possible genotypes for ABO blood group. Alleles A and B, however, are both dominant to allele O and codominant to each other. This results in just four possible phenotypes (blood types) for the ABO system. These genotypes and phenotypes are shown in Table 6.5.1.

Table 6.5.1

ABO Blood Group System: Genotypes and Phenotypes

ABO Blood Group System
Genotype	Phenotype (Blood Type, or Group)
AA	A
AO	A
BB	B
BO	B
OO	O
AB	AB

The diagram below (Figure 6.5.3) shows an example of how ABO blood type is inherited. In this particular example, the father has blood type A (genotype AO) and the mother has blood type B (genotype BO). This mating type can produce children with each of the four possible ABO phenotypes, although in any given family, not all phenotypes may be present in the children.

The ABO system is the most important blood group system in blood transfusions. If red blood cells containing a particular ABO antigen are transfused into a person who lacks that antigen, the person’s immune system will recognize the antigen on the red blood cells as non-self. Antibodies specific to that antigen will attack the red blood cells, causing them to agglutinate (or clump) and break apart. If a unit of incompatible blood were to be accidentally transfused into a patient, a severe reaction (called acute hemolytic transfusion reaction) is likely to occur, in which many red blood cells are destroyed. This may result in kidney failure, shock, and even death. Fortunately, such medical accidents virtually never occur today.

These antibodies are often spontaneously produced in the first years of life, after exposure to common microorganisms in the environment that have antigens similar to blood antigens. Specifically, a person with type A blood will produce anti-B antibodies, while a person with type B blood will produce anti-A antibodies. A person with type AB blood does not produce either antibody, while a person with type O blood produces both anti-A and anti-B antibodies. Once the antibodies have been produced, they circulate in the plasma. The relationship between ABO red blood cell antigens and plasma antibodies is shown in Figure 6.5.4.

 

Which blood types are compatible and which are not? Type O blood contains both anti-A and anti-B antibodies, so people with type O blood can only receive type O blood. However, they can donate blood to people of any ABO blood type, which is why individuals with type O blood are called universal donors. Type AB blood contains neither anti-A nor anti-B antibodies, so people with type AB blood can receive blood from people of any ABO blood type. That’s why individuals with type AB blood are called universal recipients. They can donate blood, however, only to people who also have type AB blood. These and other relationships between blood types of donors and recipients are summarized in the simple diagram to the right.

Geographic Distribution of ABO Blood Groups

The frequencies of blood groups for the ABO system vary around the world. You can see how the A and B alleles and the blood group O are distributed geographically on the maps in Figure 6.5.6.

• Worldwide, B is the rarest ABO allele, so type B blood is the least common ABO blood type. Only about 16 per cent of all people have the B allele. Its highest frequency is in Asia. Its lowest frequency is among the indigenous people of Australia and the Americas.
• The A allele is somewhat more common around the world than the B allele, so type A blood is also more common than type B blood. The highest frequencies of the A allele are in Australian Aborigines, the Lapps (Sami) of Northern Scandinavia, and Blackfoot Native Americans in North America. The allele is nearly absent among Native Americans in Central and South America.
• The O allele is the most common ABO allele around the world, and type O blood is the most common ABO blood type. Almost two-thirds of people have at least one copy of the O allele. It is especially common in Native Americans in Central and South America, where it reaches frequencies close to 100 per cent. It also has relatively high frequencies in Australian Aborigines and Western Europeans. Its frequencies are lowest in Eastern Europe and Central Asia.

Evolution of the ABO Blood Group System

The geographic distribution of ABO blood type alleles provides indirect evidence for the evolutionary history of these alleles. Evolutionary biologists hypothesize that the allele for blood type A evolved first, followed by the allele for blood type O, and then by the allele for blood type B. This chronology accounts for the percentages of people worldwide with each blood group, and is also consistent with known patterns of early population movements.

The evolutionary forces of founder effect and genetic drift have no doubt played a significant role in the current distribution of ABO blood types worldwide. Geographic variation in ABO blood groups is also likely to be influenced by natural selection, because different blood types are thought to vary in their susceptibility to certain diseases. For example:

• People with type O blood may be more susceptible to cholera and plague. They are also more likely to develop gastrointestinal ulcers.
• People with type A blood may be more susceptible to smallpox and more likely to develop certain cancers.
• People with types A, B, and AB blood appear to be less likely to form blood clots that can cause strokes. However, early in our history, the ability of blood to form clots — which appears greater in people with type O blood — may have been a survival advantage.
• Perhaps the greatest natural selective force associated with ABO blood types is malaria. There is considerable evidence to suggest that people with type O blood are somewhat resistant to malaria, giving them a selective advantage where malaria is endemic.

Another well-known blood group system is the Rhesus (Rh) blood group system. The Rhesus system has dozens of different antigens, but only five main antigens (called D, C, c, E, and e). The major Rhesus antigen is the D antigen. People with the D antigen are called Rh positive (Rh+), and people who lack the D antigen are called Rh negative (Rh-). Rhesus antigens are thought to play a role in transporting ions across cell membranes by acting as channel proteins.

The Rhesus blood group system is controlled by two linked genes on chromosome 1. One gene, called RHD, produces a single antigen, antigen D. The other gene, called RHCE, produces the other four relatively common Rhesus antigens (C, c, E, and e), depending on which alleles for this gene are inherited.

Rhesus Blood Group and Transfusions

After the ABO system, the Rhesus system is the second most important blood group system in blood transfusions. The D antigen is the one most likely to provoke an immune response in people who lack the antigen. People who have the D antigen (Rh+) can be safely transfused with either Rh+ or Rh- blood, whereas people who lack the D antigen (Rh-) can be safely transfused only with Rh- blood.

Unlike anti-A and anti-B antibodies to ABO antigens, anti-D antibodies for the Rhesus system are not usually produced by sensitization to environmental substances. People who lack the D antigen (Rh-), however, may produce anti-D antibodies if exposed to Rh+ blood. This may happen accidentally in a blood transfusion, although this is extremely unlikely today. It may also happen during pregnancy with an Rh+ fetus if some of the fetal blood cells pass into the mother’s blood circulation.

Hemolytic Disease of the Newborn

If a woman who is Rh- is carrying an Rh+ fetus, the fetus may be at risk. This is especially likely if the mother has formed anti-D antibodies during a prior pregnancy because of a mixing of maternal and fetal blood during childbirth. Unlike antibodies against ABO antigens, antibodies against the Rhesus D antigen can cross the placenta and enter the blood of the fetus. This may cause hemolytic disease of the newborn (HDN), also called erythroblastosis fetalis, an illness in which fetal red blood cells are destroyed by maternal antibodies, causing anemia. This illness may range from mild to severe. If it is severe, it may cause brain damage and is sometimes fatal for the fetus or newborn. Fortunately, HDN can be prevented by preventing the formation of anti-D antibodies in the Rh- mother. This is achieved by injecting the mother with a medication called Rho(D) immune globulin.

Geographic Distribution of Rhesus Blood Types

The majority of people worldwide are Rh+, but there is regional variation in this blood group system, as there is with the ABO system. The aboriginal inhabitants of the Americas and Australia originally had very close to 100 per cent Rh+ blood. The frequency of the Rh+ blood type is also very high in African populations, at about 97 to 99 per cent. In East Asia, the frequency of Rh+ is slightly lower, at about 93 to 99 per cent. Europeans have the lowest frequency of the Rh+ blood type at about 83 to 85 per cent.

What explains the population variation in Rhesus blood types? Prior to the advent of modern medicine, Rh+ positive children conceived by Rh- women were at risk of fetal or newborn death or impairment from HDN. This was an enigma, because presumably, natural selection would work to remove the rarer phenotype (Rh-) from populations. However, the frequency of this phenotype is relatively high in many populations.

Recent studies have found evidence that natural selection may actually favor heterozygotes for the Rhesus D antigen. The selective agent in this case is thought to be toxoplasmosis, a parasitic disease caused by the protozoan Toxoplasma gondii, which is very common worldwide. You can see a life cycle diagram of the parasite in Figure 6.5.7. Infection by this parasite often causes no symptoms at all, or it may cause flu-like symptoms for a few days or weeks. Exposure to the parasite has been linked, however, to increased risk of mental disorders (such as schizophrenia), neurological disorders (such as Alzheimer’s), and other neurological problems, including delayed reaction times. One study found that people who tested positive for antibodies to the parasite were more than twice as likely to be involved in traffic accidents.

 

 

 

Attributes

Figure 6.5.1

Following the Blood Donation Trail by EJ Hersom/ USA Department of Defense is in the public domain. [Disclaimer: The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.]

Figure 6.5.2

Antibody by Fvasconcellos  on Wikimedia Commons is released into the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 6.5.3

ABO system codominance.svg, adapted by YassineMrabet (original "Codominant" image from US National Library of Medicine) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 6.5.4

ABO_blood_type.svg by InvictaHOG on Wikimedia Commons is released into the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 6.5.5

Blood Donor and recipient ABO by CK-12 Foundation is used under a CC BY-NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license.

Figure 6.5.6

• Map of Blood Group A by Muntuwandi at en.wikipedia on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/) license.
• Map of Blood Group B by Muntuwandi at en.wikipedia on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/) license.
• Map of Blood Group O by anthro palomar at en.wikipedia on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/) license.

Figure 6.5.7

Toxoplasma_gondii_Life_cycle_PHIL_3421_lores by Alexander J. da Silva, PhD/Melanie Moser, Centers for Disease Control and Prevention's Public Health Image Library (PHIL#3421) on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/Public_domain).

Table 6.5.1 

ABO Blood Group System: Genotypes and Phenotypes was created by Christine Miller.

 

References

Dean, L. (2005). Chapter 4 Hemolytic disease of the newborn. In Blood Groups and Red Cell Antigens [Internet]. National Center for Biotechnology Information (US). https://www.ncbi.nlm.nih.gov/books/NBK2266/

Mayo Clinic Staff. (n.d.). Toxoplasmosis [online article]. MayoClinic.org. https://www.mayoclinic.org/diseases-conditions/toxoplasmosis/symptoms-causes/syc-20356249

MedlinePlus. (2019, January 29). Hemolytic transfusion reaction [online article]. U.S. National Library of Medicine. https://en.wikipedia.org/w/index.php?title=Chromosome_9&oldid=946440619

TED-Ed. (2015, June 29). Why do blood types matter? - Natalie S. Hodge. YouTube. https://www.youtube.com/watch?v=xfZhb6lmxjk&feature=youtu.be

TED-Ed. (2020, February 18). How do blood transfusions work? - Bill Schutt. YouTube. https://www.youtube.com/watch?v=qcZKbjYyOfE&feature=youtu.be

Wikipedia contributors. (2020, May 10). Chromosome 1. In Wikipedia.  https://en.wikipedia.org/w/index.php?title=Chromosome_1&oldid=955942444

Wikipedia contributors. (2020, March 20). Chromosome 9. In Wikipedia.  https://en.wikipedia.org/w/index.php?title=Chromosome_9&oldid=946440619

 

 

The female sex hormone secreted mainly by the ovaries.

