American Association of Immunologists Recommendations for an Undergraduate Course in Immunology
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American Association of Immunologists Recommendations for
an Undergraduate Course in Immunology
Edith Porter, Eyal Amiel, Nandita Bose, Andrea Bottaro, William H. Carr, Michelle
Swanson-Mungerson, Steven M. Varga and Julie M. Jameson
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ImmunoHorizons 2021, 5 (6) 448-465
doi: https://doi.org/10.4049/immunohorizons.2100030
http://www.immunohorizons.org/content/5/6/448
This information is current as of March 14, 2022.
References This article cites 13 articles, 1 of which you can access for free at:
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ImmunoHorizons is an open access journal published by
The American Association of Immunologists, Inc.,
1451 Rockville Pike, Suite 650, Rockville, MD 20852
All rights reserved.
ISSN 2573-7732.ON THE HORIZON
American Association of Immunologists Recommendations for
an Undergraduate Course in Immunology
Edith Porter,* Eyal Amiel,† Nandita Bose,‡ Andrea Bottaro,§ William H. Carr,{ Michelle Swanson-Mungerson,k
Steven M. Varga,#,**,†† and Julie M. Jameson‡‡
*Department of Biological Sciences, California State University Los Angeles, Los Angeles, CA; †Department of Biomedical and Health
Sciences, University of Vermont, Burlington, VT; ‡HiberCell, Inc., Roseville, MN; §Department of Biomedical Sciences, Cooper Medical School
Downloaded from http://www.immunohorizons.org/ by guest on March 14, 2022
of Rowan University, Camden, NJ; {Department of Biology, Medgar Evers College, City University of New York, Brooklyn, NY; kDepartment
of Microbiology and Immunology, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL; #Department of
Microbiology and Immunology, University of Iowa, Iowa City, IA; **Interdisciplinary Graduate Program in Immunology, University of Iowa,
Iowa City, IA; ††Department of Pathology, University of Iowa, Iowa City, IA; and ‡‡Department of Biological Sciences, California State
University San Marcos, San Marcos, CA
ABSTRACT
Identifying the essential components of an undergraduate immunology lecture course can be daunting because of the varying
postgraduate pathways students take. The American Association of Immunologists Education Committee commissioned an Ad Hoc
Committee, representing undergraduate, graduate, and medical institutions as well as the biotechnology community, to develop core
curricular recommendations for teaching immunology to undergraduates. In a reiterative process involving the American Association of
Immunologists teaching community, 14 key topics were identified and expanded to include foundational concepts, subtopics and
examples, and advanced subtopics, providing a flexible list for curriculum development and avenues for higher-level learning.
Recommendations for inclusive and antiracist teaching that outline opportunities to meet the needs of diverse student populations were
also developed. The consensus recommendations can be used to accommodate various course settings and will bridge undergraduate
and graduate teaching and prepare diverse students for subsequent careers in the biomedical field. ImmunoHorizons, 2021, 5: 448–465.
INTRODUCTION recognition of the critical need for enhanced guidance on
undergraduate immunology curricular development, several
Immunology is challenging to teach in the undergraduate set- recent publications have begun the process of advocacy around
ting because of its rapidly advancing and expanding field of a more-unified approach to undergraduate immunology educa-
knowledge. The task of defining the key components of an tion (3, 4). Of note, a recent study that reported the results of
undergraduate curriculum in immunology can be overwhelm- surveyed immunology educators has helped identify current
ing to undergraduate educators, who are often challenged to curricular practices by experienced instructors, which has
cover the essential components of this vast field of science highlighted curricular priorities for both course and curriculum
through a combination of smaller units in general biology design for the field (5). All of these efforts are rooted in the
courses or within a single semester-long introductory course (1, premise that broader attention to a cohesive set of key concepts
2). Few resources are available that use a methodical approach and evidence-based curriculum design leads to improved stu-
to capture the key topics for inclusion in the course. In dent understanding and outcomes (5, 6). Professional scientific
Received for publication March 25, 2021. Accepted for publication April 22, 2021.
Address correspondence and reprint requests to: Prof. Edith Porter, California State University Los Angeles, BS 143, 5151 State University Drive, Los Angeles,
CA 90032. E-mail address: eporter@calstatela.edu
ORCIDs: 0000-0002-4656-5264 (E.P.); 0000-0002-1578-8705 (E.A.); 0000-0003-1712-6796 (A.B.); 0000-0003-1987-9070 (W.H.C.); 0000-0001-6384-6933
(M.S.-M.); 0000-0001-7332-4290 (S.M.V.); 0000-0003-0727-4066 (J.M.J.).
Abbreviations used in this article: AAI, American Association of Immunologists; ITIG, Immunology Teaching Interest Group.
This article is distributed under the terms of the CC BY-NC-ND 4.0 Unported license.
Copyright © 2021 The Authors
448 https://doi.org/10.4049/immunohorizons.2100030
ImmunoHorizons is published by The American Association of Immunologists, Inc.ImmunoHorizons 449
(i.e., medical schools, graduate schools) or in the future work
environment (i.e., biotechnology and pharmaceutical sectors)
AHC should have a seat at the table for decisions on key topics to
Key topics make the undergraduate curriculum relevant. This reverse
engineering strategy will provide the knowledge needed in the
ITIG undergraduate curriculum to succeed at these higher levels. To
Survey and meet these goals, the AAI Education Committee has embarked
working on a mission to gain broad community consensus on an under-
groups graduate immunology curriculum that bridges undergraduate
education and postgraduate education/career-relevant needs.
AHC Starting in 2016, the AAI Education Committee initiated a
Refinement new annual meeting session focused on improving immunology
education: the Immunology Teaching Interest Group (ITIG).
This Education Committee--sponsored session has been dedi-
ITIG
cated to sharing novel teaching practices for immunology edu-
Survey and
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cation at undergraduate, graduate, and medical schools. ITIG
workshop
speakers and attendees have included immunology educators
spanning a range of institution types and serving students of
AHC different levels. The ITIG session has become a venue for the
Finalization exchange of ideas and a way to provide suggestions to the AAI
community as a whole. The group has grown from 20 partici-
pants in 2016 to more than 200 in 2020. Novel ideas and cut-
AAI EC
ting-edge teaching strategies have been shared at the AAI
Annual Meeting and in a special section of the AAI Newsletter
Review
that is dedicated to pedagogy. The rising interest in immunol-
ogy education is also reflected in recently published articles,
which have begun to highlight effective teaching pedagogies
AAI Council and topics to cover (4, 9, 10).
