Book Review

The Immune Response: Basic and Clinical Principles

N Engl J Med 2006; 355:2380-2381November 30, 2006

Article

The Immune Response: Basic and Clinical Principles
By Tak W. Mak and Mary E. Saunders. 1194 pp., illustrated, with CD-ROM. San Diego, CA, Elsevier Academic Press, 2006. $139.95. ISBN: 0-12-088451-8

While leafing through The Immune Response, a beautiful new textbook of immunology, I was reminded that the 30 years between 1955 and 1985, during which I was engaged in immunological investigations, were a time of extraordinary discovery. In the course of those remarkable 30 years, the following were established: the lymphocyte as the central element of the immune system; the multichain structure of the immunoglobulin molecule; the mechanisms of immunoglobulin gene recombination and of the extreme variations in the sequences of antibody-binding sites; the clonal selection hypothesis; the role of the thymus in the development of T cells; the two great families of lymphocytes, T cells and B cells; the existence of helper, cytotoxic, and suppressor T cells; the genetic control of the immune response by the H2 (mouse) and HLA (human) surface molecules on antigen-presenting cells; techniques for engineering hybridomas and reagent-quality monoclonal antibodies; the structure of the T-cell receptor; the need for cytokines in the immune response; the CD (cluster designation) system of surface molecules on immune cells; autoimmunity as a real phenomenon; techniques for organ and bone marrow transplantation; and new treatments for autoimmune diseases. All these developments, and still other fundamental discoveries, form the basis of modern immunology.

A T Cell Wriggling through a Slit between Endothelial Cells.

What's next? The composer Steve Reich has written a piece called “Explanations Come to an End Somewhere.” Have we now reached that “somewhere” in immunology? Are there any more big questions, as there were in 1955? Are we, as Nobel Prize–winning immunologist Niels Jerne said in 1967, “waiting for the end”? Has immunology run out of the kinds of challenges that seize the attention of the entire research community, as the problem of clonal diversity did 40 years ago? It seems that immunology has become fragmented under the collective weight of details, jargon, indecipherable acronyms, and narrow specialization, and that it is no longer possible to grasp the field in its entirety. Hence, it comes as a gratifying surprise to find that just two people have been able to compile a comprehensive treatise, The Immune Response, on the topic. There are precedents in the excellent, but now dated, comprehensive surveys by William Boyd, Jan Klein and Vaclav Hořejší, Ivan Roitt and Peter Delves, and Charles Janeway. This latest entry in the category of not more than two primary authors is the result of a collaboration between Tak Mak, a preeminent immunologist who has made fundamental contributions to the field, and Mary Saunders, his editor (Maya R. Chaddah and Wendy L. Tamminen are contributors). The intended audience comprises medical students, predoctoral and postdoctoral basic science trainees, and physicians who need to improve their knowledge or clarify their thinking about particular immunologic topics. It is not a book that can — or should be — read straight through. It is, rather, a compendium of what is known about the immune response and related topics as of 2006.

The book has two parts. The first, consisting of 21 chapters, covers basic immunology. In a little more than 630 pages, Mak and Saunders address all topics relevant to the ways in which the body deals with invading microbes and in which the immune system distinguishes foreign antigens from its own molecules. The second part of the book contains nine chapters concerning clinical immunology. In addition to coverage of the expected topics — immunity against pathogens, autoimmune diseases, transplantation, and allergy — there is an outstanding chapter on HIV and AIDS that explains in detail the molecular and biologic properties of the virus, discusses the epidemiology of HIV infection, and summarizes its treatment and possible prevention by vaccination. The book concludes with another unusual chapter for a textbook of immunology, “Hematopoietic Cancers,” which in 37 pages reviews what we know and don't know about this complex field.

The illustrations and tables in this book are numerous and informative. The figures, clear and to the point, are also available on a CD-ROM that comes with the book (and also includes all color plates). Missing from the CD-ROM, regrettably, is the book's appendix, which lists the properties of 339 CD antigens. An unusual feature of the book is the inclusion throughout of boxes of text set off from the main content. These boxes include explanations of technical matters or comments on the historical development of the topic under discussion. The chapter on immunoglobulin genes, for example, has five such boxes in which the reader can find information on exons, introns, and transcription; the discovery of immunoglobulin gene rearrangement; the means of detecting immunoglobulin gene rearrangement; the knockout mouse; and enhancers and gene transcription. This commentary, like the Gemara that frames the main text of the Talmud, is often more interesting than the core text.

Minor faults and a reviewer's quibbles are inevitable. There are far too many abbreviations and acronyms (why do we need LAD [leukocyte adhesion deficiency] and HAR [hyperacute rejection], when communication about immunology is already encumbered by a dense jargon?); some embarrassing omissions mar the list of landmark discoveries; the explanations of positive and negative selection in the thymus, and the consequences of these phenomena, are muddled; and the tendency toward anthropomorphic explanations is excessive (the term “danger signal” is a fig leaf hiding an interesting molecular mechanism). These and other slight errors do not, however, detract from the value of this book. The Immune Response sets a high standard of excellence in the immunologic literature.

Robert S. Schwartz, M.D.