Image shows a diagram comparing a healthy nephron and its blood supply and one with diabetic nephropathy. The diseased one has blood vessels that look deformed and fragile.

 

Case Study: Drink and Flush

“Wow, this line for the restroom is long!” Shae says to Talia, anxiously bobbing from side to side to ease the pressure in her bladder. Talia nods and says, “It’s always like this at parties. It’s the alcohol.”

Shae and Talia are 21-year-old college students at a party. They — along with the other party guests — have been drinking alcoholic beverages over the course of the evening. As the night goes on, the line for the restroom has gotten longer and longer. You may have noticed this phenomenon if you have been to places where large numbers of people are drinking alcohol, like at the ballpark in Figure 16.1.2.

Shae says, “I wonder why alcohol makes you have to pee?” Talia says she learned about this in her Human Biology class. She tells Shae that alcohol inhibits a hormone that helps you retain water. Instead of your body retaining water, you urinate more out. This could lead to dehydration, so she suggests that after their trip to the restroom, they start drinking water, instead of alcohol.

For people who drink occasionally or moderately, this effect of alcohol on the excretory system — the system that removes wastes such as urine — is usually temporary. However, in people who drink excessively, alcohol can have serious, long-term effects on the excretory system. Heavy drinking on a regular basis can cause liver and kidney disease.

As you will learn in this chapter, the liver and kidneys are important organs of the excretory system, and impairment of the functioning of these organs can cause serious health consequences. At the end of the chapter, you will learn which hormone Talia was referring to. You will also learn some of the ways alcohol can affect the excretory system — both after the occasional drink, and in cases of excessive alcohol use and abuse.

Image shows a diagram of the body and the locations where main lymph nodes are found. There are several regions along the midline of the body, a concentration in the neck, armpits, and groin.

Image shows how HIV invades a helper t cell, inserts the viral DNA into the cell's DNA, reprograms the helper T cell to mass produce more HIV viruses, and then lyses to release all the newly made HIV into the host.

Image shows a photograph of an epipen.

Image shows a photograph of a finger with a paper cut.

A substance that is formed as the result of a chemical reaction.

The fusion of haploid gametes, egg and sperm, to form the diploid zygote.

Image shows to small children in a backyard wading pool. One adult is standing by the pool resting their foot on the edge and another adult is sitting nearby in a lawn chair.

Image shows a man sneezing against a black background. You can see all the the saliva and snot he has expelled in a cloud coming out of his mouth and nose. It is super gross.

 

Eyes that are red, watery, and itchy are typical of an allergic reaction known as allergic rhinitis. Commonly called hay fever, allergic rhinitis is an immune system reaction, typically to the pollen of certain plants. Your immune system usually protects you from pathogens and keeps you well. However, like any other body system, the immune system itself can develop problems. Sometimes, it responds to harmless foreign substances as though they were pathogens. This is the basis of allergies like hay fever.

An allergy is a disorder in which the immune system makes an inflammatory response to a harmless antigen. It occurs when the immune system is hypersensitive to an antigen in the environment that causes little or no response in most people. Allergies are strongly familial. Allergic parents are more likely to have allergic children, and those children’s allergies are likely to be more severe, which is evidence that there is a heritable tendency to develop allergies. Allergies are more common in children than adults, because many children outgrow their allergies by adulthood.

Allergens

Any antigen that causes an allergy is called an allergen. Common allergens are plant pollens, dust mites, mold, specific foods (such as peanuts or shellfish), insect stings, and certain common medications (such as aspirin and penicillin). Allergens may be inhaled or ingested, or they may come into contact with the skin or eyes. Symptoms vary depending on the type of exposure, and the severity of the immune system response. Some of the most common causes of allergies are shown in Figure 17.6.2: latex, pollen, dust mites, pet dander, insect stings and various foods. Inhaling pollen may cause symptoms of allergic rhinitis, such as sneezing and red itchy eyes. Insect stings may cause an itchy rash. This type of allergy is called contact dermatitis.

Prevalence of Allergies

There has been a significant increase in the prevalence of allergies over the past several decades, especially in the rich nations of the world, where allergies are now very common disorders. In the developed countries, about 20% of people have or have had hay fever, another 20% have had contact dermatitis, and about 6% have food allergies. In the poorer nations of the world, on the other hand, allergies of all types are much less common.

One explanation for the rise in allergies in the developed world is the hygiene hypothesis. According to this hypothesis, people in developed countries live in relatively sterile environments because of hygienic practices and sanitation systems. As a result, people in these countries are exposed to fewer pathogens than their immune system evolved to cope with. To compensate, their immune system “keeps busy” by attacking harmless antigens in allergic responses.

How Allergies Occur

The diagram in Figure 17.6.3 shows how an allergic reaction occurs. At the first exposure to an allergen, B cells are activated to form plasma cells that produce large amounts of antibodies to the allergen. These antibodies attach to leukocytes called mast cells. Subsequently, every time the person encounters the allergen again, the mast cells are already primed and ready to deal with it. The primed mast cells immediately release cytokines and histamines, which in turn cause inflammation and recruitment of leukocytes, among other responses. These responses are responsible for the signs and symptoms of allergies.

Treating Allergies

The symptoms of allergies can range from mild to life-threatening. Mild allergy symptoms are often treated with antihistamines. These are drugs that reduce or eliminate the effects of the histamines that produce allergy symptoms.

Treating Anaphylaxis

The most severe allergic reaction is a systemic reaction called anaphylaxis. This is a life-threatening response caused by a massive release of histamines. Many of the signs and symptoms of anaphylaxis are shown in Figure 17.6.4. Some of them include a drop in blood pressure, changes in heart rate, shortness of breath, and swelling of the tongue and throat, which may threaten the patient with suffocation unless emergency treatment is given. People who have had anaphylactic reactions may carry an epinephrine autoinjector (widely known by its brand name EpiPen®) so they can inject themselves with epinephrine if they start to experience an anaphylactic response. The epinephrine helps control the immune reaction until medical care can be provided. Epinephrine constricts blood vessels to increase blood pressure, relaxes smooth muscles in the lungs to reduce wheezing and improve breathing, modulates heart rate, and works to reduce swelling that may otherwise block the airways.

Immunotherapy for Allergies

Another way to treat allergies is called immunotherapy, commonly called “allergy shots.” This approach may actually cure specific allergies, at least for several years if not permanently. It may be particularly beneficial for allergens that are difficult or impossible to avoid (such as pollen). First, however, patients must be tested to identify the specific allergens that are causing their allergies. As shown in Figure 17.6.5, this may involve scratching tiny amounts of common allergens into the skin, and then observing whether there is a localized reaction to any of them. Each allergen is applied in a different numbered location on the skin, so if there is a reaction — such as redness or swelling — the responsible allergens can be identified. Then, through periodic injections (usually weekly or monthly), patients are gradually exposed to larger and larger amounts of the allergens. Over time, generally from months to years, the immune system becomes desensitized to the allergens. This method of treating allergies is often effective for allergies to pollen or insect stings, but its usefulness for allergies to food is unclear.

Autoimmune Diseases

Autoimmune diseases occur when the immune system fails to recognize the body’s own molecules as self. As a result, instead of ignoring the body’s healthy cells, it attacks them, causing damage to tissues and altering organ growth and function. Most often, B cells are at fault for autoimmune responses. They are generally the cells that lose tolerance for self. Why does this occur? Some autoimmune diseases are thought to be caused by exposure to pathogens that have antigens similar to the body’s own molecules. After this exposure, the immune system responds to body cells as though they were pathogens, as well.

Certain individuals are genetically susceptible to developing autoimmune diseases. These individuals are also more likely to develop more than one such disease. Gender is a risk factor for autoimmunity — females are much more likely than males to develop autoimmune diseases. This is likely due, in part, to gender differences in sex hormones.

At a population level, autoimmune diseases are less common where infectious diseases are more common. The hygiene hypothesis has been proposed to explain the inverse relationship between infectious and autoimmune diseases, as well as the prevalence of allergies. According to the hypothesis, without infectious diseases to “keep it busy,” the immune system may attack the body’s own cells instead.

Common Autoimmune Diseases

An estimated 15 million or more people worldwide have one or more autoimmune diseases. Two of the most common autoimmune diseases are type I diabetes and multiple sclerosis. In terms of the specific body cells that are attacked by the immune system, both are localized diseases. In the case of type I diabetes, the immune system attacks and destroys insulin-secreting islet cells in the pancreas. In the case of multiple sclerosis, the immune system attacks and destroys the myelin sheaths that normally insulate the axons of neurons and allow rapid transmission of nerve impulses.

Some relatively common autoimmune diseases are systemic — or body-wide — diseases. They include rheumatoid arthritis and systemic lupus erythematosus (SLE). In these diseases, the immune system may attack and injure many tissues and organs. For example, as you can see in Figure 17.6.6, symptoms of SLE may involve the muscular, skeletal, integumentary, respiratory, and cardiovascular systems.

Treatment for Autoimmune Diseases

None of these common autoimmune diseases can be cured, although all of them have treatments that may help relieve symptoms and prevent some of the long-term damage they may cause. Traditional treatments for autoimmune diseases include immunosuppressive drugs to block the immune response, as well as anti-inflammatory drugs to quell inflammation. Hormone replacement may be another option. Type I diabetes, for example, is treated with injections of the hormone insulin, because islet cells in the pancreas can no longer secrete it.

Immunodeficiency occurs when the immune system is not working properly, generally because one or more components of the immune system are inactive. As a result, the immune system may be unable to fight off pathogens or cancers that a normal immune system would be able to resist. Immunodeficiency may occur for a variety of reasons.

Causes of Immunodeficiency

Dozens of rare genetic diseases can result in a defective immune system. This type of immunodeficiency is called primary immunodeficiency. One is born with one of these diseases, rather than acquiring it after birth. Probably the best known of these primary immunodeficiency diseases is severe combined immunodeficiency (SCID). It is also known as “bubble boy disease,” because people with this disorder are extremely vulnerable to infectious diseases, and some of them have become well known for living inside a bubble that provides a sterile environment. SCID is most often caused by an X-linked recessive mutation that interferes with normal B cell and T cell production.

Other types of immunodeficiency are not present at birth, but are acquired due to experiences or exposures that occur after birth. Acquired immunodeficiency is called secondary immunodeficiency because it is secondary to some other event or exposure. Secondary immunodeficiency may occur for a number of different reasons:

• Some pathogens attack and destroy immune system cells. An example is the virus known as HIV, which attacks and destroys T cells.
• The immune system naturally becomes less effective as people get older. This age-related decline — called immunosenescence — generally begins around the age of 50 and worsens with increasing age. Immunosenescence is the reason older people are generally more susceptible to disease than younger people.
• The immune system may be damaged by another disorder, such as obesity, alcoholism, or the abuse of other drugs.
• In developing countries, malnutrition is the most common cause of immune system damage and immunodeficiency. Inadequate protein intake is especially damaging to the immune system. It can lead to impaired complement system activity, phagocyte malfunction, and lower-than-normal production of antibodies and cytokines.
• Certain medications can suppress the immune system. This is the intended effect of immunosuppressant drugs given to people with transplanted organs so they do not reject them. In many cases, however, immunosuppression is an unwanted side effect of drugs used to treat other disorders.