The AAI Education Committee received input from the
ITIG highlighting a need for a comprehensive set of cur-
Broader ricular guidelines for teaching immunology at the under-
dissemination graduate level. In 2019, the Education Committee formed
an Ad Hoc Committee to establish recommendations for
undergraduate immunology instruction with the goal of
providing a guide for instructors in immunology that will
FIGURE 1. Process of reiterative curriculum recommendation bridge undergraduate and graduate teaching and prepare
development. students for subsequent careers in the biomedical and
AHC: American Association of Immunologists Curriculum Ad Hoc Commit- healthcare fields as well as other areas applicable to immu-
tee, eight members; ITIG: 200 members; working groups, 47 members; nology. The Ad Hoc Committee was composed of educa-
workshop, 49 participants. AAI EC, AAI Education Committee. tors from primarily undergraduate academic institutions,
educators in various healthcare sectors, and a member of
the biotechnology community. The recommendations were
societies are uniquely poised to engage in broad curricular rec- initially developed through consultation among the sub-
ommendations for their field based on the breadth of their committee members and then thoroughly vetted by ITIG
membership expertise and the depth of their communication members through a series of survey iterations, individual
platform to reach a broad section of researchers, educators, and consultation, and a virtual workshop. The strength of these
professionals in the field (7, 8). In response to the perceived recommendations lies in the vetting and broad consensus
need among immunology educators, the American Association achieved by engaging over 70 immunologists in a variety of
of Immunologists (AAI) has undertaken a process to provide a professional roles and the flexible structure to allow for
general set of core recommendations for an undergraduate cur- innovations and autonomy of topic emphasis within the
riculum in the field of immunology. Ideally, curriculum guide- curriculum.
lines would be developed with a top-down strategy identifying In this article, we first describe the methodology used for
key topics that could be covered in shorter course modules and curriculum content development, which may be useful for other
expanded subtopics that could be included in full-semester disciplines aiming to develop curriculum recommendations for
courses. Additionally, educators at the next level of learning complex, interdisciplinary subjects. Then we present the
https://doi.org/10.4049/immunohorizons.2100030450 UNDERGRADUATE IMMUNOLOGY COURSE RECOMMENDATIONS ImmunoHorizons
TABLE I. Key topics and their foundational concepts for an undergraduate course in immunology
Key Topic Foundational Concepts
Overview and terminology of the 1. Barrier function of epithelial tissues
immune system 2. Immune system organs
3. Hematopoiesis: myeloid and lymphoid lineage
4. Cell types in myeloid and lymphoid lineages
5. Primary and secondary lymphoid organs
6. Complement
7. Cytokines
8. Antigen receptors of T cells
9. Antigen receptors of B cells
10. Evolution of the immune system
Immunological techniques 1. Animal models
2. Cellular techniques considerations
3. Antibodies for research, diagnostics, and therapeutics
4. Flow cytometry
Innate immunity 1. Functions of barriers and pre-formed elements
2. Innate immune cell types and functions
3. Differences of innate immunity from adaptive immunity
4. Germline-encoded pattern recognition receptors
5. Dendritic cells (DCs)
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Inflammation 1. Principles of inflammation
2. Hallmarks of inflammation
3. Inflammatory inducers
4. Intracellular response
5. Inflammatory mediators
6. Local response
7. Systemic response
8. Down regulators of inflammation
9. Anti-inflammatory drugs
Development & activation of self- 1. Antigen receptor structure and mechanisms of diversity
tolerant adaptive immune cells 2. MHC and antigen presentation to T lymphocytes
3. Generation and development of B and T lymphocytes
4. Central tolerance mechanisms
5. Lymphocyte activation and signal transduction- three signals concept
6. Peripheral tolerance mechanisms
Adaptive immune cell effector function 1. Role of dendritic cells in activating naïve T cells
2. Effector CD4 and CD8 T cells
3. Antibody response
4. Effector function of antibodies
5. Adaptive immune response over time
Integrated immune response 1. Temporal immune response
2. Spatial immune response
3. Leukocyte trafficking
4. Sequential activation of immune cells
5. Leukocyte cross talk
6. Immune response to pathogens
Mucosal immunity 1. Organization of the mucosal immune system
2. Specialized lymphoid cells located at mucosal sites
3. Unique APC populations and uptake of antigen at mucosal sites
4. Role of IgA in protection at mucosal sites
5. Induction and regulation of the immune response at mucosal sites
Active and passive immunizations 1. Historical aspects of immunization
2. Why vaccines work and concept of herd immunity
3. Types of vaccines
4. Important aspects of vaccines
5. Vaccine production, adjuvants, and preservatives
6. Challenges of vaccine success
7. Passive immunization
Tumor immunology 1. Tumor immunosurveillance
2. Immune escape by tumors
3. Cancer immunotherapy
Allergies and Hypersensitivities 1. Immunological hypersensitivities, definition and classification
2. Main allergic reaction types according to the Gell-Coombs classification
3. Principles of therapy of allergic reactions
Autoimmune diseases 1. Causes, epidemiology, genetics
2. Mechanisms of autoimmune disease
3. Principles of therapy of autoimmune disease
Transplant rejection 1. Transplant immunology
2. Principles of immunosuppressive therapy for transplant rejection
Immunodeficiencies 1. Primary immunodeficiencies
2. Secondary immunodeficiencies
3. Immunodeficiencies and immune dysregulation
4. Diagnostic assessments used for both primary and secondary immunodeficiencies
5. Treatments for immunodeficiencies
Subtopics are numbered and examples are indicated by round bullets (●). Advanced subtopics are indicated by square bullets (■).
