Immunology · USMLE high-yield

Immunology: T & B Cell Activation

USMLE Notes — two‑signal model, subsets, checkpoints, and antibody maturation

🛡️ T‑lymphocyte activation

Overview: Naive T cells are activated in secondary lymphoid organs after antigen presentation. Two signals are required: TCR–MHC recognition (signal 1) and costimulation (signal 2). Successful activation drives clonal expansion and differentiation into effector and memory cells.

Signal 1: antigen recognition

  • TCR binds to peptide–MHC complex on APC.
  • CD4 binds MHC class II; CD8 binds MHC class I.
  • CD3 complex transduces the signal.

Signal 2: costimulation

  • B7‑1 (CD80) / B7‑2 (CD86) on APC bind CD28 on T cell.
  • B7 expression increases during infection/inflammation.
  • Without signal 2 → T‑cell anergy or tolerance.
🔬 Effector generation: IL‑2 (autocrine) drives proliferation. CD8⁺ T cells depend on help from CD4⁺ cells for full differentiation.

⚖️ CTLA‑4 & immune checkpoint

CTLA‑4 (CD152): expressed on activated T cells and Tregs. It competes with CD28 for B7 binding, delivering inhibitory signals. Critical for limiting T‑cell responses and preventing autoimmunity.

Agonists
Abatacept – RA
Belatacept – renal transplant
Antagonists
Ipilimumab – melanoma, colorectal, other cancers (enhances anti‑tumor immunity)

High‑yield: CTLA‑4 knockout mice develop fatal lymphoproliferation and autoimmunity.

⚠️ Superantigens

Superantigens (e.g., TSST‑1, staphylococcal enterotoxins) cross‑link TCR Vβ domain with MHC class II outside the peptide groove. This activates many T‑cell clones polyclonally, causing massive IFN‑γ release and macrophage activation → cytokine storm (IL‑1, IL‑6, TNF‑α).

Clinical: Toxic shock syndrome, food poisoning.

🧬 Th1, Th2, Th17 differentiation

Naive Th0 cells differentiate into distinct subsets based on pathogen and cytokine milieu.

SubsetInducersKey cytokinesEffector functions
Th1Intracellular pathogens, IL‑12, IFN‑γIFN‑γMacrophage activation, IgG switching, inhibits Th2
Th2Helminths, allergens; IL‑4IL‑4, IL‑5, IL‑10, IL‑13IgE/IgA switching, eosinophil activation, alternative macrophage
Th17Extracellular bacteria/fungi; TGF‑β + IL‑6IL‑17, IL‑22Neutrophil recruitment, antimicrobial peptides, barrier function
Th0 IL‑12 / IFN‑γ Th1 (T‑bet) Th0 IL‑4 (no IL‑12) Th2 (GATA‑3) Th0 TGF‑β + IL‑6 Th17 (RORγt)
📌 Leprosy spectrum: Th1 → tuberculoid (granulomas, controlled); Th2 → lepromatous (disseminated, antibody‑mediated but non‑protective).

🧘 Treg cells

  • Phenotype: CD4⁺, CD25⁺, FoxP3⁺
  • Secrete IL‑10 and TGF‑β → suppress Th1/Th2 responses.
  • Essential for preventing autoimmunity.

💥 Cytotoxic T lymphocytes (CTL)

CD8⁺ T cells recognize antigen on MHC class I. They require both signal 1 (TCR–MHC I) and costimulation, plus cytokines from Th cells (especially IL‑2) for proliferation and full cytotoxic function.

Effector functions: Perforin/granzyme release, Fas‑FasL, IFN‑γ.

🧫 B‑lymphocyte activation

Thymus‑independent (TI) antigens

  • Lipids, polysaccharides, LPS.
  • Directly activate B cells (no T‑cell help).
  • Mainly IgM, no memory, weak response.
  • Marginal zone B cells and B‑1 cells.

Thymus‑dependent (TD) antigens

  • Protein antigens; require CD4⁺ T‑cell help.
  • B cell internalizes antigen → MHC II presentation.
  • B7 upregulation on B cell.
  • CD40L on T cell binds CD40 on B cell → signal 2.
  • Leads to germinal center formation, affinity maturation, isotype switching, and memory.
Two waves: ① early IgM plasma cells; ② germinal center cells → high‑affinity, class‑switched antibodies.

📈 Affinity maturation & isotype switching

Affinity maturation

  • Somatic hypermutation in germinal centers → point mutations in V regions.
  • B cells with higher affinity outcompete for antigen → clonal selection.
  • Average antibody affinity increases over time.

Isotype switching

  • Heavy‑chain constant region DNA recombination (switch regions).
  • Driven by cytokines from helper T cells.
  • One‑way process: once switched, cannot return to IgM.
  • IgM predominates in primary response; IgG/IgA/IgE in secondary.
CytokineIsotype induced
IFN‑γIgG (opsonization, complement)
IL‑4 / IL‑13IgE (mast cell, basophil, eosinophil)
TGF‑β / IL‑5IgA (mucosal immunity)
💡 Pearl: Isotype switching decreases avidity (Fc changes) but affinity maturation compensates via higher affinity per binding site.