Human immunodeficiency virus (HIV) is the most common cause of immunodeficiency in the world today. HIV infections of human hosts are a relatively recent phenomenon. Scientists think that the virus originally infected monkeys, but then jumped to human populations. most likely from a bite, probably sometime during the early to mid-1900s. This most likely occurred in West Africa, but the virus soon spread around the world. HIV was first identified by medical researchers in 1981. Since then, HIV has killed almost 40 million people worldwide, and its economic toll has also been enormous. The hardest hit countries are in Africa, where the virus has infected human populations the longest, and medications to control the virus are least available.  In 2016, over 63,000 Canadians were living with HIV.

HIV Transmission

HIV is transmitted through direct contact of mucous membranes or body fluids such as blood, semen, or breast milk. As shown in Figure 17.6.7, transmission of the virus can occur through sexual contact or the use of contaminated hypodermic needles. It can also be transmitted from an infected mother’s blood during late pregnancy or childbirth, or through breast milk after birth. In the past, HIV was also transmitted occasionally through blood transfusions. Because donated blood is now screened for HIV, the virus is no longer transmitted this way.

HIV and the Immune System

HIV infects and destroys helper T cells, the type of lymphocytes that regulate the immune response. This process is illustrated in the diagram in Figure 17.6.8. The virus injects its own DNA into a helper T cell and uses the T cell’s “machinery” to make copies of itself. In the process, the helper T cell is destroyed, and the virus copies go on to infect other helper T cells. HIV is able to evade the immune system and keep destroying helper T cells by mutating frequently so its surface antigens keep changing, and by using the host cell’s membrane to hide its own antigens.

Acquired immunodeficiency syndrome (AIDS) may result from years of damage to the immune system by HIV. It occurs when helper T cells fall to a very low level and opportunistic diseases occur. Opportunistic diseases are infections and tumors that are rare, except in people with a damaged immune system. The diseases take advantage of the “opportunity” presented by people whose immune system cannot fight back. Opportunistic diseases are usually the direct cause of death for people with AIDS.

Treating HIV/AIDS

For patients who have access to HIV medications, infection with the virus is no longer the death sentence that it once was. By 1995, combinations of drugs called “highly active antiretroviral therapy” were developed. For some patients, these drugs can reduce the amount of virus they are carrying to undetectable levels. However, some level of virus always hides in the body’s immune cells, and it will multiply again if a patient stops taking the medications. Researchers are trying to develop drugs to kill these hidden viruses, as well. If their efforts are successful, it could end AIDS.

EpiPens® and their sole manufacturer (pharmaceutical company Mylan) were featured in headlines in 2016, but not for a good reason. The media outburst was triggered by a drastic price hike in EpiPens® — and Mylan’s apparent greed.

EpiPens® are auto-injectable syringes preloaded with a measured dose of epinephrine, a drug that can rapidly stop a life-threatening anaphylactic response to an allergen. Using the device is easy and does not require any special training. The injector just needs to be jammed against the thigh, which can be done through clothing or on bare skin. Each year, doctors write millions of prescriptions for EpiPens®. Many people with severe allergies always carry two of the devices with them, just in case they experience anaphylaxis, although most of them never need to use them. Other people with severe allergies have literally had their lives saved multiple times by EpiPens® when they had anaphylactic reactions. Even when the devices haven’t been used, they must be replaced each year due to expiration of the epinephrine.

You might think that EpiPens® would be relatively inexpensive, given their life-saving potential. As recently as 2009, a two-pack of EpiPens® cost about $100. However, in just seven years, the cost of the same two-pack of EpiPens® skyrocketed by an incredible 400%! By 2016, the cost was $600 or more. Mylan apparently raised the price for the sole purpose of increasing profits. The company also raised prices significantly on many other drugs. The price hike in EpiPens® alone was certainly profitable. In 2015, the sale of EpiPens® earned Mylan $1 billion. Mylan’s CEO took home almost $19 million the same year, which was an increase of more than 600% over her prior salary.

News coverage of the price hike in EpiPens® began in the summer of 2016 after a price increase in May of that year. Both private citizens and elected officials expressed outrage over the price increase, especially when coupled with the gluttonous profits of the company and its CEO. By late August, Mylan responded to the backlash by offering discount coupons for EpiPens®. A few days later, the company promised to introduce a cheaper, generic version of the device. Analysts quickly determined that selling a generic version would allow Mylan to make more money on the product than reducing the price of the name-brand device, which they still declined to do. By September of 2016, Mylan was being investigated for antitrust violations related to sales of EpiPens® to public schools in New York City.

The Mylan/EpiPen® story may still be making the news. But whatever its outcome, the story has already added fuel to public and private debates about important ethical issues — issues such as the excessive costs of life-saving drugs and the huge profits of big pharma. What is the most recent news on EpiPens® and Mylan? If you are interested, you can check the headlines online to find out. What are your views on the ethical issues they raise?

 

Attributions

Figure 17.6.1

Oedema by Championswimmer on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/en:public_domain).

Figure 17.6.2

• Medical (latex) gloves from pngimg.com is used under a CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0/) license.
• House dust mites (5247996458) by Gilles San Martin from Namur, Belgium on Wikimedia Commons is used under a CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0/deed.en) license.
•  Honey bee macro by Karunakar Rayker on Flickr is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/) license.
• Peanuts by Karolina Grabowska on Pexels is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).
• Photo of dog and grey cat by ERC4N51 on pxhere is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).
• Tags: Pollen Allergy Spring by Castagnari53 on Pixabay, is used under the Pixabay License (https://pixabay.com/service/license/).

Figure 17.6.3

512px-Mast_cells by National Institute of Allergy and Infectious Diseases (U.S.) & National Cancer Institute (p.29) is in the public domain (https://en.wikipedia.org/wiki/en:public_domain).

Figure 17.6.4

Signs_and_symptoms_of_anaphylaxis by Mikael Häggström on Wikimedia Commons is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).

Figure 17.6.5

Allergy Tests by Dan Pupius on Flickr is used under a CC BY-NC-SA 2.0 (https://creativecommons.org/licenses/by-nc-sa/2.0/) license.

Figure 17.6.6

1024px-Symptoms_of_SLE by Mikael Häggström on Wikimedia Commons is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).

Figure 17.6.7

HIV transmission by CK-12 Foundation is used under a CC BY NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license.

Figure 17.6.8

HIV life cycle by CK-12 Foundation is used under a CC BY NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license.

©CK-12 Foundation Licensed under  • Terms of Use • Attribution

Figure 17.6.9

Epipen by Stock Catalog on flickr by Stock Catalog on Flickr is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/) license.

References

Brainard, J/ CK-12 Foundation. (2016). Figure 8 HIV may be transmitted in all of the ways shown here [digital image]. In CK-12 College Human Biology (Section 19.6) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-human-biology/section/19.6/

Brainard, J/ CK-12 Foundation. (2016). Figure 9 This diagram shows how HIV infects and destroys helper T cells [digital image]. In CK-12 College Human Biology (Section 19.6) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-human-biology/section/19.6/

CBS News. (2016, August 16). Rising cost of potentially life-saving EpiPen puts pinch on families [online article]. CBS Interactive Inc. https://www.cbsnews.com/news/allergy-medication-epipen-epinephrine-rising-costs-impact-on-families/

Gross Science. (2015, June 29). What are tonsil stones? | Gross Science. YouTube. https://www.youtube.com/watch?v=RiMSmDBvgto&feature=youtu.be

Häggström, M. (2014). Medical gallery of Mikael Häggström 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436

National Institute of Allergy and Infectious Diseases (NIAID). (n.d.). Severe combined immunodeficiency (SCID) [online article]. National Institute of Health (NIH). https://www.niaid.nih.gov/diseases-conditions/severe-combined-immunodeficiency-scid

National Institute of Allergy and Infectious Diseases (U.S.) & National Cancer Institute (U.S.). (2003, September). Understanding the immune system and how it works [NIH Publication No. 03-5423]. Scholar Works -  Indiana University. https://scholarworks.iupui.edu/handle/1805/748

[The] New York Times. (2015, December 15). The boy in the bubble | Retro Report | The New York Times. YouTube. https://www.youtube.com/watch?v=pJa6KVLwl9U&feature=youtu.be

Seeker. (2014, October 3). Why are peanut allergies becoming so common? YouTube. https://www.youtube.com/watch?v=Mjr9h_QmdeM&feature=youtu.be

Summary: Estimates of HIV incidence, prevalence, and Canada's progress on meeting the 90-90-90 HIV targets 2016. (2018, July). Public Health Agency of Canada. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90/pub-eng.pdf

Swetlitz, I., Silverman, E. (2016, August 25). Mylan may have violated antitrust law in its EpiPen sales to schools, legal experts say [online article]. STATNews.com. https://www.statnews.com/2016/08/25/mylan-antitrust-epipen-schools/

TED-Ed. (2016, May 26). Why do people have seasonal allergies? - Eleanor Nelsen. YouTube.  https://www.youtube.com/watch?v=-q7Fz7NIMWM&feature=youtu.be

TED-Ed. (2015, March 16). Why it’s so hard to cure HIV/AIDS - Janet Iwasa, https://www.youtube.com/watch?v=0TipTogQT3E&feature=youtu.be

 

Created by CK-12 Foundation/Adapted by Christine Miller

Eyes that are red, watery, and itchy are typical of an allergic reaction known as allergic rhinitis. Commonly called hay fever, allergic rhinitis is an immune system reaction, typically to the pollen of certain plants. Your immune system usually protects you from pathogens and keeps you well. However, like any other body system, the immune system itself can develop problems. Sometimes, it responds to harmless foreign substances as though they were pathogens. This is the basis of allergies like hay fever.

An allergy is a disorder in which the immune system makes an inflammatory response to a harmless antigen. It occurs when the immune system is hypersensitive to an antigen in the environment that causes little or no response in most people. Allergies are strongly familial. Allergic parents are more likely to have allergic children, and those children’s allergies are likely to be more severe, which is evidence that there is a heritable tendency to develop allergies. Allergies are more common in children than adults, because many children outgrow their allergies by adulthood.

Allergens

Any antigen that causes an allergy is called an allergen. Common allergens are plant pollens, dust mites, mold, specific foods (such as peanuts or shellfish), insect stings, and certain common medications (such as aspirin and penicillin). Allergens may be inhaled or ingested, or they may come into contact with the skin or eyes. Symptoms vary depending on the type of exposure, and the severity of the immune system response. Some of the most common causes of allergies are shown in Figure 17.6.2: latex, pollen, dust mites, pet dander, insect stings and various foods. Inhaling pollen may cause symptoms of allergic rhinitis, such as sneezing and red itchy eyes. Insect stings may cause an itchy rash. This type of allergy is called contact dermatitis.