https://doi.org/10.4049/immunohorizons.2100030ImmunoHorizons 451
TABLE II. Overview and terminology of the immune system
Foundational Concepts Subtopics and Examples Advanced Subtopics
Barrier function of epithelial tissue 1. Structural features of barrier defense
• Keratinization
• Mucous production
• Ciliated epithelium
2. Chemical defenses
• pH
3. Antimicrobial peptides and polypeptides and enzymes
• Defensins
• Cathelicidins
• Lysozyme
4. Mucus, sweat, surfactants
5. Colonization of barrier surface by microbiome
Immune system organs 1. Bone marrow
2. Primary lymphoid organs
3. Secondary lymphoid organs
4. Tertiary lymphoid structure
Hematopoiesis: myeloid and 1. Hematopoietic stem cell differentiation into specific lineage progenitors (common
lymphoid lineage myeloid and common lymphoid progenitors, CMP and CLP)
2. Roles of cytokines and growth factors in hematopoiesis
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3. General functions associated with CMP and CLP progenitors
4. Modulation of hematopoiesis by environmental triggers (e.g. infection)
Cell types in myeloid and lymphoid 1. CMP Lineage
lineages • Granulocytes (neutrophils, eosinophils, mast cells, basophils)
• Monocytes, cacrophages
• Dendritic cells
• Erythrocytes
• Megakaryocytes
2. CLP Lineage
• B lymphocytes
• Classical T lymphocytes (CD4 and CD8)
• Non-classical lymphocytes (γ/δ, iNKT)
• Innate Lymphocytes (NK cells, ILCs)
• pDCs
Primary and secondary lymphoid 1. Defining role of bone marrow versus lymph nodes versus spleen in development of
organs immune cells and activation of immune responses
2. Functional distinction between primary and secondary lymphoid organs and lymphocyte
circulation
3. Spleen lymph node architecture and generalized function
4. Introduction of tissue-specific secondary lymphoid organs (e.g. BALT, GALT)
5. Lymphatics and lymph
Complement 1. Major functions of complement
• Opsonization
• Anaphylatoxin-induced inflammation
• Membrane attack complex
Cytokines 1. Cytokine definition
• Soluble protein messengers that specify and coordinate immunological activity
2. Chemokine definition
• Mediators of cellular migration/recruitment
3. Cytokines families
4. Mechanism of cytokine receptor -dependent responses
• Generic JAK/STAT signaling
Antigen receptors of T cells 1. Overview of TCR Structure
• Alpha/beta chains
2. T cell receptor ligand (peptide/MHC)
3. Classes of MHC and antigen presentation
• MHC I
• MHC II
4. Major T cell subsets
• CD8
• CD4
Antigen receptors of B cells 1. Overview of antibody structure Description of diversity of
• Heavy chains, light chains antibody structure across
• Shape vertebrate species
2. B cell receptor ligand (antigens) (camelids, sharks, etc.)
3. Functional domains of antibodies
• Fab region, Fc region, hinge region
4. Overview of antibody functional properties determined by its structure
• Secretion of receptor
• Types of interactions with antigen
• Flexibility of hinge region
• Bivalency
Evolution of the immune system 1. Innate immune system (all multicellular organisms and unifying characteristics)
2. Adaptive immune system (vertebrates only, unifying characteristics)
3. Interactions between innate and adaptive immune responses
Subtopics are numbered, and examples are indicated by round bullets (●). Advanced subtopics are indicated by square bullets (■).
https://doi.org/10.4049/immunohorizons.2100030452 UNDERGRADUATE IMMUNOLOGY COURSE RECOMMENDATIONS ImmunoHorizons
TABLE III. Immunological techniques
Foundational Concepts Subtopics and Examples Advanced Subtopics
Animal models 1. Human studies: advantages versus disadvantages Other types of animal models beyond
2. Brief overview of different animal models that can be used to study immunological k/o and knock in
concepts Specific model organisms (e.g.,
• Knock-out Drosophila mice, rats, Zebra fish,
• Knock-in Xenopus, C. elegans, humanized
mice)
Non-model organisms
Cellular techniques 1. Overview of sample preparation consideration Next Generation
considerations 2. Overview of assay sensitivity versus specificity Sequencing/bioinformatics
3. in vitro, ex vivo, in vivo experiments - differences and techniques
4. Isolation of immune cells from tissue
5. Flow cytometry (see below)
Antibodies for research, 1. Introduction CyTOF
diagnostics, and therapeutics 2. Generation of antibodies for research and clinical use Noninvasive imaging techniques
3. Immunoassays (luminescence, PET/CT)
• Pros and cons
• Overview of technical concepts
• Interpretation of Results
•
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Examples
o ELISA/EIA/ELISPOT
o Western Immunoblot
o Immunohistochemistry and immunofluorescence
o Microscopic imaging
o Flow cytometry (see below)
Flow cytometry 1. Overview of technical concepts Multiparameter analysis
• Overview of instrumentation Statistics and data analysis in
• Controls for experiments immunology
• Sample preparation
• Data acquisition
2. Interpretation of results
3. Cellular analysis versus cell sorting
Subtopics are numbered, and examples are indicated by round bullets (●). Advanced subtopics are indicated by square bullets (■).
recommendations for curriculum content, as well as additional graduate/medical school level, needs for biotechnology
resources for further classroom enrichment, compiled from a and biomedical careers, and their own teaching experien-
survey of the AAI teaching community. Finally, we as educators ces. These resources were selected based on individual
are not only responsible for the scientific content in our courses experiences and not from a targeted validation study.
but are also obligated by a responsibility to convey this content Absence from the sources cited in this article does not
in an equitable manner to serve a diverse student population as reflect an intentional decision against inclusion. In Decem-
effectively as possible. To speak to these principles, we have ber 2019, a survey was sent out to all members of the ITIG
included recommendations for antiracist and inclusive teaching (203) for initial feedback to the suggested key topics (78
with a few examples of how to translate this desire into peda- responses) and to recruit team members (47 volunteered)
gogy. The intent of the AAI Ad Hoc Committee and ITIG mem- to define foundational concepts, determine subtopics, and
bers is to provide a resource for new as well as seasoned identify examples in small working groups. Subsequently,
undergraduate immunology instructors for curriculum develop- in January 2020, working groups were formed with three
ment and curriculum improvement. or four participants facilitated by one Ad Hoc Committee
member. Each working group included at least one under-
Process of recommendations development graduate educator and one educator from a graduate
The development of the recommendations was a highly school. From April to May 2020, the Ad Hoc Committee
inclusive and reiterative process (Fig. 1) designed to members compiled the working group recommendations,
ensure that the recommendations would reflect topics that removed redundancies, sequenced the individual topics,
immunologists highly prioritize and bridge undergraduate and uniformly formatted the document. A second survey
and graduate immunology education. In October 2019, the was sent out to the ITIG (10 responses) in June 2020, and
AAI Education Committee formed an eight-member Ad the Ad Hoc Committee further refined the recommenda-
Hoc Committee composed of current and former AAI Edu- tions. Finally, the draft document was shared with the
cation Committee members representing undergraduate, ITIG, and the ITIG was invited to provide written feed-
graduate, and medical school educators as well as a mem- back and participate in a virtual workshop to further dis-
ber of the biotech industry. The Ad Hoc Committee cre- cuss the recommendations. This 3-h workshop (49 ITIG
ated a list of key topics informed by current textbook attendees) took place on July 24, 2020. In breakout ses-
content (11--16), other resources, requirements at the sions dedicated to one or two key topics and facilitated by
https://doi.org/10.4049/immunohorizons.2100030ImmunoHorizons 453
TABLE IV. Innate immunity
Foundational Concepts Subtopics and Examples Advanced Subtopics
Functions of barriers and pre- 1. Functions of anatomical & chemical barriers Non-vertebrate innate
formed elements 2. Functions of intrinsic mechanisms immunity
• microRNA Regulation of complement
• CRISPR activation
3. Functions of complement (e.g., Ig clearance, MAC) Complement interaction
with coagulation cascade
and kallikrein system
Blood brain barrier
Innate immune cell types and 1. Description of cell types Developmental origins of
functions • Epithelial cells tissue resident and
• Neutrophils infiltrating phagocytes
• Macrophages Neutrophil extracellular
• Dendritic cells traps
• NK cells Maintenance of tissue
• Basophils, Eosinophils, Mast cells homeostasis by macrophage
2. Characterization of effector functions by innate immune cells Apoptosis pathways
• Secretion of type I interferons Innate lymphoid cell
• Antimicrobial peptides
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• Phagocytosis
• Reactive oxygen and nitrogen radicals
• Cell death induction
Differences of innate immunity from 1. Rapid response time Innate memory
adaptive immunity 2. No memory
3. Generalized recognition of pathogens based on pathogen-associated molecular patterns
(PAMPs)
Germline-encoded pattern 1. Pattern Recognition Receptors (PRR) Fungal and protozoan PRR
recognition receptors • extracellular and intracellular (e.g., TLRs) and PRR ligands
• intracellular only (e.g., cytosolic or endosomal -NODs and RIGs)
2. PRR signaling
3. PRR ligands
• Bacterial
• Viral
• Host derived
4. PAMPs
5. DAMPs
Dendritic cells 1. Survey, capture, migration, and processing of antigens
2. Presentation of processed antigen to B cells and T cells in secondary lymphoid tissues
Subtopics are numbered, and examples are indicated by round bullets (●). Advanced subtopics are indicated by square bullets (■).
