IB Biology textbook

Ldg`ZY ZmVbeaZ (

0OF PG UIF IFUFSP[ZHPVT ' NJDF XJUI CSPXO GVS BOE SPVOEFE FBST GSPN UIF DSPTT JO 8PSLFE FYBNQMF 1 XBT
DSPTTFE XJUI B NPVTF XJUI XIJUF GVS BOE SPVOEFE FBST 4PNF PG UIF PĄ TQSJOH IBE QPJOUFE FBST %FEVDF UIF
HFOPUZQF PG UIF TFDPOE NPVTF BOE TUBUF UIF QIFOPUZQF SBUJP PG UIF PĄ TQSJOH

Step 1 6TF UIF TBNF MFUUFST BT JO 8PSLFE FYBNQMF 1 B CSPXO GVS BOE b XIJUF GVS
R SPVOEFE FBST BOE
r QPJOUFE FBST

Step 2 5IF ê STU NPVTF IBT UIF HFOPUZQF BbRr
8F BSF UPME UIF TFDPOE NPVTF JT XIJUF
TP JU NVTU IBWF UIF BMMFMFT rr *U IBT SPVOEFE FBST CVU XF BSF OPU

UPME JG UIJT JT IPNP[ZHPVT PS IFUFSP[ZHPVT
TP UIF BMMFMFT DPVME CF RR PS Rr
3FBEJOH PO
XF ê OE UIBU UIFSF BSF TPNF PĄ TQSJOH XJUI QPJOUFE FBST
TP UIFZ NVTU IBWF UIF HFOPUZQF

rr 5IJT NFBOT UIBU UIF QBSFOU HFOPUZQF NVTU IBWF CFFO IFUFSP[ZHPVT
Rr *G UIF QBSFOU XBT RR
OP
SFDFTTJWF BMMFMF XPVME IBWF CFFO QSFTFOU BOE OPOF PG UIF PĄ TQSJOH XPVME IBWF QPJOUFE FBST
Step 3 )BWJOH XSJUUFO EPXO ZPVS SFBTPOJOH
BT BCPWF
OPX TFU PVU UIF VTVBM HFOFUJD EJBHSBN

eVgZciVa e]ZcdineZh/ Wgdlc! l]^iZ!
7G gdjcYZY ZVgh Wg gdjcYZY ZVgh
eVgZciVa \ZcdineZh/ WWGg
7WGg
\VbZiZh/ 7g WG WG Wg

EjccZii \g^Y [dg ;&/ \VbZiZh [gdb Wgdlc! gdjcYZY"ZVgZY eVgZci

7G 7g WG Wg

\VbZiZh [gdb l]^iZ! 7WGG 7WGg WWGG WWGg
gdjcYZY"ZVgZY eVgZci
WG Wgdlc! Wgdlc! l]^iZ! l]^iZ!

gdjcYZY ZVgh gdjcYZY ZVgh gdjcYZY ZVgh gdjcYZY ZVgh

7WGg 7Wgg WWGg WWgg

Wg Wgdlc! Wgdlc! l]^iZ! l]^iZ!

gdjcYZY ZVgh ed^ciZY ZVgh gdjcYZY ZVgh ed^ciZY ZVgh

Step 4 5IF QIFOPUZQFT QSPEVDFE BSF
CSPXO GVS
SPVOEFE FBST
XIJUF GVS
SPVOEFE FBST
CSPXO GVS
QPJOUFE FBST
XIJUF GVS
QPJOUFE FBST
5IJT QSPEVDFT B SBUJP PG QIFOPUZQFT PG
XIJDI JT BO JNQPSUBOU .FOEFMJBO SBUJP

6jidhdbZh VcY hZm X]gdbdhdbZh

5IF QBJS PG TFY DISPNPTPNFT
9 BOE :
EFUFSNJOF UIF HFOEFS PG BO
JOEJWJEVBM "MM UIF PUIFS DISPNPTPNFT JO B OVDMFVT BSF DBMMFE autosomes
)VNBOT IBWF BVUPTPNFT BOE JO BEEJUJPO POF QBJS PG TFY DISPNPTPNFT
m 9: GPS B NBMF BOE 99 GPS B GFNBMF

&% <:C:I>8H >> ')(

Mendelian ratios 8]gdbdhdbZh VcY \ZcZh

*O NPOPIZCSJE DSPTTFT
UXP SBUJPT 5IF IVNBO HFOPNF DPOUBJOT CFUXFFO BOE HFOFT CVU UIFSF
GPS UIF PĄ TQSJOH PG B HFOFUJD DSPTT BSF POMZ QBJST PG DISPNPTPNFT 5IJT NFBOT UIBU FBDI DISPNPTPNF
BSF QPTTJCMF NVTU DBSSZ WFSZ NBOZ HFOFT $ISPNPTPNF DPOUBJOT PWFS HFOFT
CVU UIF NVDI TNBMMFS DISPNPTPNF DPOUBJOT POMZ BSPVOE HFOFT
5IF ê STU JT JG B IFUFSP[ZHPVT "OZ UXP HFOFT PO UIF TBNF DISPNPTPNF BSF TBJE UP CF linked -JOLFE
JOEJWJEVBM Aa
BOE B IPNP[ZHPVT HFOFT BSF VTVBMMZ QBTTFE PO UPHFUIFS 5IF HFOFT PO BOZ DISPNPTPNF
SFDFTTJWF JOEJWJEVBM aa
BSF DSPTTFE GPSN B linkage group
TP B IVNBO IBT MJOLBHF HSPVQT 5IF EJĄ FSFODF
CFUXFFO VOMJOLFE BOE MJOLFE HFOFT JT TIPXO JO 'JHVSF 10.4
5IF TFDPOE JT XIFO UXP
IFUFSP[ZHPVT JOEJWJEVBMT BSF Jca^c`ZY \ZcZh A^c`ZY \ZcZh
DSPTTFE Aa t Aa
5IFTF BSF DBMMFE
.FOEFMJBO SBUJPT 6V 99
<<
.FOEFMJBO SBUJPT BMTP PDDVS JO
EJIZCSJE DSPTTFT
CVU XJUI NPSF 77
HBNFUFT UIFSF BSF NPSF QPTTJCJMJUJFT
" IFUFSP[ZHPVT JOEJWJEVBM AaBb
<ZcZh 6 VcY 7 VgZ dc hZeVgViZ <ZcZh 9 VcY < VgZ dc i]Z hVbZ
DSPTTFE XJUI B IPNP[ZHPVT X]gdbdhdbZh VcY hd VgZ cdi a^c`ZY# X]gdbdhdbZh VcY hd VgZ a^c`ZY#
SFDFTTJWF aabb
QSPEVDFT B I]Zn l^aa dWZn BZcYZaÉh aVl d[ I]Zn l^aa cdi [daadl BZcYZaÉh aVl d[
SBUJP BOE UIF SBUJP ^cYZeZcYZci VhhdgibZci VcY WZ ^cYZeZcYZci VhhdgibZci# <ZcZh 9
QSPEVDFE CZ DSPTTJOH UXP EPVCMF ^c]Zg^iZY ^cYZeZcYZcian# VcY < [dgb V a^c`V\Z \gdje#
IFUFSP[ZHPVT AaBb
JOEJWJEVBMT
JT 5IF SBUJP JO ;^\jgZ &%#) I]Z Y^[[ZgZcXZ WZilZZc jca^c`ZY VcY a^c`ZY \ZcZh#
8PSLFE FYBNQMF 3 JT BOPUIFS
.FOEFMJBO SBUJP *U JT IFMQGVM UP CF A^c`V\Z VcY \ZcZh
GBNJMJBS XJUI UIFTF SBUJPT
*G BMMFMFT BSF MJOLFE UPHFUIFS PO B DISPNPTPNF
UIFO JU GPMMPXT UIBU UIFZ
Linkage group B MJOLBHF HSPVQ JT XJMM CF JOIFSJUFE UPHFUIFS CFDBVTF EVSJOH NFJPTJT UIFZ XJMM NPWF UPHFUIFS
BMM UIF HFOFT UIBU IBWF UIFJS MPDJ PO UP UIF TBNF QPMF BT UIF DFMM EJWJEFT *O HFOFUJDT QSPCMFNT
EJIZCSJE DSPTTFT
B QBSUJDVMBS DISPNPTPNF JOWPMWJOH MJOLFE HFOFT EP OPU QSPEVDF .FOEFMJBO SBUJPT -JOLFE HFOFT
EP OPU GPMMPX .FOEFM T MBX PG JOEFQFOEFOU BTTPSUNFOU m UIFZ BSF OPU
JOIFSJUFE JOEFQFOEFOUMZ BOE DBO HJWF B WBSJFUZ PG EJĄ FSFOU SBUJPT

Ldg`ZY ZmVbeaZ )

*O UIF GSVJU ë Z
Drosophila
SFE FZF DPMPVS JT EPNJOBOU UP QVSQMF FZFT BOE MPOH XJOHT JT EPNJOBOU UP EVNQZ XJOHT

5IFTF HFOFT BSF MJOLFE PO DISPNPTPNF " ë Z UIBU XBT IPNP[ZHPVT GPS SFE FZFT BOE MPOH XJOHT XBT DSPTTFE

XJUI B ë Z UIBU IBE QVSQMF FZFT BOE EVNQZ XJOHT %FUFSNJOF UIF HFOPUZQF BOE QIFOPUZQF PG UIF ' PĄ TQSJOH CZ
VTJOH B GVMM HFOFUJD EJBHSBN

Step 1 3FE FZF DPMPVS JT EPNJOBOU TP R SFE FZF BOE r QVSQMF FZF -POH XJOHT JT EPNJOBOU TP N MPOH

XJOHT BOE n EVNQZ XJOHT

Step 2 5IF ë Z XJUI UIF EPNJOBOU DIBSBDUFSJTUJDT JT IPNP[ZHPVT BOE UIF PUIFS ë Z TIPXT CPUI SFDFTTJWF

DIBSBDUFSJTUJDT 5IF QBSFOUBM HFOPUZQFT BSF

R NN BOE rr n
R n

'))

Step 3 4FU PVU UIF HFOFUJD EJBHSBN BT CFMPX Writing a linkage genotype

eVgZciVa e]ZcdineZh/ gZY ZnZh! ejgeaZ ZnZh! *O UIF EJIZCSJE DSPTTFT DPOTJEFSFE
adc\ l^c\h Yjben l^c\h TP GBS
HFOPUZQFT IBWF CFFO XSJUUFO
eVgZciVa \ZcdineZh/ JO UIF GPSN AABB 8JUI MJOLFE
G CC g c HFOFT
B EJĄ FSFOU OPUBUJPO IBT UP
\VbZiZh/ G g c CF VTFE CFDBVTF
BMUIPVHI UIFSF BSF
EjccZii \g^Y [dg ;&/ TUJMM GPVS BMMFMFT UP CF DPOTJEFSFE

Vaa GC Vaa gc UIFZ BSF GPVOE PO POMZ POF QBJS
PG DISPNPTPNFT 5IF HFOPUZQF JT
\VbZiZh [gdb gZY" UIFSFGPSF BMXBZT XSJUUFO BT TIPXO
ZnZY! adc\"l^c\ZY JO 'JHVSF 10.5 5IF IPSJ[POUBM MJOFT
TJHOJGZ UIBU UIF UXP HFOFT PDDVS PO
eVgZci UIF TBNF DISPNPTPNF

\VbZiZh [gdb GC
ejgeaZ"ZnZY! Yjben"
G C
l^c\ZY eVgZci g c
gc 9< 9\
6aa i]Z ;& ]VkZ gZY ZnZh VcY adc\ l^c\h# gZY ZnZh!
adc\ l^c\h

Y\ Y<

/PX
UIF ' HFOFSBUJPO JT PCUBJOFE CZ DSPTTJOH UXP PĄ TQSJOH =ZgZ! 9 ^h a^c`ZY id < =ZgZ! 9 ^h a^c`ZY id \
GSPN UIF ' HFOFSBUJPO VcY Y ^h a^c`ZY id \# VcY Y ^h a^c`ZY id <#
I]ZgZ[dgZ 9 VcY < VgZ I]ZgZ[dgZ 9 VcY \ VgZ
^c]Zg^iZY id\Zi]Zg VcY ^c]Zg^iZY id\Zi]Zg VcY
Y VcY \ VgZ ^c]Zg^iZY Y VcY < VgZ ^c]Zg^iZY
id\Zi]Zg# id\Zi]Zg#

eVgZciVa e]ZcdineZh/ gZY ZnZh! gZY ZnZh! ;^\jgZ &%#* I]^h h]dlh i]Z ild edhh^WaZ
adc\ l^c\h adc\ l^c\h a^c`V\Z eViiZgch [dg i]ZhZ [djg VaaZaZh# I]Z
eVgZciVa \ZcdineZh/ Y^[[ZgZcXZ WZilZZc i]Z ild a^c`V\Z eViiZgch
G Cc G C bV`Zh V kZgn W^\ Y^[[ZgZcXZ ^c i]Z gVi^dh d[
\VbZiZh/ g g c i]Z e]ZcdineZh ^c i]Z d[[heg^c\ d[ V Xgdhh#
EjccZii \g^Y [dg ;'/
GC gc GC gc

\VbZiZh [gdb gZY"ZnZY! Drosophila
adc\"l^c\ZY eVgZci
Drosophila JT B HFOVT PG GSVJU ë Z
GC gc UIBU JT DPNNPOMZ VTFE JO HFOFUJD
FYQFSJNFOUT *U CSFFET RVJDLMZ

\VbZiZh [gdb gZY"ZnZY! G C G C QSPEVDJOH MBSHF OVNCFST PG
adc\"l^c\ZY eVgZci PĄ TQSJOH
BOE JUT HFOFUJD NBLF
GC G C g c VQ IBT CFFO XFMM TUVEJFE 7BSJPVT
gZY ZnZh! gZY ZnZh! EJĄ FSFOU BMMFMFT
DPOUSPMMJOH
DIBSBDUFSJTUJDT TVDI BT FZF DPMPVS

adc\ l^c\h adc\ l^c\h XJOH TIBQF BOE CPEZ DPMPVS
BSF
VTFE JO HFOFUJD DSPTTFT 5IFTF
G C g c GFBUVSFT BSF FBTZ UP TFF BOE FOBCMF
HFOFUJDJTUT UP EFEVDF UIF HFOPUZQFT
gc g c g c PG UIF ë JFT GSPN UIFJS BQQFBSBODF

gZY ZnZh! ejgeaZ ZnZh!

adc\ l^c\h Yjben l^c\h

Step 4 *O UIF ' HFOFSBUJPO
UIF SBUJP PG QIFOPUZQFT JT
SFE FZF
MPOH XJOH QVSQMF FZF
EVNQZ XJOH

/PUF UIBU UIJT SBUJP JT XIBU ZPV XPVME FYQFDU JO B NPOPIZCSJE
DSPTT 5IF SFBTPO GPS UIJT JT UIBU UIF UXP HFOFT BSF MJOLFE BOE TP UIFSF
JT POMZ POF QBJS PG DISPNPTPNFT JOWPMWFE
BT JO NPOPIZCSJE DSPTTFT

6 [gj^i Ó n! :heief^_bW c[bWde]Wij[h! d[
Èl^aY ineZÉ l^i] gZY ZnZh VcY adc\ l^c\h#