Prevalence of Allergies

There has been a significant increase in the prevalence of allergies over the past several decades, especially in the rich nations of the world, where allergies are now very common disorders. In the developed countries, about 20% of people have or have had hay fever, another 20% have had contact dermatitis, and about 6% have food allergies. In the poorer nations of the world, on the other hand, allergies of all types are much less common.

One explanation for the rise in allergies in the developed world is the hygiene hypothesis. According to this hypothesis, people in developed countries live in relatively sterile environments because of hygienic practices and sanitation systems. As a result, people in these countries are exposed to fewer pathogens than their immune system evolved to cope with. To compensate, their immune system “keeps busy” by attacking harmless antigens in allergic responses.

How Allergies Occur

The diagram in Figure 17.6.3 shows how an allergic reaction occurs. At the first exposure to an allergen, B cells are activated to form plasma cells that produce large amounts of antibodies to the allergen. These antibodies attach to leukocytes called mast cells. Subsequently, every time the person encounters the allergen again, the mast cells are already primed and ready to deal with it. The primed mast cells immediately release cytokines and histamines, which in turn cause inflammation and recruitment of leukocytes, among other responses. These responses are responsible for the signs and symptoms of allergies.

Treating Allergies

The symptoms of allergies can range from mild to life-threatening. Mild allergy symptoms are often treated with antihistamines. These are drugs that reduce or eliminate the effects of the histamines that produce allergy symptoms.

Treating Anaphylaxis

The most severe allergic reaction is a systemic reaction called anaphylaxis. This is a life-threatening response caused by a massive release of histamines. Many of the signs and symptoms of anaphylaxis are shown in Figure 17.6.4. Some of them include a drop in blood pressure, changes in heart rate, shortness of breath, and swelling of the tongue and throat, which may threaten the patient with suffocation unless emergency treatment is given. People who have had anaphylactic reactions may carry an epinephrine autoinjector (widely known by its brand name EpiPen®) so they can inject themselves with epinephrine if they start to experience an anaphylactic response. The epinephrine helps control the immune reaction until medical care can be provided. Epinephrine constricts blood vessels to increase blood pressure, relaxes smooth muscles in the lungs to reduce wheezing and improve breathing, modulates heart rate, and works to reduce swelling that may otherwise block the airways.

Immunotherapy for Allergies

Another way to treat allergies is called immunotherapy, commonly called “allergy shots.” This approach may actually cure specific allergies, at least for several years if not permanently. It may be particularly beneficial for allergens that are difficult or impossible to avoid (such as pollen). First, however, patients must be tested to identify the specific allergens that are causing their allergies. As shown in Figure 17.6.5, this may involve scratching tiny amounts of common allergens into the skin, and then observing whether there is a localized reaction to any of them. Each allergen is applied in a different numbered location on the skin, so if there is a reaction — such as redness or swelling — the responsible allergens can be identified. Then, through periodic injections (usually weekly or monthly), patients are gradually exposed to larger and larger amounts of the allergens. Over time, generally from months to years, the immune system becomes desensitized to the allergens. This method of treating allergies is often effective for allergies to pollen or insect stings, but its usefulness for allergies to food is unclear.

Autoimmune Diseases

Autoimmune diseases occur when the immune system fails to recognize the body’s own molecules as self. As a result, instead of ignoring the body’s healthy cells, it attacks them, causing damage to tissues and altering organ growth and function. Most often, B cells are at fault for autoimmune responses. They are generally the cells that lose tolerance for self. Why does this occur? Some autoimmune diseases are thought to be caused by exposure to pathogens that have antigens similar to the body’s own molecules. After this exposure, the immune system responds to body cells as though they were pathogens, as well.

Certain individuals are genetically susceptible to developing autoimmune diseases. These individuals are also more likely to develop more than one such disease. Gender is a risk factor for autoimmunity — females are much more likely than males to develop autoimmune diseases. This is likely due, in part, to gender differences in sex hormones.

At a population level, autoimmune diseases are less common where infectious diseases are more common. The hygiene hypothesis has been proposed to explain the inverse relationship between infectious and autoimmune diseases, as well as the prevalence of allergies. According to the hypothesis, without infectious diseases to “keep it busy,” the immune system may attack the body’s own cells instead.

Common Autoimmune Diseases

An estimated 15 million or more people worldwide have one or more autoimmune diseases. Two of the most common autoimmune diseases are type I diabetes and multiple sclerosis. In terms of the specific body cells that are attacked by the immune system, both are localized diseases. In the case of type I diabetes, the immune system attacks and destroys insulin-secreting islet cells in the pancreas. In the case of multiple sclerosis, the immune system attacks and destroys the myelin sheaths that normally insulate the axons of neurons and allow rapid transmission of nerve impulses.

Some relatively common autoimmune diseases are systemic — or body-wide — diseases. They include rheumatoid arthritis and systemic lupus erythematosus (SLE). In these diseases, the immune system may attack and injure many tissues and organs. For example, as you can see in Figure 17.6.6, symptoms of SLE may involve the muscular, skeletal, integumentary, respiratory, and cardiovascular systems.

Treatment for Autoimmune Diseases

None of these common autoimmune diseases can be cured, although all of them have treatments that may help relieve symptoms and prevent some of the long-term damage they may cause. Traditional treatments for autoimmune diseases include immunosuppressive drugs to block the immune response, as well as anti-inflammatory drugs to quell inflammation. Hormone replacement may be another option. Type I diabetes, for example, is treated with injections of the hormone insulin, because islet cells in the pancreas can no longer secrete it.

Immunodeficiency occurs when the immune system is not working properly, generally because one or more components of the immune system are inactive. As a result, the immune system may be unable to fight off pathogens or cancers that a normal immune system would be able to resist. Immunodeficiency may occur for a variety of reasons.

Causes of Immunodeficiency

Dozens of rare genetic diseases can result in a defective immune system. This type of immunodeficiency is called primary immunodeficiency. One is born with one of these diseases, rather than acquiring it after birth. Probably the best known of these primary immunodeficiency diseases is severe combined immunodeficiency (SCID). It is also known as “bubble boy disease,” because people with this disorder are extremely vulnerable to infectious diseases, and some of them have become well known for living inside a bubble that provides a sterile environment. SCID is most often caused by an X-linked recessive mutation that interferes with normal B cell and T cell production.

Other types of immunodeficiency are not present at birth, but are acquired due to experiences or exposures that occur after birth. Acquired immunodeficiency is called secondary immunodeficiency because it is secondary to some other event or exposure. Secondary immunodeficiency may occur for a number of different reasons:

• Some pathogens attack and destroy immune system cells. An example is the virus known as HIV, which attacks and destroys T cells.
• The immune system naturally becomes less effective as people get older. This age-related decline — called immunosenescence — generally begins around the age of 50 and worsens with increasing age. Immunosenescence is the reason older people are generally more susceptible to disease than younger people.
• The immune system may be damaged by another disorder, such as obesity, alcoholism, or the abuse of other drugs.
• In developing countries, malnutrition is the most common cause of immune system damage and immunodeficiency. Inadequate protein intake is especially damaging to the immune system. It can lead to impaired complement system activity, phagocyte malfunction, and lower-than-normal production of antibodies and cytokines.
• Certain medications can suppress the immune system. This is the intended effect of immunosuppressant drugs given to people with transplanted organs so they do not reject them. In many cases, however, immunosuppression is an unwanted side effect of drugs used to treat other disorders.

Human immunodeficiency virus (HIV) is the most common cause of immunodeficiency in the world today. HIV infections of human hosts are a relatively recent phenomenon. Scientists think that the virus originally infected monkeys, but then jumped to human populations. most likely from a bite, probably sometime during the early to mid-1900s. This most likely occurred in West Africa, but the virus soon spread around the world. HIV was first identified by medical researchers in 1981. Since then, HIV has killed almost 40 million people worldwide, and its economic toll has also been enormous. The hardest hit countries are in Africa, where the virus has infected human populations the longest, and medications to control the virus are least available.  In 2016, over 63,000 Canadians were living with HIV.

HIV Transmission

HIV is transmitted through direct contact of mucous membranes or body fluids such as blood, semen, or breast milk. As shown in Figure 17.6.7, transmission of the virus can occur through sexual contact or the use of contaminated hypodermic needles. It can also be transmitted from an infected mother’s blood during late pregnancy or childbirth, or through breast milk after birth. In the past, HIV was also transmitted occasionally through blood transfusions. Because donated blood is now screened for HIV, the virus is no longer transmitted this way.

HIV and the Immune System

HIV infects and destroys helper T cells, the type of lymphocytes that regulate the immune response. This process is illustrated in the diagram in Figure 17.6.8. The virus injects its own DNA into a helper T cell and uses the T cell’s “machinery” to make copies of itself. In the process, the helper T cell is destroyed, and the virus copies go on to infect other helper T cells. HIV is able to evade the immune system and keep destroying helper T cells by mutating frequently so its surface antigens keep changing, and by using the host cell’s membrane to hide its own antigens.

Acquired immunodeficiency syndrome (AIDS) may result from years of damage to the immune system by HIV. It occurs when helper T cells fall to a very low level and opportunistic diseases occur. Opportunistic diseases are infections and tumors that are rare, except in people with a damaged immune system. The diseases take advantage of the “opportunity” presented by people whose immune system cannot fight back. Opportunistic diseases are usually the direct cause of death for people with AIDS.

Treating HIV/AIDS

For patients who have access to HIV medications, infection with the virus is no longer the death sentence that it once was. By 1995, combinations of drugs called “highly active antiretroviral therapy” were developed. For some patients, these drugs can reduce the amount of virus they are carrying to undetectable levels. However, some level of virus always hides in the body’s immune cells, and it will multiply again if a patient stops taking the medications. Researchers are trying to develop drugs to kill these hidden viruses, as well. If their efforts are successful, it could end AIDS.

EpiPens® and their sole manufacturer (pharmaceutical company Mylan) were featured in headlines in 2016, but not for a good reason. The media outburst was triggered by a drastic price hike in EpiPens® — and Mylan’s apparent greed.

EpiPens® are auto-injectable syringes preloaded with a measured dose of epinephrine, a drug that can rapidly stop a life-threatening anaphylactic response to an allergen. Using the device is easy and does not require any special training. The injector just needs to be jammed against the thigh, which can be done through clothing or on bare skin. Each year, doctors write millions of prescriptions for EpiPens®. Many people with severe allergies always carry two of the devices with them, just in case they experience anaphylaxis, although most of them never need to use them. Other people with severe allergies have literally had their lives saved multiple times by EpiPens® when they had anaphylactic reactions. Even when the devices haven’t been used, they must be replaced each year due to expiration of the epinephrine.