the Ad Hoc Committee members, the current recommen- Immunology content recommendations
dations were further refined according to the survey com- The format of the recommendations is layered, allowing educa-
ments, and in the following plenary session, a preferred tors to start with key topics of immunology, which are further
sequence of the recommendations was discussed. In broken down into foundational concepts that may be covered
August 2020, the Ad Hoc Committee finalized the curricu- in each section. Key topics represent critical categories recom-
lum recommendations and developed a recommendation mended for inclusion in undergraduate immunology curricula,
for inclusive and antiracist teaching. These materials were and the foundational concepts are embedded beneath the key
then presented in September 2020 to the AAI Education topics as important subcategories. If educators are interested in
Committee, which approved the recommendations with more-specific guidance within the foundational concepts, they
some minor edits and presented them to the AAI Council, can then refer to the subtopics and examples provided. Sub-
which endorsed the recommendations and suggested a topics and examples offer flexible opportunities to elaborate
broader dissemination in November 2020. and work with students on the foundational concepts.
Advanced subtopics are flexible opportunities to explore con-
The recommendations cepts more in depth in accordance with an instructors inter-
The curriculum recommendations provided are intended to ests, expertise, and available time. This layered approach
serve a two-fold purpose: the first, to provide guidance for provides the instructor with flexibility in how much detail they
immunology content selection and the second, to provide a want to provide and allows the instructor to shape the curricu-
framework for equity in the classroom (17--19). The curricular lum according to the needs of their particular undergraduate
content recommendations are presented first (Tables I--XV), students, the length of the module or course, and the
followed by the recommendations for inclusive and antiracist instructors individual expertise. The examples are intended for
teaching. new educators as a springboard for curriculum development in
https://doi.org/10.4049/immunohorizons.2100030454 UNDERGRADUATE IMMUNOLOGY COURSE RECOMMENDATIONS ImmunoHorizons
TABLE V. Inflammation
Foundational Concepts Subtopics and Examples Advanced Subtopics
Principles of inflammation 1. Protective response involving immune cells, blood vessels, protein and lipid-based
mediators
2. Beneficial aspects
Hallmarks of inflammation 1. Calor, rubor, tumor, dolor, loss of function
Inflammatory inducers 1. Microbial products
PAMPs (e.g., LPS, bacterial DNA, viral nucleic acid)
2. Host associated products:
DAMPs (e.g., ATP, nucleic acids, HMGB1, hyaluronic acid)
Complement factor C5a
Intracellular response 1. Inflammasome
2. Pyroptosis
Inflammatory mediators 1. Cytokines (e.g., TNF, IL-1 , IL-6)
2. Chemokines (e.g., IL-8)
3. Lipids (e.g., prostaglandins, leukotrienes)
Local response 1. Cells involved
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Neutrophils
Monocytes/M1 macrophages
Endothelial cells
2. Cell trafficking to the site of inflammation
P-selectin, integrins
Margination, rolling adhesion, firm adhesion, transmigration
IL-8 and chemotaxis
Systemic response 1. Acute phase Basophils
Hepatocyte involvement Mast cells
CRP Eosinophils
IL-6
2. Fever response
Hypothalamus involvement
3. Effect on bone marrow
4. Other symptoms
Pain
Loss of appetite
Malaise
Down regulators of inflammation 1. Inhibitory cells
M2 macrophages
Treg
2. Inhibitory biomolecules
Resolvins
IL-10
TGF-
Anti-inflammatory drugs 1. NSAID (aspirin or ibuprofen)
2. Biologics (anti-TNF)
Subtopics are numbered, and examples are indicated by roundbullets ( ). Advanced subtopics are indicated by square bullets ( ).
their classroom. They are also intended for seasoned educators be avoided in a subject matter with so many intercon-
as a cross-check to modify course content or to add a new nected facets. In some cases, it was determined that the
module to an existing course. Although the Ad Hoc Committee redundancy was actually important and necessary to rein-
key topics are intentionally arranged in their current order force important topics. Finally, instructors may be limited
based on classroom experience, each key topic is self-standing by the time they have available. Instructors are encour-
and can be taught in any logical sequence according to the aged to prioritize the foundational concepts. For minimum
instructors preference. Additionally, content from one key hours available, instructors could choose to only cover
topic may be distributed throughout the semester when material listed in Table II. For a quarter system--based
related content is discussed. This may be most appropri- course, instructors could plan to cover key topics listed in
ate for the final four topics (Tables XII--XV), which have Tables II to X and incorporate the clinical material pre-
clinical relevance that may pique student interest sented in Tables XI to XV in the form of case studies
throughout the course in the form of case studies or active throughout the term, whereas a semester-long standalone
learning projects. Although great effort was taken to immunology course could allow for incorporating all key
remove unnecessary redundancy, some redundancy cannot topics.