&% <:C:I>8H >> ')*

eVgZciVa b VcY c B VcY C A^c`V\Z VcY Xgdhh^c\ dkZg
XdbW^cVi^dch B VcY c b VcY C
'JHVSF 10.1 TIPXFE IPX DSPTTJOH PWFS DSFBUFT HFOFUJD WBSJFUZ CZ
gZXdbW^cVcih FYDIBOHJOH QBSUT PG UIF NBUFSOBM BOE QBUFSOBM DISPNPTPNFT 'JHVSF 10.6
gVgZ TIPXT XIBU IBQQFOT UP UXP DMPTFMZ MJOLFE BMMFMFT BGUFS B DSPTT PWFS PDDVST
CFUXFFO UIFN
;^\jgZ &%#+ 6 h^c\aZ X]^VhbV ]Vh [dgbZY
WZilZZc ild X]gdbVi^Yh hd Xgdhh^c\ dkZg -PPL CBDL BU UIF MFGU IBOE FYBNQMF JO 'JHVSF 10.5 QBHF 245
8JUIPVU
d[ i]Z VaaZaZh l^aa iV`Z eaVXZ id [dgb i]Z DSPTTJOH PWFS
UIF QBSFOUBM HBNFUFT GPSNFE XJMM CF DG BOE dg *G B DSPTT
gZXdbW^cVci \VbZiZh# Cd Xgdhh^c\ dkZg ]Vh PWFS EPFT UBLF QMBDF BT TIPXO CZ UIF CMVF DSPTT
CFMPX
UIFO BEEJUJPOBM
iV`Zc eaVXZ l^i] i]Z di]Zg X]gdbVi^Yh VcY recombinant HBNFUFT Dg BOE dG XJMM CF GPSNFE
hd i]ZhZ l^aa gZiV^c i]Z eVgZciVa XdbW^cVi^dc
d[ VaaZaZh# 9<

Recombinant PĄ TQSJOH JO XIJDI Y\
UIF HFOFUJD JOGPSNBUJPO IBT CFFO
SFBSSBOHFE CZ DSPTTJOH PWFS TP BT 'PVS UZQFT PG HBNFUF m DG
dg
Dg BOE dG m BSF QPTTJCMF
CVU UIFSF JT
UP QSPEVDF QIFOPUZQFT UIBU BSF B WFSZ TJHOJê DBOU EJĄ FSFODF JO UIF OVNCFST PG FBDI UZQF UIBU BSF GPSNFE
EJĄ FSFOU GSPN UIPTF PG UIF QBSFOUT 5IF DIBODF PG B DIJBTNB GPSNJOH CFUXFFO UIF UXP MPDJ UIBU BSF DMPTF
UPHFUIFS JT WFSZ TNBMM 4P UIF DIBODF PG GPSNJOH UIF HBNFUFT Dg BOE dG
JT BMTP WFSZ TNBMM 5IF NBKPSJUZ PG HBNFUFT UIFSFGPSF DBSSZ UIF BMMFMFT DG
BOE dg BOE UIFZ XJMM GPSN JO FRVBM OVNCFST *G B DSPTT PWFS EPFT UBLFT
QMBDF
GPS FWFSZ Dg HBNFUF UIFSF XJMM CF B dG HBNFUF 5IF OVNCFST PG
UIFTF UXP HBNFUFT XJMM BMTP CF FRVBM CVU WFSZ TNBMM

/PX MPPL BU UIF SJHIU IBOE FYBNQMF JO 'JHVSF 10.5 8IBU XJMM CF UIF
BMMFMF DPNCJOBUJPOT JO HBNFUFT XIFSF DSPTTJOH PWFS IBT OPU UBLFO QMBDF
8IBU XJMM CF UIF BMMFMF DPNCJOBUJPOT JO HBNFUFT XIFSF DSPTTJOH PWFS IBT
UBLFO QMBDF
BOE XIJDI DPNCJOBUJPOT XJMM CF QSFTFOU JO HSFBUFS OVNCFST

Ldg`ZY ZmVbeaZ *

(SFZ CPEZ BOE SFE FZFT BSF EPNJOBOU UP TUSJQF CPEZ BOE DBSEJOBM FZF JO Drosophila 5IFZ BSF BVUPTPNBM
MJOLFE
HFOFT PO DISPNPTPNF )PNP[ZHPVT HSFZ ë JFT XJUI SFE FZFT XFSF DSPTTFE XJUI TUSJQF ë JFT XJUI DBSEJOBM FZFT
/P DSPTTJOH PWFS PDDVSSFE
5IFO UIF ' ë JFT XFSF DSPTTFE XJUI TUSJQF
DBSEJOBM ë JFT

r *G OP DSPTTJOH PWFS PDDVST CFUXFFO UIF UXP MPDJ
XIBU QIFOPUZQFT XPVME CF FYQFDUFE JO UIF PĄ TQSJOH PG UIJT

TFDPOE DSPTT

r *G DSPTTJOH PWFS EJE PDDVS CFUXFFO UIF MPDJ
XIBU QIFOPUZQFT XPVME CF FYQFDUFE UIJT UJNF

'JSTU DSPTT
XJUI OP DSPTTJOH PWFS

Step 1 (SFZ CPEZ JT EPNJOBOU
TP G HSFZ CPEZ BOE g TUSJQF CPEZ 3FE FZF JT EPNJOBOU TP R SFE FZF BOE

r DBSEJOBM FZF

Step 2 5IF ë Z XJUI UIF EPNJOBOU DIBSBDUFSJTUJDT JT IPNP[ZHPVT BOE UIF PUIFS ë Z TIPXT CPUI SFDFTTJWF

DIBSBDUFSJTUJDT 5IF QBSFOUBM HFOPUZQFT BSF GG RR BOE gg r
r

')+

Step 3 4FU PVU UIF EJBHSBN BT PO UIF SJHIU eVgZciVa e]ZcdineZh/ \gZn WdYn! hig^eZ WdYn!
gZY ZnZh XVgY^cVa ZnZh
eVgZciVa \ZcdineZh/
< GG \ g
\VbZiZh/ < \ g
EjccZii \g^Y [dg ;&/
Vaa <G Vaa \g

\VbZiZh [gdb
\gZn"WdY^ZY!
gZY"ZnZY eVgZci

\VbZiZh [gdb <G
hig^eZ"WdY^ZY!
XVgY^cVa"ZnZY eVgZci < G

\g \ g
\gZn WdYn!

gZY ZnZh

Step 4 " MM UIF ' ë JFT IBWF B HSFZ CPEZ eVgZciVa e]ZcdineZh/ \gZn WdYn! hig^eZ WdYn!
BOE SFE FZFT gZY ZnZh XVgY^cVa ZnZh
eVgZciVa \ZcdineZh/
Second cross, with no crossing over: < Gg \ g
\VbZiZh/ \ \ g
EjccZii \g^Y [dg ;&/
<G \g Vaa \g

\VbZiZh [gdb
\gZn"WdY^ZY!
gZY"ZnZY eVgZci

\VbZiZh [gdb <G \g
hig^eZ"WdY^ZY!
XVgY^cVa"ZnZY eVgZci < G \ g

\g \ g \ g

\gZn WdYn! hig^eZ WdYn!

gZY ZnZh XVgY^cVa ZnZh

Second cross, with eVgZciVa e]ZcdineZh/ \gZn WdYn! hig^eZ WdYn!
crossing over:
eVgZciVa \ZcdineZh/ gZY ZnZh XVgY^cVa ZnZh

\VbZiZh/ < Gg \ g
<G \ \ g
EjccZii \g^Y [dg ;&/
\g <g \G Vaa \g


\VbZiZh [gdb \gZn"WdY^ZY! gZY"ZnZY eVgZci

\VbZiZh [gdb <G \g <g \G
hig^eZ"WdY^ZY
XVgY^cVa"ZnZY eVgZci < G \ g < g \ G

\g \ g \ g \ g \ g
\gZn WdYn! hig^eZ WdYn! \gZn WdYn! hig^eZ WdYn!

gZY ZnZh XVgY^cVa ZnZh XVgY^cVa ZnZh gZY ZnZh

\VbZiZh [dgbZY Vh V gZhjai d[ Xgdhh^c\ dkZg

&% <:C:I>8H >> '),

Step 4 5IF GPVS ' QIFOPUZQFT BSF

r HSFZ CPEZ BOE SFE FZFT
r TUSJQF CPEZ BOE DBSEJOBM FZFT
r HSFZ CPEZ BOE DBSEJOBM FZFT
r TUSJQF CPEZ BOE SFE FZFT

5IF AHSFZ
DBSEJOBM BOE ATUSJQF
SFE TIPXO JO SFE UZQF
ë JFT BSF recombinants BT UIFZ IBWF B QIFOPUZQF UIBU
JT EJĄ FSFOU GSPN UIF QBSFOUBM QIFOPUZQFT 5IFTF SFDPNCJOBOU QIFOPUZQFT XJMM PDDVS JO BQQSPYJNBUFMZ FRVBM
OVNCFST 5IF QBSFOUBM QIFOPUZQFT TIPXO JO CMBDL UZQF
XJMM BMTP CF JO BQQSPYJNBUFMZ FRVBM OVNCFST BNPOH UIF
PĄ TQSJOH
CVU UIF SFDPNCJOBOU QIFOPUZQFT XJMM CF WFSZ GFX JO OVNCFS DPNQBSFE UP UIF QBSFOUBM QIFOPUZQFT

) >cY^k^YjVah [gdb l]^X] \ZcZgVi^dc VgZ XgdhhZY ^c dgYZg id egdYjXZ Vc ;'
\ZcZgVi^dc4

&%#( Edan\Zc^X ^c]Zg^iVcXZ

6hhZhhbZci hiViZbZcih

r %Fê OF AQPMZHFOJD JOIFSJUBODF
r &YQMBJO UIBU QPMZHFOJD JOIFSJUBODF DBO DPOUSJCVUF UP DPOUJOVPVT WBSJBUJPO
VTJOH UXP FYBNQMFT
POF PG XIJDI NVTU CF

IVNBO TLJO DPMPVS

Polygenic inheritance UIF Edan\ZcZh
JOIFSJUBODF PG B DIBSBDUFSJTUJD UIBU
JT DPOUSPMMFE CZ UXP PS NPSF HFOFT *O UIF HFOFUJD FYBNQMFT DPOTJEFSFE TP GBS
B QBSUJDVMBS DIBSBDUFSJTUJD JT
QPMZHFOJD JOIFSJUBODF BDDPVOUT DPOUSPMMFE CZ POF HFOF
XIJDI DBO IBWF EJĄ FSFOU BMMFMFT BU B TQFDJê D QBJS
GPS UIF DPOUJOVPVT WBSJBUJPO UIBU PG MPDJ 5IFSF JT B DMFBS EJĄ FSFODF CFUXFFO PSHBOJTNT XJUI EJĄ FSFOU BMMFMFT
PDDVST JO DIBSBDUFSJTUJDT TVDI BT "O PSHBOJTN FJUIFS IBT UIF DIBSBDUFSJTUJD PS JU EPFT OPU m UIFSF BSF OP
IVNBO IFJHIU
CPEZ NBTT BOE TLJO JOUFSNFEJBUF GPSNT 5IJT JT DBMMFE discontinuous variation.
DPMPVS
7FSZ GFX DIBSBDUFSJTUJDT BSF DPOUSPMMFE CZ TJOHMF HFOFT .PTU BSF
$POUJOVPVT WBSJBUJPO GPS FYBNQMF
DPOUSPMMFE CZ HSPVQT PG HFOFT
XIJDI UPHFUIFS BSF LOPXO BT polygenes
IVNBO IFJHIU
DBO CF TIPXO PO 5IF HFOFT UIBU GPSN QPMZHFOFT BSF PGUFO VOMJOLFE m UIBU JT
UIFZ BSF
B HSBQI
XIJDI QSPEVDFT BO FWFO MPDBUFE PO EJĄ FSFOU DISPNPTPNFT 8IFO UXP PS NPSF HFOFT
FBDI XJUI
EJTUSJCVUJPO PG GSFRVFODJFT PG UIF NVMUJQMF BMMFMFT
BSF SFTQPOTJCMF GPS B DIBSBDUFSJTUJD UIF OVNCFS PG QPTTJCMF
DIBSBDUFSJTUJD 5IF CFMM TIBQFE DVSWFT QIFOPUZQFT JT HSFBUMZ JODSFBTFE &BDI HFOF TFQBSBUFMZ NBZ IBWF MJUUMF
JO 'JHVSF 1.1 QBHF 2
SFQSFTFOU JNQBDU CVU UIFJS DPNCJOFE FĄ FDU QSPEVDFT B XIPMF WBSJFUZ PG QIFOPUZQFT
DPOUJOVPVT WBSJBUPO %JTDPOUJOVPVT 6OMJOLFE QPMZHFOFT SFTVMU JO B SBOHF PG EFHSFFT PG UIF DIBSBDUFSJTUJD GSPN
WBSJBUJPO
TVDI BT UIBU PCTFSWFE JO POF FYUSFNF UP BOPUIFS m UIBU JT
continuous variation
IVNBO CMPPE HSPVQT
QSPEVDFT B CBS
HSBQI
XJUI FBDI EJTUJODU DBUFHPSZ =jbVc h`^c Xdadjg
SFQSFTFOUFE TFQBSBUFMZ
)VNBO TLJO DPMPVS EFQFOET PO UIF BNPVOU PG UIF QJHNFOU NFMBOJO
')- UIBU JT QSPEVDFE JO UIF TLJO .FMBOJO TZOUIFTJT JT DPOUSPMMFE CZ HFOFT
5IF EFHSFF PG QJHNFOUBUJPO DBO SBOHF GSPN UIF WFSZ EBSL TLJO PG QFPQMF
PSJHJOBUJOH GSPN SFHJPOT TVDI BT /BNJCJB JO TPVUIFSO "GSJDB
UISPVHI UP
UIF WFSZ QBMF TLJO PG OBUJWF 4DBOEJOBWJBO QFPQMF

.FMBOJO QSPUFDUT UIF TLJO GSPN UIF IBSNGVM 67 SBZT GSPN UIF 4VO *O
QBSUT PG UIF XPSME DMPTF UP UIF FRVBUPS
UIF 4VO T SBZT BSF WFSZ JOUFOTF TP
QFPQMF OFFE QSPUFDUJPO GSPN TVOCVSO
XIJDI DBO MFBE UP B UZQF PG TLJO
DBODFS DBMMFE NFMBOPNB %BSL TLJOOFE QFPQMF IBWF B IJHI DPODFOUSBUJPO
PG NFMBOJO
XIJDI QSPUFDUT UIFN
XIJMF GBJS TLJOOFE QFPQMF IBWF NVDI
MFTT "MUIPVHI TLJO DPMPVS JT HFOFUJDBMMZ EFUFSNJOFE
FOWJSPONFOUBM
GBDUPST BMTP JOë VFODF JU 'BJS TLJOOFE QFPQMF XIP BSF FYQPTFE UP TVOMJHIU
QSPEVDF FYUSB NFMBOJO BOE EFWFMPQ B QSPUFDUJWF TVOUBO 5IFZ BSF BMTP BCMF
UP QSPEVDF NPSF WJUBNJO % JO UIFJS TLJO TFF 0QUJPO A


