Chapter 12 Immunity and Healing Copyright 2013 Wolters

Chapter 12: Immunity and Healing Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Introduction • Pathogens: disease-causing agents • Immunity: protection from or resistance to infection and disease • Immune system: group of organs and tissues throughout body • Immunity and healing processes profoundly affected by stress, emotions, beliefs, and attitudes Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Organs and Tissues of Immune System • Not physically connected, but scattered throughout body • Some structural components of cardiovascular, lymphatic, and endocrine systems • 2 broad groups: – Primary lymphoid organs and tissues where lymphocytes are produced – Secondary lymphoid organs and tissues: sites where most immune responses occur Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Organs and Tissues of Immune System Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Primary Lymphoid Organs and Tissues • Organs and tissues that produce lymphocytes: – Red bone marrow – Thymus • Lymphocytes target specific pathogens • 2 types of lymphocytes: – B cells – T cells Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Secondary Lymphoid Organs and Tissues • Sites where most specific immune responses occur • Mucosa-associated lymphoid tissue (MALT): – Lymph nodes – Spleen – Tonsils (see Figure 12 -3) – Peyer patches • Manual therapy contraindicated with enlarged spleen or severe infection Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pathology Alert: Tonsillitis • Inflammation of tonsils • Viral or bacterial infection • Common signs and symptoms: – Red, swollen tonsils, may have white patches – Sore throat, pain or difficulty swallowing – Headache, fever, and chills • Manual therapy contraindicated Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nonspecific Immune Defenses • Generic and universal immune responses • Also called innate immune defenses • Responses not stimulated by or directed toward single type of pathogen or foreign invader • Include physical and chemical barriers Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physical Barriers • Physical barriers: – Epidermis of skin – Mucous membranes lining respiratory, digestive, and reproductive tracts • Barriers that physically block microbes from entering body • If barrier is broken, pathogens can enter Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chemical Barriers • Sebum: protective acidic barrier on skin surface • Sweat: enzymes and p. H discourage microbial growth • Tears, saliva: wash away microbes, contains antimicrobial protein lysozyme • Gastric juice: destroys pathogens that reach stomach • Urine: flushes urethra, p. H inhibits microbial growth • Vaginal secretions: flushes vagina, acidic p. H inhibits bacterial growth Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Internal Antimicrobial Proteins • Interferons: protect surrounding uninfected cells from viral infection • Complement proteins: support phagocytosis, microbe destruction, inflammation • Transferrins: bind with iron to inhibit bacterial growth • Antimicrobial peptides: cause cytolysis of microbes Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Phagocytes and Natural Killer Cells • Neutrophils and macrophages – Eat microbes and cellular debris – Phagocytosis (see Figure 12 -4) • NK cells – Lymphocytes found in blood – Kill infected cells through cytolysis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Inflammation and Fever • Inflammation – Fights infectious agents by increasing vasodilation, capillary permeability, and phagocytosis – Prepares tissue for repair • Fever – Speeds up metabolism to facilitate tissue repair – Kills or inhibits growth of certain bacteria – Increases effect of interferons Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pathology Alert: Allergies • Allergic reaction: excessive immune response to an antigen (allergen) • Allergens can be inhaled, ingested, injected, implanted, or contact skin • Reaction marked by massive histamine and heparin release with several physiological effects • Most allergic responses localized • Anaphylaxis: widespread response, can be fatal • Manual therapists: avoid substances that may stimulate allergic response Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Antibody-Mediated Immune Responses • Specific immune responses: – Triggered by specific pathogens – B and T lymphocytes – Create immunological memory • Antibody-mediated immunity (humoral immunity) – Activation of B lymphocytes to produce antibodies that render antigens harmless – See Figure 12 -5 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pathology Alert: Autoimmune Disease • Autoimmune disorder or disease: immune system attacks person’s own cells • Common autoimmune disorders: – Multiple sclerosis (MS), rheumatic fever, rheumatoid arthritis – Systemic lupus erythematosus, scleroderma, ulcerative colitis, type 1 diabetes, myasthenia gravis • Exact causes not well understood Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cell-Mediated Immune Responses • Cell-mediated immunity (see Figure 12 -6) – Activates several categories of T lymphocytes • Cytotoxic T cells that directly destroy the antigen • Memory T cells “remember” particular antigen • Helper T cells, suppressor T cells • Manual therapy: precautions for immune-compromised clients • Vaccinations recommended for manual therapists Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Acquisition of Immunity • Immunological memory – Memory cells produced with each episode of specific immune response – Accounts for how individuals acquire immunity to many diseases • Immunity acquired naturally or artificially – Both have active and passive mechanisms Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Naturally Acquired Immunity • Naturally acquired active immunity – Exposure to antigen initiates specific response resulting in formation of cells – Once recovered, body retains resistance through immunological memory • Naturally acquired passive immunity – Antibody transfer from mother to baby across placenta and through breast-feeding Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Artificially Acquired Immunity • Artificially acquired active immunity – Vaccination delivers dead or altered pathogens or synthesized antigens – Results in formation of antibodies and long-lasting resistance through immunological memory • Artificially acquired passive immunity – Immunization delivers antibodies - immediate but short-term immunity Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Aging and the Immune System • Immune defenses generally decline with age – Less responsive – Slower response – Decreasing T and NK cells – Less responsive to vaccinations • Incidence of cancer and autoimmune disorders increases Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Psychoneuroimmunology • PNI: the study of links among nervous, endocrine, digestive, and immune systems • Research supports mind–body connection • 2 body-wide communication networks: – Autonomic nervous system – Vast chemical network of “information molecules” Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Peptide Communication Network • Peptides travel throughout body • Hundreds of chemicals communicate and stimulate cells • Collectively called ligands • Communication web of peptides and receptors: – Strong functional link between immune responses and emotional states – Mind–body–spirit connection Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Holistic Healing • Disease: any disruption to dynamic balance of body, mind, and spirit causing physical, mental, or emotional trauma • Clients’ belief in value manual therapy can have powerful benefits even when not explained by medical science • Some benefits of manual therapy subjective and difficult to measure Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins