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WAO Medical Book Review

Microbial Subversion of Immunity: Current Topics
Editors: Peter J. Lachmann, M.B.A. Oldstone
American College of Physicians American Society of Internal Medicine (2003)

List Price: $230.00 USD
Available from: Caister Academic Press

Reviewer: Gary Hellermann PhD
University of South Florida, Tampa, Florida

This is a collection of nine reviews focusing on the strategies used by bacteria, viruses and parasites to avoid detection or destruction by the host's immune system. It begins with an overview of the subversion process and its effects on complement, natural killer cells and other parts of the mucosal innate immune system. This is followed by general reviews of the subversive techniques of viruses, bacteria and helminths. Lastly, there are three papers dealing more specifically with the humoral immune response and dendritic cell reaction to viruses, and a description of the measles virus serving as a model for the mechanisms of inhibition of human antiviral defenses.

The editors point out that all human pathogens by definition have achieved some degree of success in blocking attacks by the immune system and that this review of their methods 'on the battleground' should yield valuable insights into the workings of the immune system. Considering that humans are under constant threat by these highly adaptive organisms, this book fills an important need by bringing together the current findings on microbial subversion of the immune system. The difficulty of the task is matched by the high level of expertise of the contributing authors.

The book's subject, how some viruses, bacteria and parasites manage to avoid our immune defenses, is one of interest to a wide audience teachers, students, researchers and clinicians. The language and concepts are not dauntingly technical, and the current findings are brought out within a logical framework that makes them easy to understand. The contributors to the work all seem to be highly competent and knowledgeable.

While the book's main emphasis is on the various ways that microbes circumvent the innate immune response, there is an excellent review chapter on the innate immune system itself that highlights the host's defense mechanisms and sets the stage for a better understanding of microbial subversion.

The authors of the reviews have done an excellent job combing the literature for the latest information and condensing and summarizing it into a comprehensive report on the state of knowledge about microbial evasion of the human immune system. Each review has an extensive bibliography providing a complete cross section of the current literature.

Chapter 4 on Viral Immune Evasion is especially well written, comprehensive and illustrated with numerous figures showing the pathways blocked by specific viruses. The chapter on immune system subversion by helminths at 70 pages (35 pages of references!) may well be the definitive work on this subject.

Together with chapters on viral inhibition of the humoral immune response, viral effects on dendritic cells and a detailed discussion of the measles virus, the book affords a virtually complete overview of the current research findings. These recent advances in virology demonstrate the great variety of mechanisms employed by these consummate pathogens, and this improved knowledge should provide us with insights to design better vaccines and antiviral drugs.

The subjects are covered in good detail and with competent explanations, but the text seems to suffer in places from a lack of editing that could have improved the clarity and readability.

After reading this book, one comes away with a new appreciation of the value of a healthy and well prepared immune system. The immunocompromized individual is at far greater risk of infection and may even die as a result of an illness that would otherwise be just an inconvenience. By gathering together and evaluating the latest research in this important area of immunology, the authors and editors deserve much credit for producing a work that should be the reference standard in the field for some time.