4FWFSBM HFOFT BSF JOWPMWFE JO EFUFSNJOJOH TLJO DPMPVS BOE UIFZ QSPEVDF
UIF BMNPTU DPOUJOVPVT WBSJBUJPO UIBU DBO CF TFFO JO UIF HMPCBM IVNBO
QPQVMBUJPO *O UIF FYBNQMF
CFMPX POMZ UISFF HFOFT BSF TIPXO &BDI HFOF
IBT UXP BMMFMFT 0OF BMMFMF
M
DPOUSJCVUFT UP NFMBOJO QSPEVDUJPO BOE UIF
PUIFS
m
EPFT OPU 5IFTF UISFF HFOFT
FBDI XJUI UXP BMMFMFT
HJWF SJTF UP
TFWFO QPTTJCMF TLJO UPOFT m OVNCFSFE UP CFMPX 5IF OVNCFS SFGFST UP
UIF OVNCFS PG M BMMFMFT
XIJDI EFUFSNJOF UIF MFWFM PG TLJO QJHNFOUBUJPO
" QFSTPO XJUI UIF HFOPUZQF MMMMMM XJMM IBWF WFSZ EBSL TLJO



eVgZciVa e]ZcdineZh/ a^\]i Wgdlc h`^c a^\]i Wgdlc h`^c
( (
eVgZciVa \ZcdineZh/
\VbZiZh/ B&b&B'b'B(b( B&b&B'b'B(b(

EjccZii \g^Y [dg ;&/ B&B'B( B&B'b( b&b'B( B&b'B( B&B'B( B&B'b( b&b'B( B&b'B(
b&B'b( B&b'b( b&B'B( b&b'b( b&B'b( B&b'b( b&B'B( b&b'b(

\VbZiZh [gdb a^\]i"Wgdlc"h`^ccZY eVgZci

B&B'B( B&B'b( b&b'B( B&b'B( b&B'b( B&b'b( b&B'B( b&b'b(

B&B'B( + * ) * ) ) * (

B&B'b( * ) ( ) ( ( ) '

\VbZiZh [gdb a^\]i"Wgdlc"h`^ccZY eVgZci b&b'B( ) ( ' ( ' ' ( &

B&b'B( * ) ( ) ( ( ) '

b&B'b( ) ( ' ( ' ' ( &

B&b'b( ) ( ' ( ' ' ( &

b&B'B( * ) ( ) ( ( ) '

b&b'b( ( ' & ' & & ' %

&% <:C:I>8H >> ').

'% XIJMF B QFSTPO XJUI mmmmmm XJMM IBWF WFSZ QBMF TLJO
5IF
1VOOFUU HSJE TIPXT UIF QPTTJCMF DPNCJOBUJPOT PG TLJO DPMPVS JO DIJMESFO
&* GSPN UXP QBSFOUT
CPUI IFUFSP[ZHPVT GPS BMM UISFF HFOFT 5IF QBSFOUT
QIFOPUZQF JT MJHIU CSPXO TLJO

;gZfjZcXn &%
"MUIPVHI JO UIJT TJNQMJê FE FYBNQMF UIFSF BSF POMZ TFWFO DBUFHPSJFT
* PG QJHNFOUBUJPO
OFWFSUIFMFTT ZPV DBO TFF UIBU JG UIF GSFRVFODJFT PG UIF
TLJO DPMPVS WBSJFUJFT JO UIF 1VOOFUU HSJE BSF QMPUUFE PO B IJTUPHSBN
BT
%% &'( )* + JO 'JHVSF 10.7
JU QSPEVDFT B OPSNBM EJTUSJCVUJPO *O UIF DBTF PG IVNBO
9Z\gZZ d[ e^\bZciVi^dc TLJO DPMPVS
JU JT LOPXO UIBU NPSF UIBO UISFF HFOFT BSF JOWPMWFE BOE UIF
OVNCFS PG DBUFHPSJFT FYDFFET TFWFO 5IF SFTVMU JT B XJEFS EJTUSJCVUJPO
;^\jgZ &%#, =^hid\gVb d[ i]Z [gZfjZcX^Zh DVSWF BOE NPSF ADPOUJOVPVT WBSJBUJPO
d[ h`^c e^\bZciVi^dc [gdb i]Z EjccZii \g^Y
VWdkZ# I]^h h]dlh Xdci^cjdjh kVg^Vi^dc# 7ZV` YZei] ^c Ò cX]Zh

'JODIFT BSF CJSET UIBU FBU TFFET BOE IBWF B TUSPOH CFBL UP CSFBL PQFO UIF
TFFET 5ISFF VOMJOLFE HFOFT BSF JOWPMWFE JO DPOUSPMMJOH UIF EFQUI PG UIF
CFBL
FBDI XJUI UXP BMMFMFT 5IF D BMMFMF DPOUSJCVUFT UP CFBL EFQUI BOE
UIF d BMMFMF EPFT OPU
TP UIF QBUUFSO PG JOIFSJUBODF JT FYBDUMZ UIF TBNF BT JO
UIF FYBNQMF TIPXO BCPWF GPS IVNBO TLJO QJHNFOUBUJPO

.BOZ PUIFS FYBNQMFT PG polygenic inheritance BSF LOPXO *O QMBOUT

UISFF HFOFT JOUFSBDU UP DPOUSPM UIF DPMPVS PG TFFET PG XIFBU )VNBO
IFJHIU BOE CPEZ NBTT BSF BMTP DPOUSPMMFE JO UIJT XBZ
BT XFMM BT TPNF
DPOEJUJPOT TVDI BT EJBCFUFT BOE BVUJTN

FjZhi^dch id Xdch^YZg HX^Zci^Ò X VYkVcXZh VcY Zi]^Xh

& 8IZ EP TPNF PG UIFTF BMUFSBUJPOT *U NBZ POF EBZ CF QPTTJCMF UP JTPMBUF BOE BMUFS DFSUBJO
TFFN NPSF BDDFQUBCMF UIBO HFOFT JO B GFUVT 5IJT XJMM SBJTF TFSJPVT FUIJDBM RVFTUJPOT $POTJEFS UIF
PUIFST IZQPUIFUJDBM TJUVBUJPOT UIBU BSF MJTUFE IFSF 8PVME ZPV IBWF ZPVS DIJME T
HFOFUJD NBLFVQ BMUFSFE JO UIF GPMMPXJOH DJSDVNTUBODFT
' *G UIF DIJME XBT HFOFUJDBMMZ BMUFSFE r 5P SFNPWF UIF UFOEFODZ UP EFWFMPQ CSFBTU DBODFS
UP NBLF UIFN NPSF DPNQFUJUJWF r 5P SFNPWF B UFOEFODZ GPS TIPSU TJHIUFEOFTT
BOE UIJT MFE UP UIFN CFJOH r 5P NBLF UIFN UBMMFS PS TIPSUFS
BHHSFTTJWF PS WJPMFOU
XPVME UIF r 5P NBLF UIFN CFUUFS MPPLJOH
DIJME CF SFTQPOTJCMF 0S XPVME r 5P NBLF UIFN NPSF BUIMFUJD
UIF QBSFOU CF SFTQPOTJCMF r 5P NBLF UIFN NPSF DPNQFUJUJWF
r 5P HJWF UIFN B CFUUFS TFOTF PG IVNPVS
( $BO BO JOEJWJEVBM FWFS CF IFME r 5P NBLF UIFN NPSF JOUFMMJHFOU
SFTQPOTJCMF GPS UIFJS BDUJPOT JG r 5P NBLF UIFN NPSF NVTJDBM
UIFZ BSF HFOFUJDBMMZ EFUFSNJOFE r 5P DIBOHF UIFJS IBJS DPMPVS
r 5P BMUFS UIFJS TFYVBM PSJFOUBUJPO
r 5P DIBOHF UIFJS TLJO DPMPVS

'*%

:cY"d["X]VeiZg fjZhi^dch

1 5IF HFOPUZQFT AABb BOE AaBb XFSF DSPTTFE 8IBU XPVME CF UIF SBUJP PG HFOPUZQFT JO UIF PĄ TQSJOH


" AABB AaBB AAbb Aabb AABb AaBb
# AABB AaBb Aabb aaBb
$ AABB aaBB AAbb Aabb
% AABb AaBb AABB AaBB AAbb Aabb

2 " NBJ[F QMBOU IPNP[ZHPVT GPS UIF HFOFT GPS HSFFO MFBWFT BOE SPVOE TUFN XBT DSPTTFE XJUI B QMBOU XJUI ZFMMPX

MFBWFT BOE TRVBSF TUFN "MM UIF PĄ TQSJOH IBE HSFFO MFBWFT BOE SPVOE TUFN 5IF ' QMBOUT XFSF DSPTTFE BNPOH
UIFNTFMWFT BOE UIF ' HFOFSBUJPO JOEJWJEVBMT XFSF PG GPVS EJĄ FSFOU QIFOPUZQFT

)PX NBOZ PG UIF ' XPVME CF FYQFDUFE UP IBWF ZFMMPX MFBWFT BOE SPVOE TUFN

"

#
$
%

3 " GSVJU ë Z PG HFOPUZQF GgTt XBT UFTU DSPTTFE 5IF PĄ TQSJOH HFOPUZQF SBUJP XBT 5IF SFBTPO GPS UIJT XBT


" 5IF HFOFT BTTPSUFE JOEFQFOEFOUMZ
# 5IF HFOFT XFSF MJOLFE BOE DSPTTJOH PWFS PDDVSSFE
$ 5IF HFOFT XFSF MJOLFE BOE OP DSPTTJOH PWFS PDDVSSFE
% /PO EJTKVODUJPO IBE UBLFO QMBDF

4 " GSVJU ë Z PG UIF HFOPUZQF RrBb XBT DSPTTFE XJUI BOPUIFS PG UIF TBNF HFOPUZQF 5IF HFOFT BSF MJOLFE

5IF PĄ TQSJOH HFOPUZQF SBUJP DPVME CF

"
#
$
%

5 0VUMJOF IPX NFJPUJD EJWJTJPO SFTVMUT JO BMNPTU JOê OJUF HFOFUJD WBSJBUJPO JO UIF HBNFUFT QSPEVDFE


6 6TJOH B TQFDJê D FYBNQMF
FYQMBJO B DSPTT CFUXFFO UXP BVUPTPNBM MJOLFE HFOFT
JODMVEJOH UIF XBZ JO

XIJDI SFDPNCJOBOUT BSF QSPEVDFE :PV BSF BEWJTFE UP VTF B UFTU DSPTT

&% <:C:I>8H >> '*&

7 *O UIF GSVJU ë Z
Drosophila melanogaster
UIF BMMFMF GPS EBSL CPEZ D
JT EPNJOBOU PWFS UIF BMMFMF GPS FCPOZ
CPEZ d
5IF BMMFMF GPS TUSBJHIU CSJTUMFT T
JT EPNJOBOU PWFS UIF BMMFMF GPS EJDIBFUF CSJTUMFT t
1VSF CSFFEJOH
ë JFT XJUI EBSL CPEZ BOE TUSBJHIU CSJTUMFT XFSF DSPTTFE XJUI QVSF CSFFEJOH ë JFT XJUI FCPOZ CPEZ BOE
EJDIBFUF CSJTUMFT

a 4UBUF UIF HFOPUZQF BOE UIF QIFOPUZQF PG UIF ' JOEJWJEVBMT QSPEVDFE BT B SFTVMU PG UIJT DSPTT



b 5IF ' ë JFT XFSF DSPTTFE XJUI ë JFT UIBU IBE UIF HFOPUZQF ddtt %FUFSNJOF UIF FYQFDUFE SBUJP PG


QIFOPUZQFT JO UIF ' HFOFSBUJPO
BTTVNJOH UIBU UIFSF JT JOEFQFOEFOU BTTPSUNFOU
5IF PCTFSWFE QFSDFOUBHFT PG QIFOPUZQFT JO UIF ' HFOFSBUJPO BSF TIPXO CFMPX

EBSL CPEZ
TUSBJHIU CSJTUMFT

FCPOZ CPEZ
TUSBJHIU CSJTUMFT

EBSL CPEZ
EJDIBFUF CSJTUMFT

FCPOZ CPEZ
EJDIBFUF CSJTUMFT

5IF PCTFSWFE SFTVMUT EJĄ FS TJHOJê DBOUMZ GSPN UIF SFTVMUT FYQFDUFE PO UIF CBTJT PG JOEFQFOEFOU BTTPSUNFOU

c &YQMBJO UIF SFBTPOT GPS UIF PCTFSWFE SFTVMUT PG UIF DSPTT EJĄ FSJOH TJHOJê DBOUMZ GSPN UIF FYQFDUFE SFTVMUT

'*'

=jbVc ]ZVai] VcY e]nh^dad\n >> &&

>cigdYjXi^dc

5IJT DIBQUFS FYUFOET JEFBT JOUSPEVDFE JO $IBQUFS 6
BOE EFBMT JO NPSF EFUBJM XJUI UIF QSPDFTTFT PG
SFQSPEVDUJPO
NPWFNFOU BOE EFGFODF PG UIF CPEZ BHBJOTU JOGFDUJPO

&&#& 9Z[ZcXZ V\V^chi ^c[ZXi^djh Y^hZVhZ

6hhZhhbZci hiViZbZcih

r %FTDSJCF UIF QSPDFTT PG CMPPE DMPUUJOH
r 0VUMJOF UIF QSJODJQMF PG DIBMMFOHF BOE SFTQPOTF
DMPOBM TFMFDUJPO BOE NFNPSZ DFMMT BT UIF CBTJT PG JNNVOJUZ
r %Fê OF ABDUJWF BOE AQBTTJWF JNNVOJUZ
r &YQMBJO BOUJCPEZ QSPEVDUJPO
r %FTDSJCF UIF QSPEVDUJPO PG NPOPDMPOBM BOUJCPEJFT BOE UIFJS VTF JO EJBHOPTJT BOE JO USFBUNFOU
r &YQMBJO UIF QSJODJQMF PG WBDDJOBUJPO
r %JTDVTT UIF CFOFê UT BOE EBOHFST PG WBDDJOBUJPO

7addY Xadii^c\

"SUFSJFT
WFJOT BOE DBQJMMBSJFT GPSN B DMPTFE TZTUFN PG CMPPE WFTTFMT *G
TLJO BOE CMPPE WFTTFMT BSF CSPLFO XIFO UJTTVF JT EBNBHFE
QBUIPHFOT
IBWF B SPVUF JOUP UIF CMPPETUSFBN 5P QSFWFOU CMPPE MPTT BOE UIF FOUSZ PG
QBUIPHFOT
BOZ CMPPE UIBU FTDBQFT GSPN B EBNBHFE WFTTFM RVJDLMZ GPSNT B
clot
XIJDI QMVHT UIF HBQ

Platelets, erythrocytes SFE CMPPE DFMMT
BOE leucocytes B UZQF
PG XIJUF CMPPE DFMM
BSF BMM JNQPSUBOU JO UIF DMPUUJOH QSPDFTT 1MBUFMFUT
BSF TNBMM DFMM GSBHNFOUT
XIJDI GPSN JO UIF CPOF NBSSPX BOE DJSDVMBUF
JO UIF CMPPETUSFBN "MTP JNQPSUBOU BSF UXP QMBTNB QSPUFJOT
XIJDI BSF
QSFTFOU JO UIF CMPPE JO UIFJS JOBDUJWF GPSNT VOUJM UIFZ BSF BDUJWBUFE