You might think that EpiPens® would be relatively inexpensive, given their life-saving potential. As recently as 2009, a two-pack of EpiPens® cost about $100. However, in just seven years, the cost of the same two-pack of EpiPens® skyrocketed by an incredible 400%! By 2016, the cost was $600 or more. Mylan apparently raised the price for the sole purpose of increasing profits. The company also raised prices significantly on many other drugs. The price hike in EpiPens® alone was certainly profitable. In 2015, the sale of EpiPens® earned Mylan $1 billion. Mylan’s CEO took home almost $19 million the same year, which was an increase of more than 600% over her prior salary.

News coverage of the price hike in EpiPens® began in the summer of 2016 after a price increase in May of that year. Both private citizens and elected officials expressed outrage over the price increase, especially when coupled with the gluttonous profits of the company and its CEO. By late August, Mylan responded to the backlash by offering discount coupons for EpiPens®. A few days later, the company promised to introduce a cheaper, generic version of the device. Analysts quickly determined that selling a generic version would allow Mylan to make more money on the product than reducing the price of the name-brand device, which they still declined to do. By September of 2016, Mylan was being investigated for antitrust violations related to sales of EpiPens® to public schools in New York City.

The Mylan/EpiPen® story may still be making the news. But whatever its outcome, the story has already added fuel to public and private debates about important ethical issues — issues such as the excessive costs of life-saving drugs and the huge profits of big pharma. What is the most recent news on EpiPens® and Mylan? If you are interested, you can check the headlines online to find out. What are your views on the ethical issues they raise?

 

Attributions

Figure 17.6.1

Oedema by Championswimmer on Wikimedia Commons is in the public domain (https://en.wikipedia.org/wiki/en:public_domain).

Figure 17.6.2

• Medical (latex) gloves from pngimg.com is used under a CC BY-NC 4.0 (https://creativecommons.org/licenses/by-nc/4.0/) license.
• House dust mites (5247996458) by Gilles San Martin from Namur, Belgium on Wikimedia Commons is used under a CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0/deed.en) license.
•  Honey bee macro by Karunakar Rayker on Flickr is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/) license.
• Peanuts by Karolina Grabowska on Pexels is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).
• Photo of dog and grey cat by ERC4N51 on pxhere is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).
• Tags: Pollen Allergy Spring by Castagnari53 on Pixabay, is used under the Pixabay License (https://pixabay.com/service/license/).

Figure 17.6.3

512px-Mast_cells by National Institute of Allergy and Infectious Diseases (U.S.) & National Cancer Institute (p.29) is in the public domain (https://en.wikipedia.org/wiki/en:public_domain).

Figure 17.6.4

Signs_and_symptoms_of_anaphylaxis by Mikael Häggström on Wikimedia Commons is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).

Figure 17.6.5

Allergy Tests by Dan Pupius on Flickr is used under a CC BY-NC-SA 2.0 (https://creativecommons.org/licenses/by-nc-sa/2.0/) license.

Figure 17.6.6

1024px-Symptoms_of_SLE by Mikael Häggström on Wikimedia Commons is used under a CC0 1.0 Universal Public Domain Dedication license (https://creativecommons.org/publicdomain/zero/1.0/).

Figure 17.6.7

HIV transmission by CK-12 Foundation is used under a CC BY NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license.

Figure 17.6.8

HIV life cycle by CK-12 Foundation is used under a CC BY NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license.

©CK-12 Foundation Licensed under  • Terms of Use • Attribution

Figure 17.6.9

Epipen by Stock Catalog on flickr by Stock Catalog on Flickr is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0/) license.

References

Brainard, J/ CK-12 Foundation. (2016). Figure 8 HIV may be transmitted in all of the ways shown here [digital image]. In CK-12 College Human Biology (Section 19.6) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-human-biology/section/19.6/

Brainard, J/ CK-12 Foundation. (2016). Figure 9 This diagram shows how HIV infects and destroys helper T cells [digital image]. In CK-12 College Human Biology (Section 19.6) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-human-biology/section/19.6/

CBS News. (2016, August 16). Rising cost of potentially life-saving EpiPen puts pinch on families [online article]. CBS Interactive Inc. https://www.cbsnews.com/news/allergy-medication-epipen-epinephrine-rising-costs-impact-on-families/

Gross Science. (2015, June 29). What are tonsil stones? | Gross Science. YouTube. https://www.youtube.com/watch?v=RiMSmDBvgto&feature=youtu.be

Häggström, M. (2014). Medical gallery of Mikael Häggström 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 2002-4436

National Institute of Allergy and Infectious Diseases (NIAID). (n.d.). Severe combined immunodeficiency (SCID) [online article]. National Institute of Health (NIH). https://www.niaid.nih.gov/diseases-conditions/severe-combined-immunodeficiency-scid

National Institute of Allergy and Infectious Diseases (U.S.) & National Cancer Institute (U.S.). (2003, September). Understanding the immune system and how it works [NIH Publication No. 03-5423]. Scholar Works -  Indiana University. https://scholarworks.iupui.edu/handle/1805/748

[The] New York Times. (2015, December 15). The boy in the bubble | Retro Report | The New York Times. YouTube. https://www.youtube.com/watch?v=pJa6KVLwl9U&feature=youtu.be

Seeker. (2014, October 3). Why are peanut allergies becoming so common? YouTube. https://www.youtube.com/watch?v=Mjr9h_QmdeM&feature=youtu.be

Summary: Estimates of HIV incidence, prevalence, and Canada's progress on meeting the 90-90-90 HIV targets 2016. (2018, July). Public Health Agency of Canada. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90/pub-eng.pdf

Swetlitz, I., Silverman, E. (2016, August 25). Mylan may have violated antitrust law in its EpiPen sales to schools, legal experts say [online article]. STATNews.com. https://www.statnews.com/2016/08/25/mylan-antitrust-epipen-schools/

TED-Ed. (2016, May 26). Why do people have seasonal allergies? - Eleanor Nelsen. YouTube.  https://www.youtube.com/watch?v=-q7Fz7NIMWM&feature=youtu.be

TED-Ed. (2015, March 16). Why it’s so hard to cure HIV/AIDS - Janet Iwasa, https://www.youtube.com/watch?v=0TipTogQT3E&feature=youtu.be

 

Image shows a photomicrograph in which a stain has been applied that attached to only one specific type of cell.

 

These people are participating in a bike ride to raise funds for leukemia and lymphoma research (Figure 17.7.1). Leukemia and lymphoma are blood cancers. In 2020,  approximately 6,900 Canadians will be diagnosed with leukemia and 3,000 will die from this cancer. Lymphoma is the most common type of blood cancer. As a lymphoma patient, Hakeem, who you learned about in the beginning of this chapter, may eventually benefit from research funded by a bike ride like this one.

What type of blood cell is affected in lymphoma? As the name implies, lymphoma is a cancer that affects lymphocytes, which are a type of leukocyte. As you have learned in this chapter, there are different types of lymphocytes, including the B and T cells of the adaptive immune system. Different types of lymphoma affect different types of lymphocytes in different ways. It is important to correctly identify the type of lymphoma, so that patients can be treated appropriately.

You may recall that one of Hakeem’s symptoms was a swollen lymph node, and he was diagnosed with lymphoma after a biopsy of that lymph node. Swollen lymph nodes are a common symptom of lymphoma. As you have learned, lymph nodes are distributed throughout the body along lymphatic vessels, as part of the lymphatic system. The lymph nodes filter lymph and store lymphocytes. Therefore, they play an important role in fighting infections. Because of this, they will often swell in response to an infection. In Hakeem’s case, the swelling and other symptoms did not improve after several weeks and a course of antibiotics, which caused Dr. Hayes to suspect lymphoma instead. The biopsy showed that Hakeem did indeed have cancerous lymphocytes in his lymph nodes.

But which type of lymphocytes were affected? Lymphoma most commonly affects B or T lymphocytes. The two major types of lymphoma are called Hodgkin (HL) or non-Hodgkin lymphoma (NHL). NHL is more common than HL. In 2020, the Canadian Cancer Society estimates 10,400 Canadians will be diagnosed with non-Hodgkin lymphoma, whereas 1,000 will be diagnosed with Hodgkin lymphoma. While HL is one distinct type of lymphoma, NHL has about 60 different subtypes, depending on which specific cells are affected and how.

Hakeem was diagnosed with a type of NHL called diffuse large B-cell lymphoma (DLBCL) — the most common type of NHL. This type of lymphoma affects B cells and causes them to appear large under the microscope. In addition to Hakeem’s symptoms of fatigue, swollen lymph nodes, loss of appetite, and weight loss, common symptoms of this type of lymphoma include fever and night sweats. It is an aggressive and fast-growing type of lymphoma that is fatal if not treated. The good news is that with early detection and proper treatment, about 70% of patients with DLBCL can be cured.

How do physicians determine the specific type of lymphoma? Tissue obtained from a biopsy can be examined under a microscope to observe physical changes (such as abnormal cell size or shape) that are characteristic of a particular subtype of lymphoma. Additionally, tests can be performed on the tissue to determine which cell-surface antigens are present. Recall that antigens are molecules that bind to specific antibodies. Antibodies can be produced in the laboratory and labeled with compounds that can be identified by their colour under a microscope. When these antibodies are applied to a tissue sample, this colour will appear wherever the antigen is present, because it binds to the antibody. This technique was used in the photomicrograph in Figure 17.7.2 to identify the presence of a cell-surface antigen (shown as reddish-brown) in a sample of skin cells. This technique, called immunohistochemistry, is also commonly used to identify antigens in tissue samples from lymphoma patients.

Why would identifying cell-surface antigens be important in diagnosing and treating lymphoma? As you have learned, the immune system uses antigens present on the surface of cells or pathogens to distinguish between self and non-self, and to launch adaptive immune responses. Cells that become cancerous often change their cell-surface antigens. This is one way that the immune system can identify and destroy them. Also, different cell types in the body can sometimes be identified by the presence of specific cell-surface antigens. Knowing the types of cell-surface antigens present in a tissue sample can help physicians identify which cells are cancerous, and possibly the specific subtype of cancer. Knowing this information can be helpful in choosing more tailored and effective treatments.

One treatment for NHL is, in fact, the use of medications made from antibodies that bind to cell-surface antigens present on cells affected by the specific subtype of NHL. This is called immunotherapy. These drugs can directly bind to and kill the cancerous cells. For patients with DLBCL like Hakeem, immunotherapy is often used in conjunction with chemotherapy and radiation as a course of treatment. Although Hakeem has a difficult road ahead, he and his medical team are optimistic that — given the high success rate when DLBCL is caught and treated early — he may be cured. More research into how the immune system functions may lead to even better treatments for lymphoma — and other types of cancers — in the future.

Attributions

Figure 17.7.1

Cycling to Beat Blood Cancer by Blood Cancer UK (Formerly Bloodwise) on Flickr is used under a CC BY-NC-ND 2.0 (https://creativecommons.org/licenses/by-nc-nd/2.0/) license.