https://doi.org/10.4049/immunohorizons.2100030ImmunoHorizons 455
TABLE VI. Development and activation of self-tolerant adaptive immune cells
Foundational Concepts Subtopics and Examples Advanced Subtopics
Antigen receptor structure and 1. BCR structure
mechanisms of diversity • Immunoglobulin structure
• IgM/IgD coexpression
• Structural switch to secreted IgM
2. TCR structure
• α/β chains
• γ/δ chains
3. VDJ recombination
4. Modifications of immunoglobulins
• Somatic hypermutation
• Class switching
• Affinity maturation
MHC and antigen presentation to T 1. Classical antigen processing and presentation
lymphocytes • MHC Class I
• MHC Class II
2. Non-classical antigen presentation
3. Self vs foreign antigen presentation
Generation and development of B 1. Clonal selection theory ILC development
and T lymphocytes 2. B cell development
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• Developmental checkpoints
• Negative selection
• B1 vs B2 cells
3. T cell development
• Gamma/delta vs alpha/beta
• Developmental checkpoints
• CD4 vs CD8
• Positive (MHC restriction and negative selection)
Central tolerance mechanisms 1. Fate of autoreactive B cells
• Clonal deletion
• Receptor editing
2. Role of thymic epithelial cells and bone marrow stromal cells dendritic cells in central
tolerance
3. Function of Aire transcriptional regulator in T cell and B tolerance
4. Fate of autoreactive thymocytes
• Differentiation into nTregs
Lymphocyte activation and signal 1. Co-stimulation for T and B cell activation (signal 2)
transduction- three signals concept • Cell adhesion, synapse formation
• Activation of transcription factors in lymphocytes
2. Cytokine receptor signaling for clonal expansion and differentiation (signal 3)
• IL-2 (JAK/STAT)
• NF-kB
• NFAT
• AP1
3. Regulation of activation
• Inhibitory signals from immune checkpoint inhibitors and death receptors
Peripheral tolerance mechanisms 1. Necessity of peripheral tolerance Other Treg types (e.g., Tr1)
• Leaky central tolerance Types and functions of
• Peripherally restricted antigens tolerogenic cell subsets
2. Phenotype and immunoregulatory functions of Tregs (dendritic cells, types of
• Role of FoxP3 peripheral Aire-expressing
• nTregs v iTregs cells, B1 and Breg cells,
3. Mechanisms of B cell and T cell peripheral tolerance MDSCs)
• IL-10 and TGF-β Mechanisms and
• Cytotoxicity significance of immune
• Cell metabolism regulation privilege
Oral tolerance (role of IgA
• Clonal deletion
and microbiome, oral
• Anergy
allergen immunotherapy)
• Exclusion Maternal tolerance to the
semi-allogeneic fetus
Subtopics are numbered, and examples are indicated by round bullets (●). Advanced subtopics are indicated by square bullets (■).
The key topics and their foundational concepts about immunological techniques early in the course is
Table I lists the key topics and their foundational concepts that intended to prepare students for the inclusion of primary
were universally identified as critical content for an undergrad- research papers. Although educators often express interest
uate immunology course. The foundational concepts are num- in introducing undergraduates to reading and interpreting
bered in the sequence that was deemed to be most conducive scientific research articles, there can be hesitancy that with-
for learning immunology. There was extensive discussion out background in scientific techniques it is difficult to
around some of the key topics, and the rationale for final selec- interpret data. Early introduction and reinforcement of key
tion and sequence are highlighted in this article. Teaching techniques open up new possibilities for higher learning in
https://doi.org/10.4049/immunohorizons.2100030456 UNDERGRADUATE IMMUNOLOGY COURSE RECOMMENDATIONS ImmunoHorizons
TABLE VII. Adaptive immune cell effector function
Foundational Concepts Subtopics and Examples Advanced Subtopics
Role of dendritic cells in activating 1. Dendritic cells Outlining differences between
naïve T cells Conventional mice and humans
Plasmacytoid
2. Differences between mature and immature DC
3. Routes of antigen processing by DC
4. Cross-presentation in DC
5. PAMPs and DC migration
a. LPS, flagellin, CpG, dsRNA etc
6. Delivery of the 3 signals to naïve T cells
Effector CD4 and CD8 T cells 1. Overview of CD4 subsets Metabolism differences resting
Th1 versus activated T cells
Th2 Calcium flux
Th17
Treg
2. Transcription factors and Stats that control CD4 T cell differentiation
3. Activities of effector cytokines
IL-2
IFN-
TNF
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IL-4, IL-5
IL-17, IL-22
IL-10, TGF-
4. CD4 T cell influence on macrophage phenotype
5. Overview of CD8 T cells
Tc1
Tc2
Regulatory CD8 T cells
6. Mechanisms of T cell-mediated cytotoxicity (e.g., perforin/granzyme, Fas/FasL,
TRAIL/DR4, DR5)
Antibody response 1. Types of antigens Key cytokine/chemokine
Exogenous signals for organizing GC
Endogenous
Autoantigens
Haptens
2. T cell dependent versus T cell independent activation of B cells
3. Differentiation of B cells into antibody-secreting plasma cell
4. Germinal center formation and role of Tfh and FDC
5. Somatic hypermutation, class switching and affinity maturation
Effector function of antibodies 1. Antibody isotypes and their functions Glycosylation of hinge
2. Antibody activation of complement Fc-receptor mediated NK
3. Opsonization activation
4. Antibody-dependent cell-mediated cytotoxicity (ADCC) Details of IgA secretion
5. Placental transport Monoclonal antibody
6. Neutralizing antibodies production
7. Mast cell degranulation Use of monoclonal antibodies
versus IVIG
Adaptive immune response over 1. Kinetics and course of the response Primary versus secondary
time 2. T cell memory memory
Effector memory NK cell memory
Central memory
Tissue-resident memory
3. Humoral memory
Memory B cells
Long-lived plasma cells
4. Regulations of the immune response (e.g., Tregs, IL-10, TGF- , PD1/PDL1, PDL2)
Subtopics are numbered, and examples are indicated by round bullet points ( ). Advanced subtopics are indicated by square bullet points ( ).
the undergraduate classroom. Tolerance, which is often important for students to put together all of the information
introduced later in an immunology course when autoim- they have learned up to that point before delving more in depth
mune diseases are discussed, was merged with the develop- into the more-complex, clinically relevant topics. Understand-
ment of adaptive immune cells as development is tightly ing the mucosal immune response provides a foundation for
linked to selection of self-tolerant cells. This connection immunizations and, therefore, the topic mucosal immunity was
will allow students to gain a clinical context for develop- placed before the topic on active and passive immunizations.
ment of adaptive immune cells early on. Tumor immunology follows active and passive immunizations
The topic, integrated immune response, is intended to allow because of the common principles applicable to generation of
students to construct an understanding of the entire immune tumor immune response and the significance of tumor vaccines.