Xadii^c\ [VXidgh
gZaZVhZY [gdb eaViZaZih VcY

YVbV\ZY i^hhjZ XZaah

egdi]gdbW^c i]gdbW^c
^cVXi^kZ Ä X^gXjaVi^c\ VXi^kZ

^c eaVhbV

[^Wg^cd\Zc [^Wg^c
hdajWaZ Ä Y^hhdakZY ^chdajWaZ Ä [dgbh
bZh] d[ i]gZVYh
^c eaVhbV

;^\jgZ &&#& 9^V\gVb h]dl^c\ i]Z hZfjZcXZ d[ gZVXi^dch ^c i]Z WaddY"Xadii^c\
XVhXVYZ#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '*(

;^\jgZ &&#' ;VahZ"Xdadjg I:B h]dl^c\ gZY XIFO OFFEFE 'JHVSF 11.1
5IFTF UXP JOBDUJWF QSPUFJOT BSF
WaddY XZaah VcY i]gZVYh d[ Ò Wg^c [dgb^c\ V prothrombin BOE fibrinogen
Xadi (+%% #
*G B TNBMM CMPPE WFTTFM JT EBNBHFE
JOKVSFE DFMMT PS QMBUFMFUT SFMFBTF
clotting factors
XIJDI DBVTF QMBUFMFUT UP TUJDL UP UIF BSFB 5IFTF GBDUPST
BDUJWBUF QSPUISPNCJO
XIJDI JT DPOWFSUFE UP JUT BDUJWF GPSN
thrombin
5ISPNCJO
JO UVSO BDUJWBUFT UIF TPMVCMF QSPUFJO ê CSJOPHFO
DPOWFSUJOH JU
UP BDUJWF fibrin
XIJDI JT JOTPMVCMF BOE GPSNT MPOH UISFBET 5IJT DBTDBEF PG
SFBDUJPOT FOTVSFT B TQFFEZ SFTQPOTF UP BOZ EBNBHF 'JCSJO GPSNT B NFTI PG
ê CSFT UIBU DPWFST UIF EBNBHFE BSFB BOE USBQT QBTTJOH CMPPE DFMMT
GPSNJOH B
TPGU DMPU 'JHVSF 11.2
*G B DMPU JT FYQPTFE UP BJS
JU ESJFT BOE GPSNT B TDBC

XIJDI XJMM QSPUFDU UIF BSFB VOUJM UIF UJTTVF CFOFBUI IBT CFFO SFQBJSFE

>bbjc^in/ X]VaaZc\Z VcY gZhedchZ

3FTJTUBODF UP BO JOGFDUJPO JT LOPXO BT immunity *NNVOJUZ JT BDRVJSFE
GSPN DIJMEIPPE POXBSET BT UIF CPEZ JT FYQPTFE UP
BOE MFBSOT UP SFDPHOJTF

NBOZ EJĄ FSFOU UZQFT PG QBUIPHFO UIBU IBWF UIF QPUFOUJBM UP DBVTF EJTFBTF
8F CFDPNF BCMF UP EJTUJOHVJTI CFUXFFO DFMMT UIBU BSF PVS PXO ATFMG BOE
UIPTF UIBU BSF AOPO TFMG BOE BSF UIFSFGPSF MJLFMZ UP CF QBUIPHFOT PS DBVTF
IBSN $FMMT BSF SFDPHOJTFE CZ UIF QSPUFJOT PO UIFJS QMBTNB NFNCSBOFT

$FSUBJO MFVDPDZUFT BSF BCMF UP SFDPHOJTF AOPO TFMG QSPUFJOT
PS antigens
"OUJHFOT NBZ CF PO UIF TVSGBDF PG B QBUIPHFO
PS NBZ IBWF CFFO TFDSFUFE
CZ B QBUIPHFO JO B UPYJO "OUJHFOT BSF BMTP MJLFMZ UP CF QSFTFOU PO UIF DFMM
TVSGBDFT PG USBOTQMBOUFE UJTTVFT PS PSHBOT

*G B QBUIPHFO FOUFST UIF CPEZ
UIF JNNVOF TZTUFN JT TUJNVMBUFE UP
SFTQPOE "T JU JT ADIBMMFOHFE CZ UIF QBUIPHFO
JU ASFTQPOET CZ TFUUJOH JO
NPUJPO QSPDFTTFT UIBU XJMM EFTUSPZ JU 5IF ê STU MJOF PG EFGFODF JT QIBHPDZUJD
MFVDPDZUFT 5IFTF BSF OPO TQFDJê D BOE XJMM DPOTVNF CBDUFSJB
WJSVTFT
BOE PUIFS QBUIPHFOT
BT XFMM BT EFBE DFMMT BOE DFMM GSBHNFOUT UIBU NJHIU
BDDVNVMBUF
GPS FYBNQMF
JO B XPVOE 5IF TFDPOE MJOF PG EFGFODF JT B
TQFDJê D SFTQPOTF UP BOUJHFOT
XJUI antibodies 5IFTF QSPUFJOT BSF UIF LFZ
UP UIF CPEZ T JNNVOF SFTQPOTF
BOE QSPEVDJOH UIFN FĄ FDUJWFMZ SFRVJSFT
JOUFSBDUJPO CFUXFFO UISFF UZQFT PG DFMM NBDSPQIBHFT BOE UXP UZQFT PG
MZNQIPDZUF
DBMMFE # DFMMT BOE IFMQFS 5 DFMMT

5IF immune response UBLFT TFWFSBM EBZT UP CFDPNF GVMMZ BDUJWF BOE
JO UIF NFBOUJNF XF CFDPNF JMM 4PNFUJNFT TZNQUPNT BSF NJME
TVDI
BT XJUI UIF DPNNPO DPME
CVU TPNFUJNFT UIFZ BSF TFWFSF
MFBEJOH UP
QFSNBOFOU EJTBCJMJUZ PS FWFO EFBUI

8adcVa hZaZXi^dc

B-cells BSF BOUJCPEZ QSPEVDJOH MZNQIPDZUFT
CVU FBDI # DFMM DBO POMZ
QSPEVDF POF QBSUJDVMBS UZQF PG BOUJCPEZ 4JODF UIF BOUJCPEZmBOUJHFO
SFTQPOTF JT IJHIMZ TQFDJê D
UIFSF NVTU CF B HSFBU NBOZ UZQFT PG # DFMM JO
PSEFS UP CF BCMF UP SFTQPOE UP BMM UIF QPTTJCMF UZQFT PG BOUJHFO "U BOZ UJNF

UIFSF DBO POMZ CF B WFSZ GFX PG FBDI UZQF PG # DFMM JO UIF CMPPETUSFBN
CFDBVTF NPTU PG UIF CMPPE WPMVNF JT UBLFO VQ XJUI SFE DFMMT -PPL CBDL
BU UIF NJDSPHSBQI PG B TUBJOFE CMPPE TNFBS JO 'JHVSF 6.8 QBHF 139
m UIJT
TIPXT DMFBSMZ IPX SFE DFMMT IFBWJMZ PVUOVNCFS XIJUF DFMMT JO UIF CMPPE

'*)

8IFO B QBUIPHFO FOUFST UIF CMPPETUSFBN
JUT TVSGBDF BOUJHFO NPMFDVMFT
BSF FYQPTFE UP UIF BOUJCPEJFT BUUBDIFE UP EJĄ FSFOU # DFMMT JO UIF CMPPE
*G UIFSF JT B NBUDI CFUXFFO BO BOUJHFO BOE BO BOUJCPEZ
UIF # DFMM XJUI
UIF NBUDIJOH BOUJCPEZ CFDPNFT ATFMFDUFE XIJMF BMM UIF PUIFS # DFMMT BSF
SFKFDUFE 5IF TFMFDUFE # DFMM JT TUJNVMBUFE UP EJWJEF BOE QSPEVDFT B clone
PG BOUJCPEZ TFDSFUJOH DFMMT
JO B QSPDFTT LOPXO BT clonal selection

*U JT MJLFMZ UIBU BOZ QBUIPHFO XJMM IBWF NBOZ EJĄ FSFOU BOUJHFOJD
NPMFDVMFT PO JUT TVSGBDF TP TFWFSBM EJĄ FSFOU UZQFT PG # DFMM XJMM QSPCBCMZ
CF TFMFDUFE &BDI PG UIFTF XJMM SFTVMU JO DMPOF PG BOUJCPEZ TFDSFUJOH
# DFMMT 5IJT JT UIFSFGPSF DBMMFE B polyclonal response BOE JU XJMM SFTVMU JO
B NPSF Fą DJFOU EFTUSVDUJPO PG UIF QBUIPHFO

6ci^WdYn egdYjXi^dc

*O SFBMJUZ
UIF SFTQPOTF UP QBUIPHFOT JT NPSF DPNQMFY UIBO TJNQMF DMPOBM
TFMFDUJPO BOE JU JOWPMWFT UXP UZQFT PG MZNQIPDZUF # DFMMT BOE 5 DFMMT
1 8IFO B QBUIPHFO FOUFST UIF CMPPETUSFBN JU JT DPOTVNFE CZ B

NBDSPQIBHF
QBSUMZ EJHFTUFE BOE BOUJHFO QSPUFJOT GSPN JU BSF QMBDFE
PO UIF PVUFS TVSGBDF PG UIF NBDSPQIBHF 5IJT JT DBMMFE antigen
presentation CFDBVTF UIF QSPUFJOT BSF CFJOH AQSFTFOUFE UP PUIFS DFMMT
2 Helper T-cells XJUI NBUDIJOH SFDFQUPST CJOE UP UIF NBDSPQIBHFT BOE
BSF BDUJWBUFE
3 "DUJWBUFE IFMQFS 5 DFMMT UIFO TUBSU EJWJEJOH JOUP UXP DMPOFT PG DFMMT 0OF
DMPOF JT PG BDUJWF IFMQFS 5 DFMMT
XIJDI BSF SFRVJSFE GPS UIF OFYU TUFQ
JO UIF QSPDFTT
BOE UIF PUIFS DMPOF JT PG memory cells
XIJDI XJMM CF
VTFE JG UIF TBNF QBUIPHFO FWFS JOWBEFT UIF CPEZ BHBJO
4 B-cells XJUI UIF NBUDIJOH BOUJCPEZ BMTP UBLF JO BOE QSPDFTT BOUJHFO
QSPUFJOT GSPN UIF QBUIPHFO BOE QMBDF UIFN PO UIFJS PVUFS TVSGBDF
5 "DUJWF IFMQFS 5 DFMMT CJOE UP UIFTF # DFMMT BOE
JO UVSO
BDUJWBUF UIFN
6 +VTU MJLF UIF 5 DFMMT
UIF # DFMMT OPX EJWJEF JOUP UXP DMPOFT PG DFMMT
0OF JT NBEF VQ PG BDUJWF # DFMMT
PS plasma cells
XIJDI TFDSFUF
IVHF RVBOUJUJFT PG BOUJCPEJFT JOUP UIF CMPPETUSFBN "OUJCPEJFT EFTUSPZ
QBUIPHFOT BOE BMTP IFMQ UIF NBDSPQIBHFT UP EFUFDU BOE DPOTVNF NPSF
QBUIPHFOT 5IF TFDPOE DMPOF JT NBEF VQ PG memory cells
XIJDI
BMMPX UIF CPEZ UP NBLF B MBSHF BOE SBQJE SFTQPOTF TIPVME UIF TBNF
QBUIPHFO JOWBEF BHBJO
'JHVSF 11.3 PWFSMFBG
TVNNBSJTFT UIF QSPDFTT PG BOUJCPEZ QSPEVDUJPO

6Xi^kZ VcY eVhh^kZ ^bbjc^in

"T XF IBWF TFFO
JNNVOJUZ EFWFMPQT BT B SFTVMU PG FYQPTVSF UP B QBUIPHFO
5IJT JO UVSO DBVTFT UIF QSPEVDUJPO PG BOUJCPEJFT
CVU EFWFMPQJOH
JNNVOJUZ UP B EJTFBTF DBO PDDVS FJUIFS BDUJWFMZ PS QBTTJWFMZ

r Active immunity EFWFMPQT XIFO BO JOEJWJEVBM JT FYQPTFE UP BO

BOUJHFO BOE QSPEVDFT BOUJCPEJFT BGUFS UIFJS JNNVOF TZTUFN IBT CFFO
TUJNVMBUFE 5IF BOUJHFOT NBZ CF QSFTFOU JO UIF CPEZ BT B SFTVMU PG
JOGFDUJPO PS CF JOUFOUJPOBMMZ JOUSPEVDFE EVSJOH WBDDJOBUJPOT *O CPUI
DBTFT
UIF CPEZ QSPEVDFT BOUJCPEJFT BOE TQFDJBMJTFE MZNQIPDZUFT

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '**

& BVXgde]V\Z ' HeZX^[^X ]ZaeZg I"XZaa
e]V\dXniZ W^cYh VcY ^h VXi^kViZY#
^c\Zhih
eVi]d\Zc
VcY egZhZcih
Vci^\Zc dc
^ih hjg[VXZ#

( 6Xi^kViZY ]ZaeZg I"XZaa
^h hi^bjaViZY id Y^k^YZ
^cid ild XadcZh d[ XZaah#

bZbdgn XZaah

VXi^kZ ]ZaeZg I"XZaah ) 7"XZaa l^i]
* 6Xi^kZ I"XZaa W^cYh bViX]^c\ Vci^WdYn
id egZhZciZY ^c\Zhih eVi]d\Zc
Vci^\Zc VcY VcY egZhZcih
VXi^kViZh 7"XZaa# Vci^\Zc#

+ 6Xi^kViZY 7"XZaa
^h hi^bjaViZY id
Y^k^YZ ^cid ild
XadcZ XZaah#

bZbdgn XZaah

Vci^WdYn"
hZXgZi^c\
eaVhbV XZaah

, 6ci^WdY^Zh
gZaZVhZY ^cid
WaddYhigZVb
id YZhigdn
eVi]d\Zch#

;^\jgZ &&#( I]Z egdYjXi^dc d[ Vci^WdY^Zh ^ckdak^c\ bVXgde]V\Zh! ]ZaeZg I"XZaah
VcY 7"XZaah# I]Z eaVhbV XZaah XdciV^c aVg\Z Vbdjcih d[ g:G id hnci]Zh^hZ i]Z egdiZ^c
Vci^WdY^Zh#

r Passive immunity JT BDRVJSFE XIFO BOUJCPEJFT BSF USBOTGFSSFE GSPN

POF QFSTPO PS PUIFS PSHBOJTN
UP BOPUIFS 5IF BOUJCPEJFT XJMM IBWF
CFFO QSPEVDFE BT B SFTVMU PG BDUJWF JNNVOJUZ "OUJCPEJFT QBTT GSPN
NPUIFS UP CBCZ BDSPTT UIF QMBDFOUB BOE BSF BMTP USBOTGFSSFE JO DPMPTUSVN
B TQFDJBM GPSN PG NJML
JO UIF ê STU GFX EBZT PG TVDLMJOH BGUFS CJSUI
1SFGPSNFE BOUJCPEJFT DBO CF JOKFDUFE JOUP B QFSTPO JO UIF GPSN PG B