Figure 17.7.2

antigen stain by Ed Uthman from Houston, TX, USA on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

References

Hodgkin lymphoma statistics [online article]. (2020). Canadian Cancer Society. https://www.cancer.ca:443/en/cancer-information/cancer-type/hodgkin-lymphoma/statistics/?region=on

Non-Hodgkin lymphoma statistics [online article]. (2020). Canadian Cancer Society. https://www.cancer.ca:443/en/cancer-information/cancer-type/non-hodgkin-lymphoma/statistics/?region=on

TED-Ed. (2015, April 30). What is leukemia? - Danilo Allegra and Dania Puggioni. YouTube. https://www.youtube.com/watch?v=Z3B-AaqjyjE&feature=youtu.be

 

Image shows a side view diagram of the male and female pelvis. The male urethra is much longer because it extends through the penis, and in women it exits through the pelvic floor.

A biological process which converts sugars such as glucose, fructose, and sucrose into cellular energy, producing ethanol and carbon dioxide as by-products.

Created by CK-12 Foundation/Adapted by Christine Miller

These people are participating in a bike ride to raise funds for leukemia and lymphoma research (Figure 17.7.1). Leukemia and lymphoma are blood cancers. In 2020,  approximately 6,900 Canadians will be diagnosed with leukemia and 3,000 will die from this cancer. Lymphoma is the most common type of blood cancer. As a lymphoma patient, Hakeem, who you learned about in the beginning of this chapter, may eventually benefit from research funded by a bike ride like this one.

What type of blood cell is affected in lymphoma? As the name implies, lymphoma is a cancer that affects lymphocytes, which are a type of leukocyte. As you have learned in this chapter, there are different types of lymphocytes, including the B and T cells of the adaptive immune system. Different types of lymphoma affect different types of lymphocytes in different ways. It is important to correctly identify the type of lymphoma, so that patients can be treated appropriately.

You may recall that one of Hakeem’s symptoms was a swollen lymph node, and he was diagnosed with lymphoma after a biopsy of that lymph node. Swollen lymph nodes are a common symptom of lymphoma. As you have learned, lymph nodes are distributed throughout the body along lymphatic vessels, as part of the lymphatic system. The lymph nodes filter lymph and store lymphocytes. Therefore, they play an important role in fighting infections. Because of this, they will often swell in response to an infection. In Hakeem’s case, the swelling and other symptoms did not improve after several weeks and a course of antibiotics, which caused Dr. Hayes to suspect lymphoma instead. The biopsy showed that Hakeem did indeed have cancerous lymphocytes in his lymph nodes.

But which type of lymphocytes were affected? Lymphoma most commonly affects B or T lymphocytes. The two major types of lymphoma are called Hodgkin (HL) or non-Hodgkin lymphoma (NHL). NHL is more common than HL. In 2020, the Canadian Cancer Society estimates 10,400 Canadians will be diagnosed with non-Hodgkin lymphoma, whereas 1,000 will be diagnosed with Hodgkin lymphoma. While HL is one distinct type of lymphoma, NHL has about 60 different subtypes, depending on which specific cells are affected and how.

Hakeem was diagnosed with a type of NHL called diffuse large B-cell lymphoma (DLBCL) — the most common type of NHL. This type of lymphoma affects B cells and causes them to appear large under the microscope. In addition to Hakeem’s symptoms of fatigue, swollen lymph nodes, loss of appetite, and weight loss, common symptoms of this type of lymphoma include fever and night sweats. It is an aggressive and fast-growing type of lymphoma that is fatal if not treated. The good news is that with early detection and proper treatment, about 70% of patients with DLBCL can be cured.

How do physicians determine the specific type of lymphoma? Tissue obtained from a biopsy can be examined under a microscope to observe physical changes (such as abnormal cell size or shape) that are characteristic of a particular subtype of lymphoma. Additionally, tests can be performed on the tissue to determine which cell-surface antigens are present. Recall that antigens are molecules that bind to specific antibodies. Antibodies can be produced in the laboratory and labeled with compounds that can be identified by their colour under a microscope. When these antibodies are applied to a tissue sample, this colour will appear wherever the antigen is present, because it binds to the antibody. This technique was used in the photomicrograph in Figure 17.7.2 to identify the presence of a cell-surface antigen (shown as reddish-brown) in a sample of skin cells. This technique, called immunohistochemistry, is also commonly used to identify antigens in tissue samples from lymphoma patients.

Why would identifying cell-surface antigens be important in diagnosing and treating lymphoma? As you have learned, the immune system uses antigens present on the surface of cells or pathogens to distinguish between self and non-self, and to launch adaptive immune responses. Cells that become cancerous often change their cell-surface antigens. This is one way that the immune system can identify and destroy them. Also, different cell types in the body can sometimes be identified by the presence of specific cell-surface antigens. Knowing the types of cell-surface antigens present in a tissue sample can help physicians identify which cells are cancerous, and possibly the specific subtype of cancer. Knowing this information can be helpful in choosing more tailored and effective treatments.

One treatment for NHL is, in fact, the use of medications made from antibodies that bind to cell-surface antigens present on cells affected by the specific subtype of NHL. This is called immunotherapy. These drugs can directly bind to and kill the cancerous cells. For patients with DLBCL like Hakeem, immunotherapy is often used in conjunction with chemotherapy and radiation as a course of treatment. Although Hakeem has a difficult road ahead, he and his medical team are optimistic that — given the high success rate when DLBCL is caught and treated early — he may be cured. More research into how the immune system functions may lead to even better treatments for lymphoma — and other types of cancers — in the future.

Attributions

Figure 17.7.1

Cycling to Beat Blood Cancer by Blood Cancer UK (Formerly Bloodwise) on Flickr is used under a CC BY-NC-ND 2.0 (https://creativecommons.org/licenses/by-nc-nd/2.0/) license.

Figure 17.7.2

antigen stain by Ed Uthman from Houston, TX, USA on Wikimedia Commons is used under a CC BY 2.0 (https://creativecommons.org/licenses/by/2.0) license.

References

Hodgkin lymphoma statistics [online article]. (2020). Canadian Cancer Society. https://www.cancer.ca:443/en/cancer-information/cancer-type/hodgkin-lymphoma/statistics/?region=on

Non-Hodgkin lymphoma statistics [online article]. (2020). Canadian Cancer Society. https://www.cancer.ca:443/en/cancer-information/cancer-type/non-hodgkin-lymphoma/statistics/?region=on

TED-Ed. (2015, April 30). What is leukemia? - Danilo Allegra and Dania Puggioni. YouTube. https://www.youtube.com/watch?v=Z3B-AaqjyjE&feature=youtu.be

 

Created by CK-12 Foundation/Adapted by Christine Miller

Imagine the man in Figure 12.3.1 turns his eyes in your direction. This is a very small movement, considering the conspicuously large and strong external eye muscles that control eyeball movements. These muscles have been called the strongest muscles in the human body relative to the work they do. However, the external eye muscles actually do a surprising amount of work. Eye movements occur almost constantly during waking hours, especially when we are scanning faces or reading. Eye muscles are also exercised nightly during the phase of sleep called rapid eye movement sleep. External eye muscles can move the eyes because they are made mainly of muscle tissue.

Muscle tissue is a soft tissue that makes up most of the tissues in the muscles of the human muscular system. Other tissues in muscles are connective tissues, such as tendons that attach skeletal muscles to bones and sheaths of connective tissues that cover or line muscle tissues. Only muscle tissue per se, has cells with the ability to contract.

There are three major types of muscle tissues in the human body: skeletal, smooth, and cardiac muscle tissues. Figure 12.3.2 shows how the three types of muscle tissues appear under magnification. When you read about each type below, you will learn why the three types appear as they do.

Skeletal muscle is muscle tissue that is attached to bones by tendons, which are bundles of collagen fibres. Whether you are moving your eyes or running a marathon, you are using skeletal muscles. Contractions of skeletal muscles are voluntary, or under conscious control of the central nervous system via the somatic nervous system. Skeletal muscle tissue is the most common type of muscle tissue in the human body. By weight, an average adult male is about 42% skeletal muscles, and the average adult female is about 36% skeletal muscles. Some of the major skeletal muscles in the human body are labeled in Figure 12.3.3 below.

Skeletal Muscle Pairs

To move bones in opposite directions, skeletal muscles often consist of muscle pairs that work in opposition to one another, also called antagonistic muscle pairs.  For example, when the biceps muscle (on the front of the upper arm) contracts, it can cause the elbow joint to flex or bend the arm, as shown in Figure 12.3.4. When the triceps muscle (on the back of the upper arm) contracts, it can cause the elbow to extend or straighten the arm. The biceps and triceps muscles, also shown in Figure 12.3.4, are an example of a muscle pair where the muscles work in opposition to each other.

Skeletal Muscle Structure

Each skeletal muscle consists of hundreds — or even thousands — of skeletal muscle fibres, which are long, string-like cells. As shown in Figure 12.3.5 below, skeletal muscle fibres are individually wrapped in connective tissue called endomysium. The skeletal muscle fibres are bundled together in units called muscle fascicles, which are surrounded by sheaths of connective tissue called perimysium. Each fascicle contains between ten and 100 (or even more!) skeletal muscle fibres. Fascicles, in turn, are bundled together to form individual skeletal muscles, which are wrapped in connective tissue called epimysium. The connective tissues in skeletal muscles have a variety of functions. They support and protect muscle fibres, allowing them to withstand the forces of contraction by distributing the forces applied to the muscle. They also provide pathways for nerves and blood vessels to reach the muscles. In addition, the epimysium anchors the muscles to tendons.

The same bundles-within-bundles structure is replicated within each muscle fibre. As shown in Figure 12.3.6, a muscle fibre consists of a bundle of myofibrils, which are themselves bundles of protein filaments. These protein filaments consist of thin filaments of the protein actin, which are anchored to structures called Z discs, and thick filaments of the protein myosin. The filaments are arranged together within a myofibril in repeating units called sarcomeres, which run from one Z disc to the next. The sarcomere is the basic functional unit of skeletal and cardiac muscles. It contracts as actin and myosin filaments slide over one another. Skeletal muscle tissue is said to be striated, because it appears striped. It has this appearance because of the regular, alternating A (dark) and I (light) bands of filaments arranged in sarcomeres inside the muscle fibres. Other components of a skeletal muscle fibre include multiple nuclei and mitochondria.

Slow- and Fast-Twitch Skeletal Muscle Fibres

Skeletal muscle fibres can be divided into two types, called slow-twitch (or type I) muscle fibres and fast-twitch (or type II) muscle fibres.