response as a dynamic and interdependent system. It is In medical school, allergies and hypersensitivities are often
https://doi.org/10.4049/immunohorizons.2100030ImmunoHorizons 457
TABLE VIII. Integrated immune response
Foundational Concepts Subtopics and Examples Advanced Subtopics
Temporal immune response 1. Infection/injury Idea of lymphocytes as a
2. Induction of immune response selectable population in an
3. Effector phase, evolutionary sense
4. Pathogen/lesion clearance
5. Exhaustion
6. Memory phase
Spatial immune response 1. Epithelium
2. Subepithelial tissue
3. Regional lymph nodes including germinal centers
Leukocyte trafficking 1. Homing to lymph node and from lymph node into the tissues
HEV
LFA-1
Selectin
S1P1R
Sequential activation of immune 1. Sensor cells Th1/Th2 shift in allergy
cells Epithelial cells
Macrophages
Dendritic cells
2. ILCs and their cognate activating cytokines
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ILC1/ IL-12
ILC2/ IL-33
ILC3/ IL-23
3. Differentiation of T cells into Th1, Th2, and Th17 cells
4. iTreg and mechanisms of immune inhibition
IL-10, TGF-
CTLA-4
PD1/PD1-L
Leukocyte cross talk 1. Interaction of lymphocytes with innate immune cells T cells and NK cells
B cells (via Ab) and phagocytes, NK cells, and mast cells Placental immunology
Th1 cells and M1 macrophages and DC (establishing implantation:
Th2 cells and mast cell, eosinophils, and M2 macrophages placental trophoblast cells,
Th17 cells and epithelial cell, myeloid cells uterine NK cells, other
immune cells)
Immune response to pathogens 1. Choose two examples to compare and contrast pathogen specific responses according to Impact of infections on the
instructor's preference fetus and pregnancy
Examples:
o Viruses and obligate intracellular bacteria [NK cells, CTL, antibodies]
o Extracellular bacteria [neutrophils, macrophages, Th17 cells, IgG]
o Facultative intracellular bacteria [macrophage, Th1, granuloma]
o Fungi [macrophage, Th1, Th17]
o Protozoan [microbe-specific]
o Helminths [eosinophils, Th2, IgE]
Subtopics are numbered, and examples are indicated by round bullets ( , ). Advanced subtopics are indicated by square bullets ( ).
taught along with autoimmune diseases in a combined advanced subtopics. The subtopics are numbered to show the
approach reflecting the pathophysiological similarities. How- sequence deemed to best advance student understanding and
ever, it was felt that for an undergraduate curriculum, autoim- learning. Bullets identify subtopics, advanced subtopics, and
mune diseases should be covered as a separate topic because specific examples. The advanced subtopics were contributed by
undergraduate students are still building their knowledge and IGIT members according to their in-depth knowledge in a
are not exposed to the depth of clinical experience more typical given area, and instructors are encouraged to use advanced sub-
for medical students. To highlight the importance of turning off topics from their own specialized area.
the immune response after Ag removal, downregulatory mecha- Table II summarizes the key topic overview and terminology
nisms are taught across the topics. Finally, instead of creating a of the immune system, which primarily serves the goal to estab-
separate key topic for the therapy of diseases involving the lish vocabulary and a common ground for all students. Here, stu-
immune system, therapies are embedded where the diseases of dents are introduced to critical components of the immune
the immune system are discussed to reinforce the underlying response at the molecular, cellular, and tissue level and the
pathophysiological mechanisms and frequently used to engage respective terminology. Because immunology is notable for its
the students who are typically genuinely interested in how substantial, and often intimidating, nomenclature, establishing
immunology is applied to treat diseases. the terminology early is critical for establishing a working
language for the remainder of the course. Table III summa-
The subtopics with examples and advanced subtopics for rizes important immunological techniques from molecular and
the foundational concepts for each key topic cellular in vitro approaches to animal models. Ab-based techni-
We have created tables for each key topic to list the associated ques are extensively covered because of their applications in
foundational concepts with subtopics and examples and research, diagnostics, and therapeutics. Flow cytometry is
https://doi.org/10.4049/immunohorizons.2100030458 UNDERGRADUATE IMMUNOLOGY COURSE RECOMMENDATIONS ImmunoHorizons
TABLE IX. Mucosal immunity
Foundational Concepts Subtopics and Examples Advanced Subtopics
Organization of the mucosal 1. Overview of anatomic compartments
immune system BALT, NALT, GALT, GU
Waldeyer’s ring with adenoids, palatine, and lingual tonsils
Isolated lymphoid follicles
Lamina propria crypts
2. Mucus components
Mucins
Antimicrobial peptides and proteins
IgA
3. Difference between systemic and mucosal lymph nodes
Peyer’s Patches
Mesenteric lymph nodes
Cryptopatches
Appendix
Cecum
4. High endothelial venules
Specialized immune cells located at 1. Activation state of lymphoid cells in the area Activation markers on resident
mucosal sites 2. Mast cells and other innate cells present B and T lymphoid cells
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3. / T cells Innate lymphoid cells (ILC)
4. Plasma cells (IgA secreting) MAIT
Intraepithelial lymphocytes
(CD8)
CD8 + T cells
Activities of / T cells
Unique APC populations and 1. Overview of APC present CD103+ DCs
uptake of antigen at mucosal sites Lack of inflammatory receptors
o TLR, FcR, CD14
Lack of inflammatory cytokines
o IL-1 , TNF
2. Role of M cells
3. Antigen transport across epithelium
4. Lumenal access of DCs
Role of IgA in protection at mucosal 1. IgA secretion by plasma cell on basolateral side of epithelial surface IgA deficiency and transport of
sites 2. Transcytosis of IgA to apical face of epithelial cell via poly-Ig receptor IgM
3. IgA’s role in the mucosa/with mucin Role of secretory IgA
component
Induction and regulation of the 1. Initiation of the response in mucosal sites Differences between gut and
immune response at mucosal sites 2. Reasons for limited inflammation lung mucosal immune
3. Role of Tregs responses
Tregs control T cells with inflammatory potential Pathology at mucosal sites,
4. Tolerance to non-pathogenic substances (e.g.. food) examples:
5. Tolerance to normal microbiota Inflammatory bowel
disease
Antibiotic use and C.
difficile
Defense against
helminths
Asthma
Food allergy
IgA deficiency
Bacterial vaginosis
Subtopics are numbered, and examples are indicated by round bullets ( , ). Advanced subtopics and their examples are indicated by closed square bullets ( ) and
open square bullets ( ), respectively.