'*+

TFSVN m GPS FYBNQMF
UP USFBU B TOBLF CJUF 1BTTJWF JNNVOJUZ JT SFMBUJWFMZ Active immunity SFTJTUBODF
TIPSU MJWFE *U MBTUT BT MPOH BT UIF BOUJCPEJFT BSF QSFTFOU JO UIF CMPPE BOE UP UIF POTFU PG B EJTFBTF EVF UP
UIF SFDJQJFOU EPFT OPU QSPEVDF BOZ BOUJCPEJFT PG UIFJS PXO UIF QSPEVDUJPO PG BOUJCPEJFT JO
UIF CPEZ BGUFS TUJNVMBUJPO PG UIF
BdcdXadcVa Vci^WdY^Zh JNNVOF TZTUFN CZ EJTFBTF BOUJHFOT
BDUJWF JNNVOJUZ NBZ PDDVS BT
5IF CPEZ OPSNBMMZ QSPEVDFT B QPMZDMPOBM SFTQPOTF UP BO JOWBTJPO CZ B B SFTVMU FJUIFS PG FYQPTVSF UP B
QBUIPHFO " monoclonal antibody JT BSUJê DJBMMZ QSPEVDFE UP UBSHFU POF EJTFBTF PS WBDDJOBUJPO
TQFDJê D BOUJHFO 5IFTF BSF VTFE CPUI JO DPNNFSDJBM BQQMJDBUJPOT BOE GPS Passive immunity SFTJTUBODF
MBCPSBUPSZ SFTFBSDI 'JHVSF 11.4 TIPXT IPX NPOPDMPOBM BOUJCPEJFT BSF UP UIF POTFU PG B EJTFBTF EVF UP
PCUBJOFE BOUJCPEJFT BDRVJSFE GSPN BOPUIFS
PSHBOJTN JO XIJDI BDUJWF JNNVOJUZ
# DFMMT BSF TIPSU MJWFE BOE UIFSFGPSF PG MJUUMF WBMVF GPS DPNNFSDJBM IBT CFFO TUJNVMBUFE
BOUJCPEZ QSPEVDUJPO 5IF hybridoma cells
IPXFWFS
IBWF DIBSBDUFSJTUJDT
PG CPUI # DFMMT BOE DBODFS DFMMT UIFZ QSPEVDF BOUJCPEJFT and UIFZ
BSF BMNPTU JNNPSUBM JG UIFZ BSF LFQU JO DVMUVSF NFEJVN .POPDMPOBM
BOUJCPEJFT BSF QSPEVDFE CZ DMPOFT TP UIFZ BSF BMM JEFOUJDBM
UIFZ BSF IJHIMZ
TQFDJê D
BOE UIFZ DBO CF QSPEVDFE JO WFSZ MBSHF RVBOUJUJFT

& B^XZ VgZ ^c_ZXiZY l^i] i]Z
heZX^[^X Vci^\Zc! l]^X]
hi^bjaViZh egdYjXi^dc d[
eaVhbV XZaah VXi^kZ 7ÄXZaah #

' 6[iZg V [Zl YVnh! i]Z ( BnZadbV XZaah [gdb
eaVhbV XZaah VgZ gZbdkZY b^XZ VgZ Vahd XjaijgZY
[gdb i]Z heaZZc d[ i]Z hZeVgViZan# I]ZhZ VgZ
bdjhZ VcY XjaijgZY# XVcXZgdjh eaVhbV XZaah#
]nWg^YdbV XZaa
) I]Z eaVhbV XZaah
VcY bnZadbV XZaah
VgZ b^mZY id\Zi]Zg
^c V XjaijgZ#

* HdbZ [jhZ id [dgb
]nWg^YdbV XZaah#

+ :VX] d[ i]Z ]nWg^YdbV XZaah ^h
XjaijgZY hZeVgViZan ^c V bZY^jb
i]Vi Vaadlh dcan ]nWg^Y XZaah
id \gdl#

, I]Zn VgZ hXgZZcZY [dg ejg^in VcY i]dhZ
hZaZXiZY VgZ XjaijgZY id egdYjXZ aVg\Z
fjVci^i^Zh d[ gZfj^gZY Vci^WdYn#

;^\jgZ &&#) ;dgbVi^dc d[ bdcdXadcVa Vci^WdY^Zh#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '*,

.POPDMPOBM BOUJCPEJFT BSF VTFE JO EJBHOPTJT UP EFUFDU UIF QSFTFODF PG
QBUIPHFOT TVDI BT TUSFQUPDPDDBM CBDUFSJB BOE IFSQFT WJSVT 5IFZ BSF BMTP
VTFE JO QSFHOBODZ UFTUJOH .POPDMPOBM BOUJCPEJFT DBO SFDPHOJTF )$(
IVNBO DIPSJPOJD HPOBEPUSPQIJO

XIJDI JT QSFTFOU JO UIF VSJOF PG B
QSFHOBOU XPNBO TFF QBHF 279


.POPDMPOBM BOUJCPEJFT NBZ BMTP QSPWF UP CF JOWBMVBCMF JO UIF USFBUNFOU
PG DBODFS $BODFS DFMMT DBSSZ TQFDJê D BOUJHFOT PO UIFJS DFMM TVSGBDFT BOE
JG NPOPDMPOBM BOUJCPEJFT DBO SFDPHOJTF UIFTF
UIFZ DBO CF VTFE UP UBSHFU
UIFTF DBODFS DFMMT BOE DBSSZ DZUPUPYJD ESVHT UP UIFN *U JT IPQFE UIBU
UIFTF USFBUNFOUT
XIJDI IBWF CFFO DBMMFE ANBHJD CVMMFUT
DPVME SFEVDF UIF
BNPVOU PG ESVHT UIBU OFFE UP CF UBLFO EVSJOH DIFNPUIFSBQZ USFBUNFOU
0OF EJTFBTF
DBMMFE NBOUMF DFMM MZNQIPNB
IBT BMSFBEZ CFFO USFBUFE JO UIJT
XBZ .BOUFM DFMM MZNQIPNB JT B DBODFS PG UIF # DFMMT # MZNQIPDZUFT

BOE BDDPVOUT GPS BCPVU JO PG BMM DBTFT PG UIF HSPVQ PG DBODFST
LOPXO BT OPO )PEHLJO MZNQIPNBT 5IJT EJTFBTF IBT CFFO USFBUFE XJUI
NBOVGBDUVSFE NPOPDMPOBM BOUJCPEJFT
XJUI UIF HFOFSJD OBNF PG SJUVYJNBC
5IF BOUJCPEJFT BSF VTFE JO DPOKVODUJPO XJUI DIFNPUIFSBQZ BOE TUJDL UP
QBSUJDVMBS TVSGBDF QSPUFJOT PO UIF DBODFS DFMMT
XIJDI UIFZ TUJNVMBUF UIF
CPEZ T JNNVOF TZTUFN UP EFTUSPZ

KVXX^cVi^dc

*NNVOJUZ EFWFMPQT XIFO B QFSTPO IBT CFFO FYQPTFE UP B QBUIPHFO 'PS
NPTU NJME JMMOFTTFT
TVDI BT UIF DPNNPO DPME PS UPOTJMMJUJT
UIJT IBQQFOT
OBUVSBMMZ BT B QFSTPO DPNFT JOUP DPOUBDU XJUI UIF WJSVTFT PS CBDUFSJB
UIBU DBVTF UIFN #VU TPNF QBUIPHFOT DBVTF EJTFBTFT UIBU IBWF EBOHFSPVT
PS MJGF UISFBUFOJOH TZNQUPNT 'PS UIFTF EJTFBTFT
XIJDI JODMVEF UFUBOVT

UVCFSDVMPTJT
DIPMFSB
QPMJPNZFMJUJT BOE NFBTMFT
vaccines IBWF CFFO
EFWFMPQFE UP QSPWJEF B TBGF ê STU FYQPTVSF TP UIBU B WBDDJOBUFE QFSTPO XJMM
EFWFMPQ JNNVOJUZ CVU OPU UIF EJTFBTF

7BDDJOFT BSF NPEJê FE GPSNT PG UIF EJTFBTF DBVTJOH QBUIPHFOT "
WBDDJOF NBZ DPOUBJO FJUIFS XFBLFOFE BUUFOVBUFE
PS EFBE QBUIPHFOT
PS
UIFJS UPYJOT 7BDDJOFT BSF PGUFO QSPEVDFE CZ USFBUJOH QBUIPHFOT XJUI IFBU
PS DIFNJDBMT

.PTU WBDDJOFT BSF JOKFDUFE JOUP B QFSTPO T CPEZ
BMUIPVHI TPNF
TVDI
BT QPMJP WBDDJOF
DBO CF UBLFO PSBMMZ "OUJHFOT JO UIF WBDDJOF TUJNVMBUF
UIF JNNVOF SFTQPOTF BOE UIF GPSNBUJPO PG TVą DJFOU NFNPSZ DFMMT UP
QSPEVDF BOUJCPEJFT WFSZ RVJDLMZ JG UIF QFSTPO JT JOGFDUFE XJUI UIF SFBM
QBUIPHFO MBUFS PO

" ê STU vaccination QSPEVDFT B QSJNBSZ SFTQPOTF CVU NBOZ WBDDJOBUJPOT
BSF GPMMPXFE VQ XJUI BOPUIFS TPNF UJNF MBUFS 5IF TFDPOE PS ACPPTUFS
EPTF PG WBDDJOF DBVTFT B HSFBUFS BOE GBTUFS QSPEVDUJPO PG BOUJCPEJFT BOE
NFNPSZ DFMMT
LOPXO BT B secondary response 'JHVSF 11.5

BOE
QSPWJEFT MPOH UFSN QSPUFDUJPO 5IF UJNF UIBU BOUJCPEJFT BOE NFNPSZ DFMMT
QFSTJTU EFQFOET PO UIF EJTFBTF 3VCFMMB WBDDJOBUJPO DBO QSPWJEF QSPUFDUJPO
GPS VQ UP ZFBST
XIJMF WBDDJOBUJPOT GPS UFUBOVT TIPVME CF SFQFBUFE FWFSZ
ZFBST 7BDDJOFT EP OPU QSFWFOU JOGFDUJPO CZ QBUIPHFOT CVU UIFZ EP
FOBCMF UIF CPEZ UP SFTQPOE RVJDLMZ UP UIFN BOE QSFWFOU TFSJPVT JMMOFTT

'*-

[^ghi kVXX^cVi^dc

WddhiZg kVXX^cVi^dc WddhiZg kVXX^cVi^dc Vi hdbZ
V [Zl lZZ`h aViZg ed^ci ^c i]Z [jijgZ

AZkZa d[ Vci^WdYn egdiZXi^kZ aZkZa

hZXdcYVgn gZhedchZ I^bZ

%')+-
I^bZ $ bdci]h

;^\jgZ &&#* 6ci^WdYn aZkZah V[iZg kVXX^cVi^dc# I]Z eZgh^hiVcXZ d[ Vci^WdY^Zh kVg^Zh VcY
YZeZcYh dc i]Z kVXX^cZ jhZY#

7ZcZÒ ih VcY YVc\Zgh d[ kVXX^cVi^dc

5IF ê STU WBDDJOF BHBJOTU TNBMMQPY XBT EFWFMPQFE CZ &EXBSE +FOOFS JO
4JODF UIFO
WBDDJOBUJPO QSPHSBNNFT JO NBOZ DPVOUSJFT IBWF TBWFE
DPVOUMFTT MJWFT 4NBMMQPY XBT FSBEJDBUFE JO BT B EJSFDU SFTVMU PG B
8PSME )FBMUI 0SHBOJ[BUJPO WBDDJOBUJPO QSPHSBNNF 4JODF UIBU UJNF
UIFSF
IBWF CFFO OP DBTFT PG UIJT PODF GBUBM EJTFBTF

5IF BEWBOUBHFT PG WBDDJOBUJPO JODMVEF

r prevention of epidemics and decrease in the spread of disease

m BT QFPQMF USBWFM NPSF XJEFMZ BOE NPSF SBQJEMZ BMM PWFS UIF XPSME
UIJT
IBT CFDPNF JODSFBTJOHMZ JNQPSUBOU

r economic benefits m JU JT NVDI DIFBQFS UP WBDDJOBUF MBSHF OVNCFST

PG QFPQMF BOE QSFWFOU JMMOFTT SBUIFS UIBO CFBS UIF IFBMUIDBSF DPTUT PG
USFBUJOH UIF TJDL

r complete eradication of some diseases m UIJT IBT BMSFBEZ PDDVSSFE

GPS TNBMMQPY BOE UIF 8PSME )FBMUI 0SHBOJ[BUJPO BMTP BJNT UP FMJNJOBUF
NFBTMFT BOE QPMJP

r prevention of disability by vaccination m CFGPSF WBDDJOBUJPOT XFSF

BWBJMBCMF
QPMJP MFGU NBOZ QFPQMF QBSBMZTFE BGUFS UIFZ IBE CFFO JOGFDUFE

XIJMF SVCFMMB WJSVT DBVTFE CMJOEOFTT BOE EFBGOFTT JO UIF CBCJFT PG
NPUIFST XIP IBE UIF EJTFBTF EVSJOH UIFJS QSFHOBODZ
"MUIPVHI UIF DBTF GPS WBDDJOBUJPO JT B QPXFSGVM POF
TPNF QFPQMF BSF
DPODFSOFE UIBU WBDDJOBUJPOT NBZ IBWF EJTBEWBOUBHFT
XIJDI JODMVEF

r rare cases of allergic reaction m BMUIPVHI WBDDJOFT BSF UIPSPVHIMZ

UFTUFE CFGPSF VTF BOE VTVBMMZ DBVTF POMZ NJOPS SFBDUJPOT
TVDI BT GFWFS
PS TXFMMJOH
B TNBMM OVNCFS PG JOEJWJEVBMT EP SFBDU CBEMZ UP UIFN

r perceived risk of ‘overloading’ of immune system m WBDDJOBUJPOT

GPS TPNF DIJMEIPPE JMMOFTTFT
TVDI BT NFBTMFT
NVNQT BOE SVCFMMB
..3

BSF HJWFO UPHFUIFS JO B NVMUJQMF WBDDJOF
BOE TPNF QBSFOUT
GFBS UIBU TVDI NVMUJQMF WBDDJOBUJPOT NBZ DBVTF UIF JNNVOF TZTUFN UP
PWFSSFBDU
UIFSFCZ QPTJOH B QPTTJCMF EBOHFS UP UIFJS DIJME

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '*.

r difficulty of ensuring safe use m JO TPNF DPVOUSJFT
JU JT EJą DVMU

UP LFFQ UIF WBDDJOFT JO DPPM
TUFSJMF DPOEJUJPOT BOE BENJOJTUFS UIFN
FĄ FDUJWFMZ

r breach of civil liberties m JO TPNF DPVOUSJFT
DIJMESFO IBWF UP IBWF

DFSUBJO WBDDJOBUJPOT CFGPSF UIFZ DBO TUBSU TDIPPM
BOE UIFSF BSF QBSFOUT
XIP GFFM UIBU WBDDJOBUJPO TIPVME CF B NBUUFS PG QFSTPOBM DIPJDF
SBUIFS
UIBO DPNQVMTPSZ

&&#' BjhXaZh VcY bdkZbZci

6hhZhhbZci hiViZbZcih

r 4UBUF UIF SPMFT PG CPOFT
MJHBNFOUT
NVTDMFT
UFOEPOT BOE OFSWFT JO IVNBO NPWFNFOU
r -BCFM B EJBHSBN PG UIF IVNBO FMCPX KPJOU
JODMVEJOH DBSUJMBHF
TZOPWJBM ë VJE
KPJOU DBQTVMF
OBNFE CPOFT BOE

