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Transforming Human Health: Celebrating 50 Years of Discovery and Progress (2022)

Chapter: Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System

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Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
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Infection, Immunity, and Inflammation:

Unraveling and Applying the Capacities of the Immune System

Tremendous advances in understanding of the immune system and inflammation have led to powerful new treatments against infectious and autoimmune diseases. This golden age of immunology research continues today, offering promise that the body’s immune system could be harnessed to fight a wide range of diseases.

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Illustration of CAR (chimeric antigen receptor) T cell immunotherapy, a process that is being developed to treat cancer: T cells (one at center), are taken from the patient and have their DNA modified by viruses (spiky spheres) so that they produce CAR proteins. These proteins are specific to the patient’s cancer. The modified T cells are then multiplied in the laboratory before being reintroduced to the patient. (Science Photo Library®)
Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
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1974

Differentiating Self from Non-Self

Receptors on cells known as T cells are responsible for recognizing foreign molecules in the body and triggering an immune system response. In 1974, scientists discovered that these receptors can only recognize foreign molecules that are bound to proteins generated by what is known as the major histocompatibility complex (MHC), a set of genes that varies from person to person and population to population. This discovery heightened understanding of the immune system by revealing the link between people’s immune responses and their genetic profiles.

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NAS member George Davis Snell shared the 1980 Nobel Prize for Physiology or Medicine for his discovery of the MHC. (Science Photo Library®)

1976

Understanding the Vast Diversity of Antibodies

B cells help regulate the immune system by producing antibodies and more. Our bodies can generate many millions of structurally different antibodies that defend us against a host of foreign molecules, organisms, or substances. For many years, scientists were unsure whether the genetic diversity required to produce millions of antibodies was generated during evolution (and therefore is carried in sperm and egg cells) or occurs during development (and is generated in other body cells). In 1976, researchers answered this question by showing that the rearrangement of genes in cells other than sperm and egg cells allows the generation of a great diversity of antibodies from a finite number of genes, solving the mystery and opening the way to further discoveries involving gene rearrangements.

Image
Illustration of plasma cells (B-cells, orange) secreting antibodies (white) against viruses (blue). (Note that B cells would be larger than any known viruses.) (Shutterstock®)

1982

Infectious Proteins

In 1982, the discovery that variants of normal proteins can act as infectious agents expanded understanding of disease mechanisms and transmission. These proteins, named “prions” (short for proteinaceous infectious particles), are misfolded forms of proteins that act as templates to to promote misfolding among other proteins. Once thought to cause only relatively rare brain diseases, similar aggregates of misfolded proteins are found in Alzheimer’s disease, some cancers, and other disorders, suggesting that protein misfolding may play a larger role in human diseases than previously suspected.

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Illustration of prion spread: A normal form of prion protein (tiny green balls, lower left) is made with instructions from cell nuclei (brown, one at bottom right). The prions (pink balls, upper right) are a different shape of this normal prion protein, and cause the normal ones to flip to the abnormal shape. (Science Photo Library®)
Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×

1986

Two Types of Immune Help

A balanced immune response requires the proper regulation of immune cells known as helper T cells. In 1986, scientists identified two types of helper T cells that differ in how they respond to foreign molecules. One type orchestrates an inflammatory response that leads to direct killing of invading microbes, while the other helps stimulate the production of antibodies that ultimately destroy the invader. Recently, the discovery of new subsets of helper T cells has further illuminated the remarkable complexity of the human immune system.

Image
Illustration of a mycobacteria (upper right) infecting a dendritic cell (upper left), and triggering the release of heterodimeric cytokine (lower left), which is an important part of the inflammatory response against infection (Science Photo Library®)

1990s

Recognizing Microbial Invaders

Roughly a decade after the 1985 discovery of a protein known as Toll in the fruit fly Drosophila melanogaster, many laboratories discovered Toll-like receptors (TLRs) on human cells that play a vital role in activating the immune system in response to danger signals. TLRs are a class of proteins that are primarily produced by white blood cells and recognize white blood cells and recognize molecules broadly shared by pathogenic microbes. The specificity of TLRs and an elaborate regulatory system associated with these receptors ensure that they only recognize molecules associated with these microbial threats, do not activate an inappropriate response to benign microbes, and are highly specific in their response to the different types of antagonistic microbes.

