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ADAAdenosine deaminase
ALGAntilymphocyte globulin
APCAntigen-presenting cell
ATGAntithymocyte globulin
CDCluster of differentiation
CSFColony-stimulating factor
CTLCytotoxic T lymphocyte
DCDendritic cell
DTHDelayed-type hypersensitivity
FKBPFK-binding protein
HAMAHuman antimouse antibody
HLAHuman leukocyte antigen
IGIVImmune globulin intravenous
LFALeukocyte function-associated antigen
MABMonoclonal antibody
MHCMajor histocompatibility complex
NK cellNatural killer cell
SCIDSevere combined immunodeficiency disease
TCRT-cell receptor
TGF-βTransforming growth factor-β
Th1, Th2T helper cell types 1 and 2
TNFTumor necrosis factor

A 30-year-old woman has one living child, age 6. Her child and her husband are Rh positive and she is Rho(D) and Du negative. She is now in her ninth month of pregnancy and is in the labor room having frequent contractions. Her Rh antibody test taken earlier in the pregnancy was negative. What immunotherapy is appropriate for this patient? When and how should it be administered?


Agents that suppress the immune system play an important role in preventing the rejection of organ or tissue grafts and in the treatment of certain diseases that arise from dysregulation of the immune response. While precise details of the mechanisms of action of a number of these agents are still obscure, knowledge of the elements of the immune system is useful in understanding their effects. Agents that augment the immune response or selectively alter the balance of various components of the immune system are also becoming important in the management of certain diseases such as cancer, AIDS, and autoimmune or inflammatory diseases. A growing number of other conditions (infections, cardiovascular diseases, organ transplantation) may also be candidates for immune manipulation.


Normal Immune Responses


The immune system has evolved to protect the host from invading pathogens and to eliminate disease. At its functioning best, the immune system is exquisitely responsive to invading pathogens while retaining the capacity to recognize self tissues and antigens to which it is tolerant. Protection from infection and disease is provided by the collaborative efforts of the innate and adaptive immune systems.


The Innate Immune System


The innate immune system is the first line of defense against invading pathogens (eg, bacteria, viruses, fungi, parasites) and consists of mechanical, biochemical, and cellular components. Mechanical components include skin/epidermis and mucus; biochemical components include antimicrobial peptides and proteins (eg, defensins), complement, enzymes (eg, lysozyme, acid hydrolases), interferons, acidic pH, and free radicals (eg, hydrogen peroxide, superoxide anions); cellular components include neutrophils, monocytes, macrophages, natural killer (NK), and natural killer-T (NKT) cells. Unlike adaptive immunity, the innate immune response exists prior to infection, is not enhanced by repeated infection, and is generally not antigen-specific. An intact skin or mucosa is the first barrier to infection. When this barrier is breached, an immediate innate immune ...

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