BOUBHPOJTUJD NVTDMFT CJDFQT BOE USJDFQT


r 0VUMJOF UIF GVODUJPOT PG UIF TUSVDUVSFT JO UIF IVNBO FMCPX KPJOU
r $PNQBSF UIF NPWFNFOUT PG UIF IJQ KPJOU BOE UIF LOFF KPJOU
r %FTDSJCF UIF TUSVDUVSF PG TUSJBUFE NVTDMF ê CSFT
JODMVEJOH UIF NZPê CSJMT XJUI MJHIU BOE EBSL CBOET
NJUPDIPOESJB
UIF

TBSDPQMBTNJD SFUJDVMVN
OVDMFJ BOE UIF TBSDPMFNNB

r %SBX BOE MBCFM B EJBHSBN UP TIPX UIF TUSVDUVSF PG B TBSDPNFSF
JODMVEJOH ; MJOFT
BDUJO ê MBNFOUT
NZPTJO ê MBNFOUT

XJUI IFBET BOE UIF SFTVMUBOU MJHIU BOE EBSL CBOET

r &YQMBJO IPX TLFMFUBM NVTDMF DPOUSBDUT
JODMVEJOH UIF SFMFBTF PG DBMDJVN JPOT GSPN UIF TBSDPQMBTNJD SFUJDVMVN
UIF

GPSNBUJPO PG DSPTT CSJEHFT
UIF TMJEJOH PG BDUJO BOE NZPTJO ê MBNFOUT BOE UIF VTF PG "51 UP CSFBL DSPTT CSJEHFT BOE
SF TFU NZPTJO IFBET

r "OBMZTF FMFDUSPO NJDSPHSBQIT UP ê OE UIF TUBUF PG DPOUSBDUJPO PG NVTDMF ê CSFT

?d^cih

" joint JT B QMBDF XIFSF UXP PS NPSF CPOFT NFFU +PJOUT CFUXFFO CPOFT
JO UIF IVNBO CPEZ
UPHFUIFS XJUI UIF NVTDMFT UIBU BSF BUUBDIFE UP UIFN

FOBCMF VT UP NPWF BOE BMTP TVQQPSU UIF CPEZ .PTU KPJOUT JOWPMWF CPOFT

NVTDMFT
DBSUJMBHF
UFOEPOT
MJHBNFOUT BOE OFSWFT

r Bones QSPWJEF B GSBNFXPSL UIBU TVQQPSUT UIF CPEZ 5IFZ QSPUFDU WJUBM

PSHBOT TVDI BT UIF CSBJO BOE UIF MVOHT #MPPE DFMMT BSF GPSNFE XJUIJO
CPOFT
XIJDI DPOUBJO CPOF NBSSPX #POFT BMTP BDU BT B TJUF GPS UIF
TUPSBHF PG DBMDJVN BOE QIPTQIBUF

r Ligaments BUUBDI CPOFT UP POF BOPUIFS BU B KPJOU 4PNF TUSBQ KPJOUT

UPHFUIFS XIJMF PUIFST GPSN B QSPUFDUJWF DBQTVMF BSPVOE B KPJOU 5IFZ BSF
UPVHI BOE ê CSPVT BOE QSPWJEF TUSFOHUI BOE TVQQPSU TP UIBU KPJOUT BSF
OPU EJTMPDBUFE

r Tendons BUUBDI NVTDMFT UP CPOFT 5IFZ BSF GPSNFE PG UPVHI CBOET

PG DPOOFDUJWF UJTTVF NBEF PG DPMMBHFO ê CSFT BOE BSF DBQBCMF PG
XJUITUBOEJOH UFOTJPO BT NVTDMFT DPOUSBDU

r Muscles QSPWJEF UIF GPSDF OFFEFE GPS NPWFNFOU 5IFZ BSF BCMF UP

DPOUSBDU JO MFOHUI BOE BT UIFZ EP TP UIFZ NPWF UIF KPJOU JOUP OFX
QPTJUJPOT .VTDMFT POMZ DBVTF NPWFNFOU CZ DPOUSBDUJPO
TP UIFZ PDDVS

'+%

JO antagonistic pairs m POF NVTDMF PG UIF QBJS DBVTFT B NPWFNFOU JO ]jbZgjh WdcZ Ä egdk^YZh
POF EJSFDUJPO XIJMF UIF PUIFS SFUVSOT JU UP JUT PSJHJOBM QPTJUJPO V [^gb VcX]dgV\Z [dg i]Z
bjhXaZh
r Motor neurons TUJNVMBUF NVTDMF DPOUSBDUJPO 4FOTPSZ OFVSPOT
ig^XZeh Ä i]Z ZmiZchdg
USBOTNJU JOGPSNBUJPO GSPN QSPQSJPDFQUPST QPTJUJPO TFOTPST
JO UIF bjhXaZ! jhZY id
NVTDMFT TP UIBU NPWFNFOUT DBO CF DPPSEJOBUFE BOE NPOJUPSFE higV^\]iZc i]Z Vgb
hncdk^Va
I]Z ZaWdl _d^ci bZbWgVcZ
5IF FMCPX JT B hinge joint
TP DBMMFE CFDBVTF JU NPWFT JO B NBOOFS hncdk^Va [aj^Y Ä
SFTFNCMJOH UIF PQFOJOH BOE DMPTJOH PG B EPPS IJOHF 'JHVSF 11.6
*U JT BO ajWg^XViZh i]Z _d^ci
FYBNQMF PG B synovial joint 5IF DBQTVMF UIBU TFBMT UIF KPJOU JT MJOFE CZ B VcY gZYjXZh [g^Xi^dc
NFNCSBOF UIBU TFDSFUFT MVCSJDBUJOH synovial fluid TP UIBU UIF CPOFT NPWF
TNPPUIMZ BHBJOTU POF BOPUIFS BOE GSJDUJPO JT SFEVDFE 4NPPUI DBSUJMBHF
DPWFST UIF FOET PG UIF CPOFT BU UIF KPJOU BOE BMTP IFMQT UP SFEVDF GSJDUJPO
BOE BCTPSCT QSFTTVSF BT UIF KPJOU NPWFT

W^XZeh Ä i]Z [aZmdg
bjhXaZ! jhZY id
WZcY i]Z Vgb Vi i]Z
ZaWdl

a^\VbZcih Ä [dgb V
XVehjaZ l]^X] hjggdjcYh
i]Z _d^cih

iZcYdc Ä ViiVX]Zh
bjhXaZ id WdcZ

gVY^jh Ä WdcZ
i]Vi igVchb^ih
[dgXZh [gdb i]Z
W^XZeh i]gdj\]
i]Z [dgZVgb

jacV Ä WdcZ XVgi^aV\Z Ä V aVnZg d[ hbddi] VcY
i]Vi igVchb^ih idj\] i^hhjZ i]Vi XdkZgh i]Z ZcYh d[
[dgXZh [gdb i]Z i]Z WdcZh l]ZgZ i]Zn bZZi! id
ig^XZeh i]gdj\] gZYjXZ [g^Xi^dc
i]Z [dgZVgb

;^\jgZ &&#+ I]Z ]^c\Z _d^ci d[ i]Z ZaWdl#

5IF FMCPX KPJOU JT GPSNFE PG UISFF CPOFT m UIF SBEJVT BOE VMOB JO UIF
MPXFS BSN BOE UIF IVNFSVT JO UIF VQQFS BSN 5FOEPOT BUUBDI UIF CJDFQT
BOE USJDFQT NVTDMFT UP UIFTF CPOFT 5IF CJDFQT JT BUUBDIFE UP UIF SBEJVT
BOE UIF TIPVMEFS CMBEF 8IFO JU DPOUSBDUT UIF BSN CFOET 5IF USJDFQT
JT BUUBDIFE UP UIF VMOB
IVNFSVT BOE TIPVMEFS CMBEF BOE JU DPOUSBDUT
UP TUSBJHIUFO UIF BSN 5IF CJDFQT BOE USJDFQT BSF BO FYBNQMF PG BO
BOUBHPOJTUJD QBJS PG NVTDMFT

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '+&

I]Z `cZZ VcY ]^e _d^cih

5IF LOFF KPJOU JT BOPUIFS FYBNQMF PG B IJOHF KPJOU BOE JU NPWFT JO B
TJNJMBS XBZ UP UIF FMCPX
BMMPXJOH NPWFNFOU JO POMZ POF EJSFDUJPO 5IF
IJQ KPJOU JT B ball-and-socket joint XJUI UIF CBMM TIBQFE IFBE PG UIF
UIJHI CPOF UIF GFNVS
ê UUJOH JOUP B TPDLFU JO UIF IJQ #BMM BOE TPDLFU
KPJOUT BMMPX NPWFNFOU JO NPSF UIBO POF EJSFDUJPO BOE BMTP QFSNJU
SPUBUJPOBM NPWFNFOUT 'JHVSF 11.7


@cZZ _d^ci VcY bdkZbZci Vi i]Z `cZZ
@cZZ _d^ci VcY bdkZbZci Vi i]Z `cZZ

BdkZbZci
BdkZbZci

eViZaaV `cZZ XVe ZmiZch^dc [aZm^dc
eViZaaV `cZZ XVe ZmiZch^dc [aZm^dc
XVgi^aV\Z
XVgi^aV\Z [Zbjg
[Zbjg
bjhXaZ iZcYdc
b VjiihVXXa]ZZ iYZ cidYdc hncdk^Va bZbWgVcZ
WVdiciVZX ]ZY id hhnnccddkk^^VVaa [bajZ^YbWgVcZ
WdcZ ah^n\cVdbkZ^Vca i[haj^Y
a^\VbZcih
_d^ci XVehjaZ
_d^ci XVehjaZ
i^W^V
i^W^V

=^e _d^ci VcY bdkZbZci Vi i]Z ]^e BdkZbZci
=^e _d^ci VcY bdkZbZci Vi ie]ZZak ]^X^e BdkZbZci

\e^ZgaYka^ZX
\^gYaZ
XVgi^aV\Z
XVgi^aV\Z
_d^ci XVehjaZ X^gXjaVg
hdX`Zi _d^ci XVehjaZ X^gXjaVg
hdX`Zi
]ZVY d[ hncdk^Va bZbWgVcZ
][ZZbVYj gd[ hnchndckd^Vka^ Vba Z[abj^WYgVcZ
[ZWbVaaj g
WVaa hncdk^Va [aj^Y
a^\VbZci
;^\jgZ &&#- A^\]i b^Xgd\gVe] d[ hig^ViZY a^\VbZci [Zbjg
bjhXaZ! hiV^cZY id h]dl i]Z WVcY^c\ ^c [Zbjg
bjhXaZ Ò WgZh#
_d^ci XVehjaZ
5IF CPEZ DPOUBJOT UISFF UZQFT _d^ci XVehjaZ
PG NVTDMF m skeletal PS striated
muscle BUUBDIFE UP UIF TLFMFUPO
;^\jgZ &&#, Adc\^ijY^cVa hZXi^dch d[ i]Z `cZZ VcY ]^e _d^cih! VcY i]Z YZ\gZZ d[
cardiac muscle GPVOE POMZ JO bdkZbZci i]Zn Vaadl#
UIF IFBSU
BOE smooth PS non-
striated muscle
XIJDI JT GPVOE BjhXaZh
JO UIF XBMMT PG IPMMPX PSHBOT
TVDI BT UIF JOUFTUJOFT BOE CMBEEFS Skeletal PS striated muscle JT UIF NVTDMF UIBU DBVTFT UIF NPWFNFOU PG
4USJBUFE NVTDMF DBO CF DPOUSPMMFE PVS KPJOUT 7JFXFE VOEFS UIF MJHIU NJDSPTDPQF 'JHVSF 11.8
JU IBT B TUSJQFE
WPMVOUBSJMZ BOE FOBCMFT VT UP NPWF BQQFBSBODF NBEF VQ PG NVMUJOVDMFBUF DFMMT LOPXO BT muscle fibres
4VSSPVOEJOH UIF NVTDMF ê CSF JT B QMBTNB NFNCSBOF DBMMFE UIF sarcolemma
'+' &BDI ê CSF JT NBEF VQ PG NBOZ myofibrils SVOOJOH QBSBMMFM UP POF BOPUIFS
'JHVSF 11.9

WdcZ

6 iZcYdc ViiVX]Zh V
bjhXaZ id V WdcZ#

V bjhXaZ [^WgZ

H]dgi aZc\i] d[ V bjhXaZ [^WgZ hVgXdaZbbV hVgXdbZgZ 6 bjhXaZ ^h V WadX` d[ bVcn
bnd[^Wg^a i]djhVcYh d[ bjhXaZ [^WgZh#

cjXaZjh

=^\]an bV\c^[^ZY ZY\Z d[ V bjhXaZ [^WgZ b^idX]dcYg^V I"ijWjaZ hVgXdeaVhb^X gZi^Xjajb
hVgXdaZbbV dcan V hbVaa Vbdjci
h]dlc ^c i]^h Y^V\gVb

i]^c [^aVbZci

i]^X` [^aVbZci

bnd[^Wg^a

7VcY^c\ d[ bnd[^Wg^ah VcY [^aVbZcih l^i]^c bnd[^Wg^ah O a^cZ i]^X` i]^c
hVgXdbZgZ [^aVbZci [^aVbZci
bndh^c VXi^c

YVg` WVcY a^\]i WVcY
VXi^c [^aVbZci bndh^c [^aVbZci

;^\jgZ &&#. I]Z higjXijgZ d[ h`ZaZiVa bjhXaZ#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '+(

Muscle tone *G TLFMFUBM NVTDMF JT FYBNJOFE XJUI BO FMFDUSPO NJDSPTDPQF
JU JT QPTTJCMF
$POUSBDUJPO PG B NVTDMF DBVTFT UP TFF UIBU TVSSPVOEJOH FBDI NZPê CSJM JT B TZTUFN PG NFNCSBOFT DBMMFE
TIPSUFOJOH
BOE UIJT JO UVSO NPWFT UIF sarcoplasmic reticulum XIJDI SFTFNCMFT TNPPUI FOEPQMBTNJD
CPOFT JOUP B OFX QPTJUJPO *G POMZ B SFUJDVMVN
BOE CFUXFFO UIF DMPTFMZ QBDLFE NZPê CSJMT BSF NBOZ
GFX ê CSFT JO B NVTDMF DPOUSBDU
UIF NJUPDIPOESJB 'JHVSF 11.9