included because it is a commonly used technique that is central created with primarily bacterial and viral infections in mind;
to immunology findings described throughout each topic. There thus, innate responses to fungal and protozoan microbes are
was strong consensus to introduce immunological techniques as listed as advanced subtopics, reflecting instructional directions
a dedicated key topic early in the course to provide students that are traditionally less common in curricula. In addition to
with a robust basis for understanding primary immunology complement, phagocytic cells, and NK cells, epithelial cells are
research papers throughout the course. included as effector cells in the innate immune response as
Table IV summarizes the key topic innate immunity. As one they exemplify how different cell types and tissues, not tradi-
of the major conceptual arms of the immune system, this key tionally considered part of the immune system, can play key
topic helps frame an understanding of how the organs and cel- roles in immunity. Table V summarizes the key topic inflamma-
lular systems first recognize and combat potentially dangerous tion. It is recommended that instructors also highlight the ben-
microbial or environmental encounters. This key topic was eficial aspects of inflammation and begin this key topic with a
https://doi.org/10.4049/immunohorizons.2100030ImmunoHorizons 459
TABLE X. Active and passive immunizations
Foundational Concepts Subtopics and Examples Advanced Subtopics
Historical aspects of immunization 1. Variolation Implications of von
2. Jenner’s Experiments with smallpox Behring’s discovery of
3. Development of the polio vaccine diphtheria anti-toxin
Smallpox eradication
campaign
Cutter labs
Why vaccines work and concept of 1. Statistics of safety versus morbidity/mortality of infectious disease
herd immunity Any example would work
2. R0 and herd immunity thresholds
Measles
3. Rationale for targeting specific vaccines to particular populations
Age dependency
Pregnant mothers
Career associated exposure (e.g., veterinarians, military)
Prevalence of a disease in regards to global vaccination
Types of vaccines 1. Whole killed organism vaccines
2. Live-attenuated organism vaccines
3. Toxoid vaccines
4. Subunit vaccines
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5. Recombinant vaccines
6. Polysaccharide vaccines
7. Nucleic acid-based vaccines
Important aspects of vaccines 1. Advantages and Disadvantages of the vaccines listed above
2. Type of immune response initiated for each vaccine listed above
Humoral immunity
Humoral and cell mediated immunity
3. Example of different flu vaccine types can initiate different types of immunity (live
attenuated influenza vaccine versus the quadrivalent flu vaccine)
Vaccine production, adjuvants and 1. Vaccines preparation
preservatives 2. Route of administration
3. Common vaccine adjuvants (e.g. thimerosal, aluminum)
Purpose (depot effect, inflammasome activation)
Toxicities
Mechanism of action
4. Vaccine preservatives
Challenges of vaccine success 1. Technological difficulties associated with vaccine development
Example: influenza vaccines and seasonal variability
2. Microbial limitations for making vaccines
Example: HIV vaccine and high mutation rate
3. Societal and global challenges to achieve R0 levels required to generate herd immunity
Anti-vaccine movement
Example: Polio and global challenges for eradications
Passive immunization 1. Use of pre-formed antibodies versus active immunization
Advantages/disadvantages
Half-life of preparations
Mechanism of action
2. Polyclonal and monoclonal antibody preparations
Medical examples of how passive immunization is used (e.g., tetanol)
3. Differences of immune globulin, specific immune globulin, and intravenous IG
4. Natural examples of passive immunization (e.g., maternal antibodies via crossing the
placenta or breast feeding)
Subtopics are numbered, and examples are indicated by round bullets ( ). Advanced subtopics are indicated by square bullets ( ).
discussion of the protective aspects of acute inflammation. Table VII summarizes the key topic adaptive immune cell
Inflammation leads to initiation of the adaptive immune effector function. Dendritic cells, effector CD4 and effector
response, and thus, this key topic is followed by the key topic CD8 T cells, Ab response, and Ab function are first examined,
development and activation of self-tolerant adaptive immune and then the adaptive immune response over time is described.
cells, which is summarized in Table VI. The concept of toler- Germinal centers and NK cell functioning can be explored as
ance is introduced under this key topic because the develop- advanced subtopics. Table VIII summarizes the key topic inte-
ment of lymphocytes is tightly linked to tolerance. The grated immune response, which aims to provide students with
importance of self-tolerance for lymphocyte development is a general understanding of how the innate and adaptive
also reflected in the title of this key topic. Instructors who immune responses interweave over time. This section also
want to highlight oral tolerance or tolerance in pregnancy may defines the locations where the interactions between Ag, innate,
wish to introduce these advanced topics here. and adaptive immune cells take place throughout the course of
https://doi.org/10.4049/immunohorizons.2100030460 UNDERGRADUATE IMMUNOLOGY COURSE RECOMMENDATIONS ImmunoHorizons
TABLE XI. Tumor immunology
Foundational Concepts Subtopics and Examples Advanced Subtopics
Tumor immunosurveillance Examples of tumor antigens Role of immune cells in promoting
1.
Aberrant or overexpression of normal proteins tumor -chronic inflammation
Modifiable host factors affecting
Differentiation antigens
tumor immunity (e.g., diet,
Viral antigens
microbiota)
Antigens expressed by mutated passenger/driver mutations
2. Anti-tumor immune mechanisms
Tumor killing by cytotoxic CD8 T cells
Cross-presentation of tumor antigens to CD8 T cells by dendritic cells
Humoral antitumor responses
NK-mediated killing of tumor cells
Role of activated macrophages in tumor suppression
Immune escape by tumors 1. The three Es of immunoediting Clinical evidence of the presence of
Elimination immune cells in the tumor
Equilibrium microenvironment (tumor biopsies)
Escape and the relevance of ‘immunoscore’ to
2. Escape mechanisms assess prognosis (hot vs cold tumors)
Loss of tumor antigens Co-opting of immune cells by tumors,
Immunosuppressive tumor microenvironment especially tolerogenic mechanisms
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o Abnormal vasculature and hypoxia like recruitment of Tregs and
o Role of immune check points on CD8 and regulatory T cells (PD- changing the orientation of
1/CTLA-4) macrophages to wound-healing mode
o Tumor secreted immunosuppressive cytokines/growth factors Co-opting of stromal cells including
(TGF- /VEGF the cancer-associated fibroblasts by
o Suppressive myeloid cells (M2 macrophages, myeloid-derived tumor cells
suppressor cells, tolerogenic dendritic cells)
Cancer immunotherapy 1. Brief history of cancer immunotherapy Example of one of the successful
1854 – Virchow clinical trials of PD-1/CTLA-4 or
1883 – Fehleisen CAR-T
1891 – Coley
1909 – Ehrlich
2. Classes of cancer immunotherapy
Tumor-targeting monoclonal antibodies (e.g., anti-CD20, anti-Her2)
Cytokine therapy (e.g., high dose IL-2 and IFN-
Tumor vaccines (e.g., dendritic cell-based vaccine in prostate cancer)
3. T-cell based agents
T cell checkpoint inhibitors (anti-PD1 and anti-CTLA4)
Adoptive cell therapies (CAR-T
NK cell therapy
4. The rationale for combinatorial therapies
Subtopics are numbered, and examples are indicated by round bullets ( , ). Advanced subtopics are indicated by square bullets ( ).
the immune response. To highlight that the immune response because many novel approaches of cancer immunotherapy
to pathogens is tailored to the specific type of pathogens, the employ mechanisms of active and passive immunization.
immune responses to two different pathogens could be com- The key topic tumor immunology first explores mechanisms
pared and contrasted according to the instructors expertise. It of tumor surveillance, then investigates tumor escape from
is highly recommended that instructors choose pathogens that the immune response, and concludes with subtopics on can-
are relevant or well-known to the students. cer immunotherapy.