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Illustration of a plasma cell (left) secreting antibodies (white) against influenza viruses (right) (Shutterstock®)

2001

Triggering the Death of Cancer Cells

In 2001, scientists discovered the FOXO3 gene, which plays a pivotal role in causing cell death. Mounting evidence suggests that FOXO3 normally functions as a tumor suppressor by detecting cancerous cells and triggering a variety of responses to these abnormalities, including cell death, but is dysregulated in several types of cancer. Better understanding of the protein encoded by this gene may provide new possibilities for cancer treatment and may have implications for human longevity.

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Breast cancer scan (left) with gene mapping visualization (center) and cell cultures (right) (Science Photo Library®)
Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×

2006

A Cell That Kills Other Cells

Natural killer (NK) cells are a type of white blood cell that provides a rapid response to cells that have been invaded by a virus or have become cancerous. For many years, NK cells were thought to lack specific cell surface receptors that, if present, would enable them to recognize and kill infected or abnormal cells that they have previously encountered. However, in 2006, a subset of NK cells was found to possess memories of past exposure to a threat, demonstrating a new immunological capacity independent of B and T cells.

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Illustration of white blood cells attacking a cancer cell (Shutterstock®)

2011

Engineering the Immune System to Defeat Cancer

T cells were first used in 2011 to treat advanced cancers. By modifying the cells to express particular receptors, they could be targeted at malignancies that display the protein they were engineered to recognize. Treatment using these engineered immune cells delayed cancer progression and launched a wave of research into modulating the immune system to fight disease.

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Illustration of a genetically engineered CAR T cell (top right) recognizing cancerous cells (left) (Science Photo Library®)

2017

Adoptive Cell Transfer to Treat Cancer

In 2017, the U.S. Food and Drug Administration approved a therapy for certain kinds of leukemia and lymphoma that uses genetically engineered T cells. In an approach known as adoptive cell transfer, T cells from a person with cancer are removed, genetically altered to target tumor cells, and then transferred back into the person. The technique heralds a new era of individualized cancer therapy.

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Young girl with acute lymphocytic leukemia receiving chemotherapy (Science Photo Library®)

Continued research into the immune system will drive continual improvements in the diagnosis, prevention, and treatment of disease. At the same time, better understanding of inflammation will provide key insights into widespread diseases, such as dementia and obesity, where inflammation plays a major role.

Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 14
Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 15
Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 16
Suggested Citation:"Infection, Immunity, and Inflammation: Unraveling and Applying the Capacities of the Immune System." National Academy of Medicine. 2022. Transforming Human Health: Celebrating 50 Years of Discovery and Progress. Washington, DC: The National Academies Press. doi: 10.17226/26722.
×
Page 17
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The past half-century has been an era of astonishing progress for biomedical science, health, and health care in the United States and worldwide. This volume, commissioned to mark the occasion of the 50th anniversary of the founding of the U.S. National Academy of Medicine (NAM; formerly the Institute of Medicine [IOM]), tells the story of that progress across five major fields: biomedical science and technology, diseases and conditions, public health, U.S. health care, and global health. Since the NAM was founded in 1970, the nation and the world have seen multitudes of remarkable "firsts"—including the dawn of targeted gene therapies, the near eradication of polio, revolutionary treatments for cancers and cardiovascular disease, and many more. NAM members were the architects of many of these breakthroughs, alongside countless dedicated scientists, clinicians, educators, and public health leaders worldwide. The milestones chronicled in this volume are a testament to their remarkable work, which has saved and improved innumerable lives.

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