• Slow-twitch muscle fibres are dense with capillaries and rich in mitochondria and myoglobin, which is a protein that stores oxygen until needed for muscle activity. Relative to fast-twitch fibres, slow-twitch fibres can carry more oxygen and sustain aerobic (oxygen-using) activity. Slow-twitch fibres can contract for long periods of time, but not with very much force. They are relied upon primarily in endurance events, such as distance running or cycling.
• Fast-twitch muscle fibres contain fewer capillaries and mitochondria and less myoglobin. This type of muscle fibre can contract rapidly and powerfully, but it fatigues very quickly. Fast-twitch fibres can sustain only short, anaerobic (non-oxygen-using) bursts of activity. Relative to slow-twitch fibres, fast-twitch fibres contribute more to muscle strength and have a greater potential for increasing in mass. They are relied upon primarily in short, strenuous events, such as sprinting or weightlifting.

Proportions of fibre types vary considerably from muscle to muscle and from person to person. Individuals may be genetically predisposed to have a larger percentage of one type of muscle fibre than the other. Generally, an individual who has more slow-twitch fibres is better suited for activities requiring endurance, whereas an individual who has more fast-twitch fibres is better suited for activities requiring short bursts of power.

Smooth muscle is muscle tissue in the walls of internal organs and other internal structures such as blood vessels. When smooth muscles contract, they help the organs and vessels carry out their functions. When smooth muscles in the stomach wall contract, for example, they squeeze the food inside the stomach, helping to mix and churn the food and break it into smaller pieces. This is an important part of digestion. Contractions of smooth muscles are involuntary, so they are not under conscious control. Instead, they are controlled by the autonomic nervous system, hormones, neurotransmitters, and other physiological factors.

Structure of Smooth Muscle

The cells that make up smooth muscle are generally called myocytes. Unlike the muscle fibres of striated muscle tissue, the myocytes of smooth muscle tissue do not have their filaments arranged in sarcomeres. Therefore, smooth tissue is not striated. However, the myocytes of smooth muscle do contain myofibrils, which in turn contain bundles of myosin and actin filaments. The filaments cause contractions when they slide over each other, as shown in Figure 12.3.7.

Unlike striated muscle, smooth muscle can sustain very long-term contractions. Smooth muscle can also stretch and still maintain its contractile function, which striated muscle cannot. The elasticity of smooth muscle is enhanced by an extracellular matrix secreted by myocytes. The matrix consists of elastin, collagen, and other stretchy fibres. The ability to stretch and still contract is an important attribute of smooth muscle in organs such as the stomach and uterus (see Figures 12.3.8 and 12.3.9), both of which must stretch considerably as they perform their normal functions.

The following list indicates where many smooth muscles are found, along with some of their specific functions.

• Walls of organs of the gastrointestinal tract (such as the esophagus, stomach, and intestines), moving food through the tract by peristalsis
• Walls of air passages of the respiratory tract (such as the bronchi), controlling the diameter of the passages and the volume of air that can pass through them
• Walls of organs of the male and female reproductive tracts; in the uterus, for example, pushing a baby out of the uterus and into the birth canal
• Walls of structures of the urinary system, including the urinary bladder, allowing the bladder to expand so it can hold more urine, and then contract as urine is released
• Walls of blood vessels, controlling the diameter of the vessels and thereby affecting blood flow and blood pressure
• Walls of lymphatic vessels, squeezing the fluid called lymph through the vessels
• Iris of the eyes, controlling the size of the pupils and thereby the amount of light entering the eyes
• Arrector pili in the skin, raising hairs in hair follicles in the dermis

Cardiac muscle is found only in the wall of the heart. It is also called myocardium. As shown in Figure 12.3.10, myocardium is enclosed within connective tissues, including the endocardium on the inside of the heart and pericardium on the outside of the heart. When cardiac muscle contracts, the heart beats and pumps blood. Contractions of cardiac muscle are involuntary, like those of smooth muscles. They are controlled by electrical impulses from specialized cardiac muscle cells in an area of the heart muscle called the sinoatrial node.

Like skeletal muscle, cardiac muscle is striated because its filaments are arranged in sarcomeres inside the muscle fibres. However, in cardiac muscle, the myofibrils are branched at irregular angles rather than arranged in parallel rows (as they are in skeletal muscle). This explains why cardiac and skeletal muscle tissues look different from one another.

The cells of cardiac muscle tissue are arranged in interconnected networks. This arrangement allows rapid transmission of electrical impulses, which stimulate virtually simultaneous contractions of the cells. This enables the cells to coordinate contractions of the heart muscle.

The heart is the muscle that performs the greatest amount of physical work in the course of a lifetime. Although the power output of the heart is much less than the maximum power output of some other muscles in the human body, the heart does its work continuously over an entire lifetime without rest. Cardiac muscle contains a great many mitochondria, which produce ATP for energy and help the heart resist fatigue.

Cardiomyopathy is a disease in which the muscles of the heart are no longer able to effectively pump blood to the body — extreme forms of this disease can lead to heart failure.  There are four main types of cardiomyopathy (also illustrated in Figure 12.3.11):

• Dilated (congestive) cardiomyopathy: the left ventricle (the chamber itself) of the heart becomes enlarged and can't pump blood our to the body.  This is normally related to coronary artery disease and/or heart attack
• Hypertrophic cardiomyopathy: abnormal thickening of the muscular walls of the left ventricle make the chamber less able to work properly.  This condition is more common in patients with a family history of the disease.
• Restrictive cardiomyopathy: the myocardium becomes abnormally rigid and inelastic and is unable to expand in between heartbeats to refill with blood.  Restrictive cardiomyopathy typically affects older people.
• Arrhythmogenic right ventricular cardiomyopathy: the right ventricular muscle is replaced by adipose or scar tissue, reducing elasticity and interfering with normal heartbeat and rhythm.  This disease is often caused by genetic mutations.

Cardiomyopathy is typically diagnosed with a physical exam supplemented by medical and family history, an angiogram, blood tests, chest x-rays and electrocardiograms.  In some cases your doctor would also requisition a CT scan and/or genetic testing.

When treating cardiomyopathy, the goal is to reduce symptoms that affect everyday life.  Certain medications can help regularize and slow heart rate, decrease chances of blood clots and cause vasodilation in the coronary arteries.  If medication is not sufficient to manage symptoms, a pacemaker or even a heart transplant may be the best option.  Lifestyle can also help manage the symptoms of cardiomyopathy — people living with this disease are encouraged to avoid drug and alcohol use, control high blood pressure, eat a healthy diet, get ample rest and exercise, as well as reduce stress levels.

 

Attributions

Figure 12.3.1

Look by ali-yahya-155huuQwGvA [photo] by Ali Yahya on Unsplash is used under the Unsplash License (https://unsplash.com/license).

Figure 12.3.2

Skeletal_Smooth_Cardiac by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.3

Anterior_and_Posterior_Views_of_Muscles by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.4

Antagonistic Muscle Pair by Laura Guerin at CK-12 Foundation on Wikimedia Commons is used under a CC BY-NC 3.0 (https://creativecommons.org/licenses/by-nc/3.0/) license. 

Figure 12.3.5

Muscle_Fibes_(large) by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.6

Muscle_Fibers_(small) by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.7

Smooth_Muscle_Contraction by OpenStax on Wikimedia Commons is used under a CC BY 4.0 (https://creativecommons.org/licenses/by/4.0) license.

Figure 12.3.8

Blausen_0747_Pregnancy by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.9

Size_of_Uterus_Throughout_Pregnancy-02 by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.10

1024px-Blausen_0470_HeartWall by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 12.3.11

Tipet_e_kardiomiopative by Npatchett at English Wikipedia on Wikimedia Commons is used under a CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) license. (Work derived from Blausen 0165 Cardiomyopathy Dilated by BruceBlaus)

References

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 4.18 Muscle tissue [digital image].  In Anatomy and Physiology (Section 4.4). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/4-4-muscle-tissue-and-motion

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 28.18 Size of uterus throughout pregnancy [digital image].  In Anatomy and Physiology (Section 28.4). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/28-4-maternal-changes-during-pregnancy-labor-and-birth

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 10.3 The three connective tissue layers [digital image].  In Anatomy and Physiology (Section 10.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/10-2-skeletal-muscle

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 10.4 Muscle fiber [digital image].  In Anatomy and Physiology (Section 10.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/10-2-skeletal-muscle

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 10.24 Muscle contraction [digital image].  In Anatomy and Physiology (Section 10.8). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/10-8-smooth-muscle

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2016, May 18). Figure 11.5 Overview of the muscular system [digital image].  In Anatomy and Physiology (Section 11.2). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/11-2-naming-skeletal-muscles

Blausen.com staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

Brainard, J/ CK-12 Foundation. (2012). Figure 5 Triceps and biceps muscles in the upper arm are opposing muscles. [digital image]. In CK-12 Biology (Section 21.3) [online Flexbook]. CK12.org. https://www.ck12.org/book/ck-12-biology/section/21.3/ (Last modified August 11, 2017.)

khanacademymedicine. (2012, October 19). Three types of muscle | Circulatory system physiology | NCLEX-RN | Khan Academy. YouTube.

TED-Ed. (2017, February 14).  What happens during a heart attack? - Krishna Sudhir. YouTube. https://www.youtube.com/watch?v=3_PYnWVoUzM&feature=youtu.be

 

 

Lub dub, lub dub, lub dub... That’s how the sound of a beating heart is typically described. Those are also the only two sounds that should be audible when listening to a normal, healthy heart through a stethoscope, as in Figure 14.3.1.  If a doctor hears something different from the normal lub dub sounds, it’s a sign of a possible heart abnormality. What causes the heart to produce the characteristic lub dub sounds? Read on to find out.

The heart is a muscular organ behind the sternum (breastbone), slightly to the left of the center of the chest. A normal adult heart is about the size of a fist. The function of the heart is to pump blood through blood vessels of the cardiovascular system. The continuous flow of blood through the system is necessary to provide all the cells of the body with oxygen and nutrients, and to remove their metabolic wastes.

The heart has a thick muscular wall that consists of several layers of tissue. Internally, the heart is divided into four chambers through which blood flows. Because of heart valves, blood flows in just one direction through the chambers.

Heart Wall

As shown in Figure 14.3.2, the wall of the heart is made up of three layers, called the endocardium, myocardium, and pericardium.

• The endocardium is the innermost layer of the heart wall. It is made up primarily of simple epithelial cells. It covers the heart chambers and valves. A thin layer of connective tissue joins the endocardium to the myocardium.
• The myocardium is the middle and thickest layer of the heart wall. It consists of cardiac muscle surrounded by a framework of collagen. There are two types of cardiac muscle cells in the myocardium: cardiomyocytes — which have the ability to contract easily — and pacemaker cells, which conduct electrical impulses that cause the cardiomyocytes to contract. About 99 per cent of cardiac muscle cells are cardiomyocytes, and the remaining one per cent is pacemaker cells. The myocardium is supplied with blood vessels and nerve fibres via the pericardium.
• The pericardium is a protective sac that encloses and protects the heart. The pericardium consists of two membranes (visceral pericardium and parietal pericardium), between which there is a fluid-filled cavity. The fluid helps to cushion the heart, and also lubricates its outer surface.