Table IX summarizes the key topic mucosal immunity, The remaining four key topics are dedicated to pathology
which examines the immune response in the mucosa with spe- associated with the immune system, and each include therapeu-
cial attention paid to the gut mucosa. Here, examples for patho- tic interventions as a foundational concept. Table XII summa-
logical conditions affecting the mucosa can be introduced as rizes the key topic allergies and hypersensitivities. With a
advanced subtopics. Many types of immunizations target the reference to the medical school curriculum, hypersensitivities
mucosal immune system. Thus, the key topic active and passive are first introduced as pathological responses to Ag that can be
immunizations, summarized in Table X, follows the key topic classified as allergies, autoimmunity, and transplant rejection.
mucosal immunity. A brief historical overview and a descrip- Thereafter, hypersensitivities are classified based on the under-
tion of parameters for vaccine success have been included as a lying mechanism according to the Gell--Coombs classification
foundational concept to increase awareness of the complexity more consistent with the undergraduate immunology curricu-
and difficulty of developing a protective vaccine. Passive immu- lum, and the remainder of the key topic follows this classifica-
nization is focused on Ab-related subtopics. Table XI summa- tion. Table XIII summarizes the key topic autoimmune
rizes the key topic tumor immunology. This key topic diseases. The foundational concepts include causes and epide-
follows the key topic active and passive immunizations miology of autoimmune diseases and a classification based on
https://doi.org/10.4049/immunohorizons.2100030ImmunoHorizons 461
TABLE XII. Allergies and hypersensitivities
Foundational Concepts Subtopics and Examples Advanced Subtopics
Immunological hypersensitivities, 1. General definition of immunological hypersensitivities and contrast to non-
definition and classification immunological hypersensitivities
Role of sensitization
2. Classification of immunological hypersensitivities based on antigen types
Allergies (pathological responses to harmless environmental antigens)
Autoimmunity (pathological responses to self-antigens)
Graft rejection/transfusion reactions (pathological responses to alloantigens)
3. Classification of immunological HS based on mechanism (Gell-Coombs classification)
Primarily antibody-mediated via IgE (Type 1) and IgG/IgM (Types 2 and 3)
T cell-mediated via inflammatory and cytotoxic T cells (Type 4)
Main allergic reaction types 1. “Classical” allergies (Type 1 HS, IgE-mediated) Recognizing anaphylactic
according to the Gell-Coombs Role of mast cells, histamine, eicosanoids reactions
classification “Immediate”, biphasic pattern (early and late phase) Hygiene hypothesis
Anaphylaxis Role of early exposure to
Atopy definition: genetic predisposition to IgE hyper-responsiveness allergens
Examples (based on student interest): The skin-prick test and serum
o Hay fever IgE testing for diagnosis of
o Acute asthma allergy diagnosis
o Eczema
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o Food and drug allergies IgG-mediated allergies (Type 2
o Insect bites and 3 hypersensitivities):
2. T cell-mediated allergies (Type 4 hypersensitivity reactions): cytotoxic and cytolytic effects,
Delayed-type reactions inflammation with examples
Inflammatory (Th1, Th2, Th17-mediated) and/or cytotoxic reactions (typically drug-induced):
Penicillin (hemolytic
Examples:
disease)
o Contact dermatitis
Biologicals (serum
o Chronic asthma
sickness)
o Stevens-Johnson syndrome
Principles of therapy of allergic 1. Drugs used to treat allergic reactions Epinephrine and use of Epi pens
reactions Anti-histamines
Corticosteroids
Bronchodilators (rescue inhalers) Allergen desensitization
2. Allergen immunotherapy (desensitization strategies) protocols
Subtopics are numbered, and examples are indicated by closed round bullets ( ). Advanced subtopics are indicated by square bullets ( ). Examples for specific
diseases and drugs are indicated by open bullets ( , ).
their underlying mechanism. It is strongly recommended eliminating institutional racism and structural inequality (19).
that instructors choose clinical examples for autoimmune Inclusivity in science education means expanding access to
diseases based on student interest. Table XIV summarizes educational and professional opportunities to underrepresented
the key topic transplant rejection and includes references groups and crafting our teaching in a way that specifically
to both organ transplants and blood transfusions. Finally, acknowledges and engages all learners and validates their indi-
Table XV summarizes the key topic immunodeficiencies, vidual and collective experiences. Our teaching practices must
which are presented as primary and secondary immunode- be informed by not only our students personal histories but
ficiencies. As time permits and according to instructor also the history and dynamics of how their world is and was
expertise, one or more examples for each type of immuno- shaped before their arrival into our classroom.
deficiency can be presented. Diagnostic assessments used As educators, we hope to empower the next generation
for both primary and secondary immunodeficiencies are through knowledge and agency. As educators in the scien-
included here and may be a tool to reinforce immunologic ces, we have a responsibility to ensure that all of our schol-
ars from diverse backgroundsrepresenting individuals
techniques described earlier in Table III.
who differ in racial, cultural, and ethnic identity; gender
identity; sexual orientation; age; physical and intellectual
Recommendations for inclusive and antiracist teaching disability; spiritual beliefs; and socioeconomic statuswill
Our society is undergoing transformative changes in the aware- have an opportunity to contribute to the scientific enter-
ness of institutional racism and structural inequality that limit prise. Students in an immunology course typically come
the participation of all. It is imperative to recognize the need to academically prepared by having completed prerequisite
include different perspectives in solving scientific problems. courses in general biology and general and organic chemis-
Yet it is not enough to enable all to come to the table where try. However, their life stories and their living circumstan-
decisions are made; rather, it is time to reconstruct this table, ces at the time they take your immunology course will vary
collaboratively informed by all participants vision in our soci- widely. Some students might be caregivers or breadwinners,
ety. We, as educators, have an opportunity to take part in live in crowded quarters, and may have grown up doubting
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