NVTDMF UJHIUFOT CVU EPFT OPU DBVTF
NPWFNFOU 1BSUJBM DPOUSBDUJPO .ZPê CSJMT BSF NBEF VQ PG SFQFBUJOH TVCVOJUT DBMMFE sarcomeres
XIJDI
QSPEVDFT NVTDMF UPOF
XIJDI JT QSPEVDF UIF TUSJQFE BQQFBSBODF PG B NVTDMF ê CSF BOE BSF SFTQPOTJCMF GPS
JNQPSUBOU JO NBJOUBJOJOH QPTUVSF NVTDMF DPOUSBDUJPO 5IF FOET PG B TBSDPNFSF BSF DBMMFE UIF Z lines
BOE CPEZ TIBQF
5IFSF BSF UXP UZQFT PG ê MBNFOU UIBU GPSN UIF TUSJQFE QBUUFSO PG B
'+) NVTDMF 5IFTF ê MBNFOUT BSF GPSNFE GSPN UIF DPOUSBDUJMF QSPUFJOT actin
BOE myosin 5IF OBSSPX ê MBNFOUT PG BDUJO BSF BUUBDIFE UP UIF ; MJOFT
BOE FYUFOE JOUP UIF TBSDPNFSF 5IJDLFS ê MBNFOUT PG NZPTJO SVO CFUXFFO
UIFN 8IFSF NZPTJO JT QSFTFOU
UIF NZPê CSJM IBT B EBSL BQQFBSBODF BOE
B MJHIU CBOE JT TFFO XIFSF POMZ BDUJO JT QSFTFOU .ZPTJO ê MBNFOUT IBWF
AIFBET XIJDI QSPUSVEF GSPN UIFJS NPMFDVMFT BOE BSF BCMF UP CJOE UP
TQFDJBM TJUFT PO UIF BDUJO ê MBNFOUT

BjhXaZ XdcigVXi^dc

.VTDMF DPOUSBDUJPO JT FYQMBJOFE CZ UIF ATMJEJOH ê MBNFOU UIFPSZ
XIJDI
EFTDSJCFT IPX BDUJO BOE NZPTJO ê MBNFOUT TMJEF PWFS POF BOPUIFS UP
TIPSUFO UIF NVTDMF $POUSBDUJPO JT JOJUJBUFE CZ UIF BSSJWBM PG B OFSWF
JNQVMTF GSPN B NPUPS OFVSPO XIJDI TUJNVMBUFT UIF TBSDPMFNNB PG UIF
NVTDMF ê CSF 5IJT
JO UVSO
DBVTFT UIF SFMFBTF PG DBMDJVN JPOT $B

GSPN UIF TBSDPQMBTNJD SFUJDVMVN BOE CFHJOT UIF QSPDFTT UIBU DBVTFT BDUJO
ê MBNFOUT UP TMJEF JOXBSE UPXBSET UIF DFOUSF PG UIF TBSDPNFSF 5IF TFSJFT PG
FWFOUT JT TIPXO JO 'JHVSF 11.10
1 /FSWF JNQVMTFT BDUJPO QPUFOUJBMT
USBWFM BMPOH UIF NVTDMF ê CSF

NFNCSBOF
PS TBSDPMFNNB
BOE BSF DBSSJFE EPXO JOUP UIF ê CSF
UISPVHI JOGPMEJOHT DBMMFE 5 UVCVMFT 5IF JNQVMTFT UIFO TQSFBE BMPOH
UIF NFNCSBOF PG UIF TBSDPQMBTNJD SFUJDVMVN
DBVTJOH $B JPOT UP CF
SFMFBTFE
2 #FGPSF DPOUSBDUJPO
CJOEJOH TJUFT GPS NZPTJO IFBET PO UIF BDUJO ê MBNFOUT
BSF DPWFSFE CZ UXP NPMFDVMFT
troponin BOE tropomyosin 5IF NZPTJO
IFBET BSF QSFQBSFE JO BO FSFDU QPTJUJPO BT "51 CJOET UP UIFN
3 /PX $B JPOT CJOE UP UIF BDUJO ê MBNFOUT
DBVTJOH UIF USPQPOJO BOE
USPQPNZPTJO UP DIBOHF TIBQF BOE FYQPTF UIF NZPTJO CJOEJOH TJUFT 5IF
NZPTJO IFBET CJOE UP UIF BDUJO ê MBNFOUT BU UIF FYQPTFE CJOEJOH TJUFT

GPSNJOH DSPTT CSJEHFT
4 5IJT DBVTFT JOPSHBOJD QIPTQIBUF 1i
UP CF SFMFBTFE BOE
BT FBDI DSPTT
CSJEHF GPSNT
"%1 JT BMTP SFMFBTFE 5IF NZPTJO IFBET CFOE UPXBSET
UIF DFOUSF PG UIF TBSDPNFSF
QVMMJOH UIF BDUJO ê MBNFOUT JOXBSE QBTU UIF
NZPTJO ê MBNFOUT
CZ BCPVU ON 5IJT QSPEVDFT B AQPXFS TUSPLF
5 /FX "51 NPMFDVMFT CJOE UP UIF NZPTJO IFBET
CSFBLJOH UIF DSPTT
CSJEHFT BOE EFUBDIJOH UIFN GSPN UIF BDUJO ê MBNFOUT "51 JT VTFE BOE
UIF NZPTJO IFBET SFUVSO UP UIF TUBSU QPTJUJPO *G UIF NVTDMF SFDFJWFT
GVSUIFS TUJNVMBUJPO
UIF QSPDFTT JT SFQFBUFE BOE UIF NZPTJO IFBET BUUBDI
GVSUIFS BMPOH UIF BDUJO ê MBNFOUT

cZgkZ ^bejahZh gjc Vadc\ hVgXdaZbbV
i]Z hVgXdaZbbV I"ijWjaZ
hVgXdeaVhb^X gZi^Xjajb
hVgXdaZbbV ^h [daYZY VXi^c [^aVbZci
^cid i]Z [^WgZ Vadc\ i]Z
I"ijWjaZh @Zn
cZgkZ ^bejahZh
I"ijWjaZh iV`Z cZgkZ VXi^dc ediZci^Vah
^bejahZh g^\]i ^cid i]Z [^WgZ! gZaZVhZ d[ 8V' ^dch
Vadc\ i]Z bZbWgVcZ d[ i]Z bdkZbZci d[ bjhXaZ [^WgZh
hVgXdeaVhb^X gZi^Xjajb

& L]Zc cZgkZ ^bejahZh
Vgg^kZ Vi i]Z hVgXdeaVhb^X
gZi^Xjajb! 8V' ^dch VgZ
gZaZVhZY#

' >c i]Z gZaVmZY hiViZ! igdedc^c igdedbndh^c
VcY igdedbndh^c XdkZg i]Z VXi^c
bndh^c W^cY^c\ h^iZh dc i]Z igdedc^c
VXi^c [^aVbZcih#

69E bndh^c ]ZVY ^h Vc
E^
( 6h 8V' ^dch Vgg^kZ! i]Z 6IEVhZ bdaZXjaZ! l]^X]
W^cY^c\ h^iZh VgZ ZmedhZY! XVc ]nYgdanhZ 6IE id
VcY bndh^c ]ZVYh W^cY id
i]Z VXi^c! [dgb^c\ Xgdhh"Wg^Y\Zh# 69E E^ Ä ^c gZhi^c\
bjhXaZ! 69E VcY E^ VgZ
WdjcY id ^i

) Bndh^c ]ZVYh i^ai! ejaa^c\ 69E * 6IE ]nYgdanh^h
i]Z VXi^c VcY XVjh^c\ i]Z E^ XVjhZh i]Z gZaZVhZ d[
bjhXaZ id XdcigVXi Wn
VWdji &% cb# bndh^c ]ZVYh# I]Zn 69E
E^
;^\jgZ &&#&% BjhXaZ XdcigVXi^dc# heg^c\ WVX` VcY 6IE

gZeZVi i]Z W^cY^c\

VcY i^ai^c\ egdXZhh#

69E VcY E^ VgZ dcXZ V\V^c WdjcY id bndh^c
]ZVY! gZVYn id hiVgi XnXaZ V\V^c#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '+*

"MUIPVHI UIF BDUJO BOE NZPTJO ê MBNFOUT EP OPU DIBOHF JO MFOHUI XIFO B
NVTDMF DPOUSBDUT
UIF BQQFBSBODF PG UIF CBOEJOH QBUUFSOT JO UIF TBSDPNFSF
JT DIBOHFE 5IF MJHIU CBOET CFDPNF SFEVDFE
BOE BT UIF PWFSBMM MFOHUI PG
UIF TBSDPNFSF EFDSFBTFT UIF EBSL CBOET UBLF VQ B HSFBUFS QSPQPSUJPO PG UIF
MFOHUI 'JHVSF 11.11


hVgXdbZgZ

jcXdcigVXiZY
bjhXaZ

a^\]i WVcY YVg` WVcY ^c jcXdcigVXiZY bjhXaZ! i]Z YVg` WVcYh
VcY a^\]i WVcYh VgZ VWdji i]Z hVbZ l^Yi]

XdcigVXiZY
bjhXaZ

a^\]i YVg` ^c XdcigVXiZY bjhXaZ! i]Z YVg`
WVcY WVcY WVcYh VgZ gZaVi^kZan bjX] l^YZg
i]Vc i]Z a^\]i WVcYh

I:B h]dl^c\ bndÒ Wg^ah ^c Vc jcXdcigVXiZY h`ZaZiVa bjhXaZ Ò WgZ

a^\]i WVcY YVg` WVcY a^\]i WVcY

O a^cZ O a^cZ

3JHPS NPSUJT JT B QBSUJBM hVgXdbZgZ
DPOUSBDUJPO PG NVTDMFT UIBU
PDDVST BGUFS B QFSTPO IBT EJFE ;^\jgZ &&#&& L]Zc bjhXaZ XdcigVXih! i]Z ^ciZgaZVkZY Ò WgZh ha^YZ ^clVgY! eVhi ZVX]
5IF NVTDMFT CFDPNF TUJĄ BOE di]Zg# I]^h bV`Zh i]Z a^\]i WVcYh VeeZVg cVggdlZg! Wji i]Z YVg` WVcYh gZbV^c i]Z
MPDLFE JO QPTJUJPO *U JT DBVTFE hVbZ l^Yi]#
CFDBVTF "51 QSPEVDUJPO TUPQT
BOE NZPTJO IFBET BSF VOBCMF UP & :meaV^c l]n bjhXaZh dXXjg ^c VciV\dc^hi^X eV^gh#
EFUBDI GSPN BDUJO ê MBNFOUT *U MBTUT ' Djia^cZ i]Z [jcXi^dch d[ XVgi^aV\Z VcY hncdk^Va Ó j^Y ^c i]Z ZaWdl _d^ci#
GPS BCPVU IPVST
BU XIJDI UJNF ( 8dbeVgZ i]Z bdkZbZci d[ V ]^c\Z _d^ci VcY V WVaa"VcY"hdX`Zi _d^ci#
EFDPNQPTJUJPO CFHJOT UP CSFBL ) :meaV^c ]dl VXi^c VcY bndh^c Ò aVbZcih egdYjXZ i]Z hig^eZY VeeZVgVcXZ
EPXO UIF NVTDMF UJTTVFT
d[ h`ZaZiVa bjhXaZ#
'++ * 9ZhXg^WZ i]Z gdaZ d[ 6IE ^c bjhXaZ XdcigVXi^dc#

&&#( I]Z `^YcZn

6hhZhhbZci hiViZbZcih

r %Fê OF AFYDSFUJPO
r %SBX BOE MBCFM B EJBHSBN PG UIF LJEOFZ
r "OOPUBUF B EJBHSBN PG B HMPNFSVMVT BOE BTTPDJBUFE OFQISPO UP TIPX UIF GVODUJPO PG FBDI QBSU
r &YQMBJO UIF QSPDFTT PG VMUSBê MUSBUJPO
JODMVEJOH CMPPE QSFTTVSF
GFOFTUSBUFE CMPPE DBQJMMBSJFT BOE CBTFNFOU NFNCSBOF
r %Fê OF APTNPSFHVMBUJPO
r &YQMBJO UIF SFBCTPSQUJPO PG HMVDPTF
XBUFS BOE TBMUT JO UIF QSPYJNBM DPOWPMVUFE UVCVMF
JODMVEJOH UIF SPMFT PG

NJDSPWJMMJ
PTNPTJT BOE BDUJWF USBOTQPSU

r &YQMBJO UIF SPMFT PG UIF MPPQ PG )FOMF
NFEVMMB
DPMMFDUJOH EVDU BOE "%) WBTPQSFTTJO
JO NBJOUBJOJOH UIF XBUFS

CBMBODF PG UIF CMPPE

r &YQMBJO UIF EJĄ FSFODFT JO UIF DPODFOUSBUJPO PG QSPUFJOT
HMVDPTF BOE VSFB CFUXFFO CMPPE QMBTNB
HMPNFSVMBS ê MUSBUF

BOE VSJOF

r &YQMBJO UIF QSFTFODF PG HMVDPTF JO UIF VSJOF PG VOUSFBUFE EJBCFUJD QBUJFOUT

;jcXi^dch d[ i]Z `^YcZn Excretion UIF SFNPWBM GSPN UIF
CPEZ PG UIF XBTUF QSPEVDUT PG
5IF NBOZ NFUBCPMJD QSPDFTTFT PDDVSSJOH JO DFMMT SFTVMU JO XBTUF TVCTUBODFT NFUBCPMJD QBUIXBZT
UIBU NVTU CF SFNPWFE 'PS FYBNQMF
urea JT QSPEVDFE BT B XBTUF QSPEVDU Osmoregulation DPOUSPM PG UIF
GSPN UIF NFUBCPMJTN PG BNJOP BDJET 8BTUF QSPEVDUT TVDI BT UIJT BSF XBUFS QPUFOUJBM PG CPEZ ë VJET CZ
DBSSJFE BXBZ GSPN DFMMT CZ UIF CMPPETUSFBN
CVU UIFZ NVTU CF DPOUJOVPVTMZ UIF SFHVMBUJPO PG XBUFS BOE TBMU
SFNPWFE GSPN UIF CMPPE TP UIBU UIFZ EP OPU SFBDI UPYJD MFWFMT 0OF PG UIF DPOUFOU
NBJO GVODUJPOT PG UIF LJEOFZT JT UP BDU BT ê MUFST
SFNPWJOH XBTUF NPMFDVMFT
GSPN UIF CMPPE QBTTJOH UISPVHI UIFN 5IJT QSPDFTT JT DBMMFE excretion Kidney functions at a glance
r FYDSFUJPO PG XBTUF QSPEVDUT

5IF LJEOFZT BSF BMTP WJUBM JO osmoregulation 5IJT JT UIF DPOUSPM PG
UIF XBUFS BOE TBMU CBMBODF PG UIF CPEZ
UP NBJOUBJO B DPOTUBOU JOUFSOBM XBUFS TPMVCMF UPYJD TVCTUBODFT
FOWJSPONFOU JO UIF CMPPE
UJTTVF ë VJE BOE DZUPQMBTN
XIJDI JT FTTFOUJBM UP BOE ESVHT
FOTVSF UIBU BMM DFMM QSPDFTTFT PDDVS FĄ FDUJWFMZ 0TNPSFHVMBUJPO JT BDIJFWFE r SFHVMBUJPO PG UIF XBUFS BOE TBMU
NBJOMZ CZ SFHVMBUJOH UIF DPNQPTJUJPO BOE WPMVNF PG VSJOF QSPEVDFE CZ DPOUFOU PG UIF CPEZ
UIF LJEOFZT r SFUFOUJPO PG TVCTUBODFT WJUBM UP
UIF CPEZ TVDI BT QSPUFJO BOE
HigjXijgZ d[ i]Z `^YcZn HMVDPTF
r NBJOUFOBODF PG Q) CBMBODF
5IF LJEOFZT BSF TJUVBUFE JO UIF MPXFS CBDL
POF PO FJUIFS TJEF PG UIF TQJOF
r FOEPDSJOF GVODUJPOT
BT TIPXO JO 'JHVSF 11.12 PWFSMFBG
&BDI SFDFJWFT B CMPPE TVQQMZ GSPN
B SFOBM BSUFSZ
XIJDI JT B CSBODI PG UIF NBJO BPSUB "GUFS ê MUSBUJPO
CMPPE && =JB6C =:6AI= 6C9 E=NH>DAD<N >> '+,
MFBWFT UIF LJEOFZ WJB B SFOBM WFJO UIBU KPJOT UIF WFOB DBWB