Heart Chambers

As shown in Figure 14.3.3 the four chambers of the heart include two upper chambers called atria (singular, atrium), and two lower chambers called ventricles. The atria are also referred to as receiving chambers, because blood coming into the heart first enters these two chambers. The right atrium receives deoxygenated blood from the upper and lower body through the superior vena cava and inferior vena cava, respectively. The left atrium receives oxygenated blood from the lungs through the pulmonary veins. The ventricles are also referred to as discharging chambers, because blood leaving the heart passes out through these two chambers. The right ventricle discharges blood to the lungs through the pulmonary artery, and the left ventricle discharges blood to the rest of the body through the aorta. The four chambers are separated from each other by dense connective tissue consisting mainly of collagen.

Heart Valves

Figure 14.3.4 shows the location of the heart's four valves in a top-down view, looking down at the heart as if the arteries and veins feeding into and out of the heart were removed. The heart valves allow blood to flow from the atria to the ventricles, and from the ventricles to the pulmonary artery and aorta. The valves are constructed in such a way that blood can flow through them in only one direction, thus preventing the backflow of blood. Figure 14.3.5 shows how valves open to let blood into the appropriate chamber, and then close to prevent blood from moving in the wrong direction and the next chamber contracts.  The four valves are the:

1. Tricuspid atrioventricular valve, (can be shortened to tricuspid AV valve) which allows blood to flow from the right atrium to the right ventricle.
2. Bicuspid atrioventricular valve (also know as the mitral valve), which allows blood to flow from the left atrium to the left ventricle.
3. Pulmonary semilunar valve, which allows blood to flow from the right ventricle to the pulmonary artery.
4. Aortic semilunar valve, which allows blood to flow from the left ventricle to the aorta.

The cardiomyocytes of the muscular walls of the heart are very active cells, because they are responsible for the constant beating of the heart. These cells need a continuous supply of oxygen and nutrients. The carbon dioxide and waste products they produce also must be continuously removed. The blood vessels that carry blood to and from the heart muscle cells make up the coronary circulation. Note that the blood vessels of the coronary circulation supply heart tissues with blood, and are different from the blood vessels that carry blood to and from the chambers of the heart as part of the general circulation. Coronary arteries supply oxygen-rich blood to the heart muscle cells. Coronary veins remove deoxygenated blood from the heart muscles cells.

• There are two coronary arteries — a right coronary artery that supplies the right side of the heart, and a left coronary artery that supplies the left side of the heart. These arteries branch repeatedly into smaller and smaller arteries and finally into capillaries, which exchange gases, nutrients, and waste products with cardiomyocytes.
• At the back of the heart, small cardiac veins drain into larger veins, and finally into the great cardiac vein, which empties into the right atrium. At the front of the heart, small cardiac veins drain directly into the right atrium.

Figure 14.3.7 shows how blood circulates through the chambers of the heart. The right atrium collects blood from two large veins, the superior vena cava (from the upper body) and the inferior vena cava (from the lower body). The blood that collects in the right atrium is pumped through the tricuspid valve into the right ventricle. From the right ventricle, the blood is pumped through the pulmonary valve into the pulmonary artery. The pulmonary artery carries the blood to the lungs, where it enters the pulmonary circulation, gives up carbon dioxide, and picks up oxygen. The oxygenated blood travels back from the lungs through the pulmonary veins (of which there are four), and enters the left atrium of the heart. From the left atrium, the blood is pumped through the mitral valve into the left ventricle. From the left ventricle, the blood is pumped through the aortic valve into the aorta, which subsequently branches into smaller arteries that carry the blood throughout the rest of the body. After passing through capillaries and exchanging substances with cells, the blood returns to the right atrium via the superior vena cava and inferior vena cava, and the process begins anew.

The cardiac cycle refers to a single complete heartbeat, which includes one iteration of the lub and dub sounds heard through a stethoscope. During the cardiac cycle, the atria and ventricles work in a coordinated fashion so that blood is pumped efficiently through and out of the heart. The cardiac cycle includes two parts, called diastole and systole, which are illustrated in the diagrams in Figure 14.3.8.

• During diastole, the atria contract and pump blood into the ventricles, while the ventricles relax and fill with blood from the atria.
• During systole, the atria relax and collect blood from the lungs and body, while the ventricles contract and pump blood out of the heart.

Electrical Stimulation of the Heart

The normal, rhythmical beating of the heart is called sinus rhythm. It is established by the heart’s pacemaker cells, which are located in an area of the heart called the sinoatrial node (shown in Figure 14.3.9). The pacemaker cells create electrical signals with the movement of electrolytes (sodium, potassium, and calcium ions) into and out of the cells. For each cardiac cycle, an electrical signal rapidly travels first from the sinoatrial node, to the right and left atria so they contract together. Then, the signal travels to another node, called the atrioventricular node (Figure 14.3.9), and from there to the right and left ventricles (which also contract together), just a split second after the atria contract.

The normal sinus rhythm of the heart is influenced by the autonomic nervous system through sympathetic and parasympathetic nerves. These nerves arise from two paired cardiovascular centers in the medulla of the brainstem. The parasympathetic nerves act to decrease the heart rate, and the sympathetic nerves act to increase the heart rate. Parasympathetic input normally predominates. Without it, the pacemaker cells of the heart would generate a resting heart rate of about 100 beats per minute, instead of a normal resting heart rate of about 72 beats per minute. The cardiovascular centers receive input from receptors throughout the body, and act through the sympathetic nerves to increase the heart rate, as needed. Increased physical activity, for example, is detected by receptors in muscles, joints, and tendons. These receptors send nerve impulses to the cardiovascular centers, causing sympathetic nerves to increase the heart rate, and allowing more blood to flow to the muscles.

Besides the autonomic nervous system, other factors can also affect the heart rate. For example, thyroid hormones and adrenal hormones (such as epinephrine) can stimulate the heart to beat faster. The heart rate also increases when blood pressure drops or the body is dehydrated or overheated. On the other hand, cooling of the body and relaxation — among other factors — can contribute to a decrease in the heart rate.

When a patient’s heart is too diseased or damaged to sustain life, a heart transplant is likely to be the only long-term solution. The first successful heart transplant was undertaken in South Africa in 1967. There are over 2,200 Canadians walking around today because of life-saving heart transplant surgery.  Approximately 180 heart transplant surgeries are performed each year, but there are still so many Canadians on the transplant list that some die while waiting for a heart. The problem is that far too few hearts are available for transplant — there is more demand (people waiting for a heart transplant) than supply (organ donors). Sometimes, recipient hopefuls will receive a device called a Total Artificial Heart (see Figure 14.3.10), which can buy them some time until a donor heart becomes available.

Watch the video below "Total artificial heart option..." from Stanford Health Care to see how it works:

https://youtu.be/1PtxaxcPnGc

Total artificial heart option at Stanford (Includes surgical graphic footage), Stanford Health Care, 2014.

Attributions

Figure 14.3.1

• Female clinician dressed in scrubs using a stethoscope by Amanda Mills, USCDCP, on Pixnio is used under a CC0 public domain certification license (https://creativecommons.org/licenses/publicdomain/).
• Human heart beating loud and strong (audio) by Daniel Simion on Soundbible.com is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 14.3.2

Blausen_0470_HeartWall by BruceBlaus on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 14.3.3

Diagram_of_the_human_heart_(cropped).svg by Wapcaplet on Wikimedia Commons is used under a CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/) license.

Figure 14.3.4

Heart_Valves by OpenStax College on Wikimedia Commons is used under a CC BY 3.0 (https://creativecommons.org/licenses/by/3.0) license.

Figure 14.3.5

CG_Heart Valve Animation by DrJanaOfficial on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

Figure 14.3.6

Heart_tee_four_chamber_view by Patrick J. Lynch, medical illustrator from Yale University School of Medicine, on Wikimedia Commons is used under a CC BY 2.5 (https://creativecommons.org/licenses/by/2.5) license.

Figure 14.3.7

Circulation of blood through the heart by Christinelmiller on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license. [Original image in the bottom right is by Wapcaplet / CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)]

Figure 14.3.8

Human_healthy_pumping_heart_en.svg by Mariana Ruiz Villarreal [LadyofHats] on Wikimedia Common is released into the public domain (https://en.wikipedia.org/wiki/Public_domain).

Figure 14.3.9

Cardiac_Conduction_System by Cypressvine on Wikimedia Commons is used under a CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0) license.

 

References

Betts, J. G., Young, K.A., Wise, J.A., Johnson, E., Poe, B., Kruse, D.H., Korol, O., Johnson, J.E., Womble, M., DeSaix, P. (2013, June 19). Figure 19.12 Heart valves with the atria and major vessels removed [digital image].  In Anatomy and Physiology (Section 19.1). OpenStax. https://openstax.org/books/anatomy-and-physiology/pages/19-1-heart-anatomy#fig-ch20_01_04

Blausen.com Staff. (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

Heart and Stroke Foundation of Canada. (n.d.). https://www.heartandstroke.ca/

Sliwa, K., Zilla, P. (2017, December 7). 50th anniversary of the first human heart transplant—How is it seen today? European Heart Journal, 38(46):3402–3404. https://doi.org/10.1093/eurheartj/ehx695

Stanford Health Care. (2014, December 3). Total artificial heart option at Stanford (Includes surgical graphic footage). YouTube. https://www.youtube.com/watch?v=1PtxaxcPnGc&feature=youtu.be

TED. (2012, March 21). Noel Bairey Merz: The single biggest health threat women face. YouTube. https://www.youtube.com/watch?v=1bnzVjOJ6NM&feature=youtu.be

TEDx Talks. (2018, April 18). A change of heart: My transplant experience | Thomas Volk | TEDxUWLaCrosse. YouTube. https://www.youtube.com/watch?v=zU6mmix04PI&feature=youtu.be

UMagazine. (2015, Fall). The cutting edge: Patient first to bridge from experimental total artificial heart to transplant. UCLA Health. https://www.uclahealth.org/u-magazine/patient-first-to-bridge-from-experimental-total-artificial-heart-to-transplant

UnityPoint Health - Cedar Rapids. (2018, February 7). Watch a transcatheter aortic valve replacement (TAVR) Procedure at St. Luke's in Cedar Rapids, Iowa. YouTube.  https://www.youtube.com/watch?v=jJm7zBcN6-M&feature=youtu.be

WMC Health. (2018, September 13). Heart transplant recipient meets donor family for the first time. YouTube. https://www.youtube.com/watch?v=biGuwQhuAsk&feature=youtu.be

 

 

 

Image shows a diagram of the four steps of a white blood cell phagocytizing a bacterium. In the first stage, the white blood cell extends its plasma membrane to surround the bacteria and trap it inside a vesicle, very similar to endocytosis. In the next stage, a lysosome merges with the vesicle containing the bacterium; the digestive enzymes break down the bacterium, and the white blood cell absorbs the resulting nutrients.