'JHVSF 11.13 PWFSMFBG
TIPXT B LJEOFZ JO WFSUJDBM TFDUJPO 5ISFF
SFHJPOT BSF WJTJCMF m UIF PVUFS DPSUFY
UIF DFOUSBM NFEVMMB BOE UIF JOOFS
SFOBM QFMWJT 6SJOF QSPEVDFE CZ UIF LJEOFZ DPMMFDUT JO UIF SFOBM QFMWJT BOE
JT DBSSJFE EPXO UP UIF CMBEEFS JO UIF VSFUFS

&BDI LJEOFZ JT NBEF VQ PG NPSF UIBO POF NJMMJPO UJOZ TUSVDUVSFT DBMMFE
nephrons 5IFTF BSF UIF GVODUJPOBM VOJUT PG UIF LJEOFZ
TFMFDUJWFMZ ê MUFSJOH
BOE SFBCTPSCJOH TVCTUBODFT GSPN UIF CMPPE 'JHVSF 11.14 QBHF 269
TIPXT
UIF TUSVDUVSF PG B OFQISPO
XIJDI DPOTJTUT PG B ê MUFSJOH VOJU B DPNQMFY
PG DBQJMMBSJFT DBMMFE B glomerulus TVSSPVOEFE CZ B Bowman’s capsule

kZcV XVkV
VdgiV
gZcVa VgiZgn
gZcVa kZ^c

`^YcZn
jgZiZg
WaVYYZg
jgZi]gV

;^\jgZ &&#&' AdXVi^dc d[ i]Z `^YcZnh#

UPHFUIFS XJUI B UVCF UIBU FYUFOET GSPN UIF ê MUFSJOH VOJU UP UIF SFOBM QFMWJT
5IJT UVCF JT EJWJEFE JOUP GPVS SFHJPOT m UIF QSPYJNBM DPOWPMVUFE UVCVMF

UIF MPPQ PG )FOMF
UIF EJTUBM DPOWPMVUFE UVCVMF BOE ê OBMMZ B DPMMFDUJOH
EVDU &BDI PG UIFTF SFHJPOT IBT B TQFDJê D SPMF UP QMBZ JO VSJOF GPSNBUJPO

=dl i]Z `^YcZn ldg`h

5IF LJEOFZ T DPNQMFY TUSVDUVSF BMMPXT JU UP DBSSZ PVU JUT GVODUJPOT
BNB[JOHMZ Fą DJFOUMZ 5IF QSPDFTT CFHJOT BT CMPPE GSPN UIF SFOBM BSUFSZ
SFBDIFT FBDI HMPNFSVMVT

XVehjaZ
XdgiZm
bZYjaaV

WgVcX] d[
gZcVa kZ^c

WgVcX] d[
gZcVa VgiZgn

#MPPE TVQQMZ UP UIF LJEOFZ JT eZak^h
OPSNBMMZ BCPVU PG UIF IFBSU T
PVUQVU "QQSPYJNBUFMZ PG UIJT jgZiZg
CMPPE ë PX HPFT UP UIF DPSUFY
;^\jgZ &&#&( Adc\^ijY^cVa hZXi^dc d[ V `^YcZn#
'+-

Edh^i^dc d[ V cZe]gdc HigjXijgZ d[ V cZe]gdc

7dlbVcÉh gZcVa 7dlbVcÉh egdm^bVa Y^hiVa
XVehjaZ gZcVa XdckdajiZY XdckdajiZY
XVehjaZ ijWjaZ ijWjaZ
egdm^bVa XdckdajiZY
ijWjaZ Z[[ZgZci XdgiZm
VgiZg^daZ
Y^hiVa XdckdajiZY bZYjaaV
ijWjaZ XdaaZXi^c\
YjXi
adde d[ =ZcaZ
eZak^h
XdaaZXi^c\ YjXi

V[[ZgZci \adbZgjajh
VgiZg^daZ

XdgiZm [gdb gZcVa YZhXZcY^c\
bZYjaaV VgiZgn a^bW d[ adde
eZak^h d[ =ZcaZ

jgZiZg VhXZcY^c\
a^bW d[ adde
d[ =ZcaZ

7addY hjeean VhhdX^ViZY l^i] V cZe]gdc

Z[[ZgZci
VgiZg^daZ

\adbZgjajh

V[[ZgZci
VgiZg^daZ

[gdb
gZcVa
VgiZgn

id
gZcVa
kZ^c

;^\jgZ &&#&) I]Z adXVi^dc! higjXijgZ VcY WaddY hjeean d[ V cZe]gdc#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '+.

JaigVÒ aigVi^dc VcY i]Z \adbZgjajh

Ultrafiltration PDDVST JO UIF HMPNFSVMVT
BT WBSJPVT TNBMM NPMFDVMFT MFBWF
UIF CMPPE

#FDBVTF UIF JODPNJOH afferent BSUFSJPMF B CSBODI PG UIF SFOBM BSUFSZ

IBT B XJEFS EJBNFUFS UIBO UIF PVUHPJOH efferent BSUFSJPMF
CMPPE QSFTTVSF
JO UIF HMPNFSVMVT DBQJMMBSJFT JT WFSZ IJHI m TP IJHI
JO GBDU
UIBU BCPVU
PG UIF CMPPE QMBTNB MFBWFT UIF DBQJMMBSJFT JO UIF HMPNFSVMVT BOE QBTTFT JOUP
UIF #PXNBO T DBQTVMF

5IF CMPPE QMBTNB QBTTFT UISPVHI UISFF MBZFST m UIF XBMM PG UIF DBQJMMBSZ
JO UIF HMPNFSVMVT
UIF basement membrane XIJDI BDUT BT B NPMFDVMBS
ê MUFS
BOE ê OBMMZ UIF FQJUIFMJVN PG UIF #PXNBO T DBQTVMF *U MFBWFT UIF
DBQJMMBSJFT UISPVHI TNBMM QPSFT PS fenestrations
XIJDI UIF IJHI CMPPE
QSFTTVSF DBVTFT UP PQFO JO UIF DBQJMMBSZ XBMMT 5IF GFOFTUSBUJPOT BMMPX BMM
NPMFDVMFT UP QBTT UISPVHI FBTJMZ
CVU ê MUSBUJPO PDDVST BU UIF CBTFNFOU
NFNCSBOF
XIJDI JT NBEF PG B HMZDPQSPUFJO 0OMZ NPMFDVMFT XJUI B
NPMFDVMBS NBTT TNBMMFS UIBO BSF BCMF UP QBTT UISPVHI 4P XBUFS
TBMUT

HMVDPTF
BNJOP BDJET BOE TNBMM QSPUFJOT DBO BMM QBTT UISPVHI UIF CBTFNFOU
NFNCSBOF
CVU JU FĄ FDUJWFMZ QSFWFOUT CMPPE DFMMT BOE MBSHF NPMFDVMFT TVDI
BT QMBTNB QSPUFJOT GSPN MFBWJOH UIF CMPPE 'JHVSF 11.15


5IF CMPPE QMBTNB UIBU IBT QBTTFE UISPVHI UIF CBTFNFOU NFNCSBOF
JT OPX LOPXO BT filtrate *U OPX QBTTFT UISPVHI UIF FQJUIFMJVN PG UIF
#PXNBO T DBQTVMF JOUP UIF OFQISPO
BOE FOUFST UIF QSPYJNBM DPOWPMVUFE
UVCVMF #MPPE DFMMT BOE MBSHF NPMFDVMFT SFNBJO JO UIF CMPPE JO UIF
HMPNFSVMVT DBQJMMBSJFT BOE ë PX PO JOUP UIF FĄ FSFOU BSUFSJPMF

I]Z Vggdlh h]dl ]dl i]Z cZi Z[[ZXi d[ ]^\]Zg egZhhjgZ ^c i]Z XVe^aaVgn VcY adlZg hdajiZ XdcXZcigVi^dc
^c i]Z gZcVa XVehjaZ ^h i]Vi [aj^Y bdkZh dji d[ i]Z XVe^aaVgn VcY ^cid i]Z ajbZc d[ i]Z XVehjaZ#

egZhhjgZ \gVY^Zci hdajiZ XdcXZcigVi^dc \gVY^Zci

gZY WaddY XZaa WaddY eaVhbV edgZ dg WVhZbZci edYdXniZ Ä bdY^[^ZY \adbZgjaVg [^aigViZ
[ZcZhigVi^dc ^c bZbWgVcZ XZaa d[ 7dlbVcÉh ^c ajbZc d[
XVe^aaVgn ZcYdi]Za^jb bdaZXjaVg [^aiZg XVehjaZ lVaa 7dlbVcÉh XVehjaZ

;^\jgZ &&#&* 9ZiV^a d[ i]Z 7dlbVcÉh XVehjaZ h]dl^c\ i]Z WVhZbZci bZbWgVcZ! [ZcZhigViZY XVe^aaVgn VcY edYdXniZh# EdYdXniZh VgZ
hjeedgi^kZ! [ddi"h]VeZY XZaah d[ i]Z XVehjaZ lVaa i]Vi [dgb V cZildg` d[ ha^ih# ;^aigViZ eVhhZh i]gdj\] i]ZhZ ha^ih! VcY ^cid i]Z XVehjaZ#

',%

GZVWhdgei^dc ^c i]Z egdm^bVa XdckdajiZY ijWjaZ

"MPOH XJUI UIF VOXBOUFE NPMFDVMFT
NBOZ VTFGVM TVCTUBODFT XBUFS

HMVDPTF BOE JPOT UIBU UIF CPEZ OFFET
FOUFS UIF #PXNBO T DBQTVMF EVSJOH
VMUSBê MUSBUJPO 5IFTF NVTU CF reabsorbed JOUP UIF CMPPETUSFBN #FUXFFO
BOE PG UIF ê MUSBUF JT SFBCTPSCFE JO UIF QSPYJNBM DPOWPMVUFE UVCVMF
PG UIF OFQISPO 'JHVSF 11.16
5IF XBMM PG UIF UVCVMF JT B TJOHMF MBZFS PG
DFMMT BOE FBDI POF IBT B CPSEFS PG NJDSPWJMMJ UP JODSFBTF JUT TVSGBDF BSFB 5IF
DFMMT IBWF NBOZ NJUPDIPOESJB GVFMMJOH BDUJWF USBOTQPSU UISPVHI NFNCSBOF
QVNQT UIBU TFMFDUJWFMZ SFBCTPSC JPOT BOE HMVDPTF GSPN UIF UVCVMBS ë VJE "MM
UIF HMVDPTF JO UIF ê MUSBUF JT BDUJWFMZ SFBCTPSCFE UPHFUIFS XJUI BMNPTU PG
TPEJVN /B

QPUBTTJVN ,

NBHOFTJVN .H
BOE DBMDJVN $B
JPOT
$IMPSJEF JPOT $M
BSF BCTPSCFE QBTTJWFMZ BOE XBUFS GPMMPXT CZ PTNPTJT BT
UIF TPMVUF DPODFOUSBUJPO PG UIF DFMMT SJTFT EVF UP UIF BDUJWF VQUBLF PG JPOT
BOE HMVDPTF

5IF SFNBJOJOH ê MUSBUF OPX NPWFT JOUP UIF MPPQ PG )FOMF

I]Z adde d[ =ZcaZ

5IF ê MUSBUF UIBU FOUFST UIF loop of Henle TUJMM DPOUBJOT B HPPE EFBM PG
UIF XBUFS UIBU XBT ê MUFSFE GSPN UIF CMPPE 5IF XBMM PG UIF EFTDFOEJOH
MJNC PG UIF MPPQ JT QFSNFBCMF UP XBUFS CVU SFMBUJWFMZ JNQFSNFBCMF UP TBMUT

XIFSFBT UIF BTDFOEJOH MJNC JT JNQFSNFBCMF UP XBUFS
CVU BMMPXT TBMU UP
CF QBTTFE UISPVHI JUT XBMMT 5IF MPPQ QBTTFT EPXO JOUP UIF NFEVMMB PG UIF
LJEOFZ
XIJDI IBT B WFSZ IJHI TBMU DPODFOUSBUJPO
QSPEVDFE CZ UIF MPPQ PG
)FOMF " IJHI TBMU DPODFOUSBUJPO JO UIJT BSFB PG UIF LJEOFZ JT FTTFOUJBM GPS

@Zn WaddY ZcYdi]Za^jb egdm^bVa XdckdajiZY egdm^bVa
VXi^kZ eaVhbV d[ XVe^aaVgn ijWjaZ lVaa ijWjaZ ajbZc
eVhh^kZ

b^idX]dcYg^V
cjXaZjh

69E CV
E^
\ajXdhZ
CV VcY
Vb^cd
6IE VX^Yh
@

\ajXdhZ
VcY Vb^cd VX^Yh

( I]Z WaddY eaVhbV gVe^Yan gZbdkZh ' CV $@ ejbe ^c egdm^bVa ijWjaZ XZaa & B^Xgdk^aa^ ^cXgZVhZ hjg[VXZ VgZV! ]Zae^c\
VWhdgWZY CV ! 8aÄ ! \ajXdhZ VcY bZbWgVcZ jhZh 6IE bVYZ Wn cjbZgdjh jeiV`Z d[ hdajiZh# CV bdkZh ^cid i]Z
Vb^cd VX^Yh# I]^h ]Zaeh [jgi]Zg jeiV`Z b^idX]dcYg^V# I]Z bZbWgVcZ ^h [daYZY id XZaa jh^c\ egdiZ^c bdaZXjaZh ^c i]Z
[gdb i]Z ajbZc d[ i]Z ijWjaZ# ^cXgZVhZ hjg[VXZ VgZV# I]Z ejbe adlZgh bZbWgVcZ! l]^X] Wg^c\ ^c \ajXdhZ
i]Z XdcXZcigVi^dc d[ CV ^c i]Z XZaa# VcY Vb^cd VX^Yh Vi i]Z hVbZ i^bZ#

;^\jgZ &&#&+ GZVWhdgei^dc ^c i]Z egdm^bVa XdckdajiZY ijWjaZ#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> ',&

YZhXZcY^c\ a^bW VhXZcY^c\ a^bW & CV VcY 8aÄ VgZ VXi^kZan igVchedgiZY
dji d[ i]Z VhXZcY^c\ a^bW#

='D CV ' I]^h gV^hZh i]Z XdcXZcigVi^dc d[ CV
='D 8aÄ VcY 8aÄ ^c i]Z i^hhjZ [aj^Y#

( I]^h ^c ijgc XVjhZh i]Z adhh d[ lViZg
[gdb i]Z YZhXZcY^c\ a^bW#

) I]Z adhh d[ lViZg XdcXZcigViZh CV
VcY 8aÄ ^c i]Z YZhXZcY^c\ a^bW#

* CV VcY 8aÄ ^dch Y^[[jhZ dji d[ i]^h
XdcXZcigViZY hdaji^dc ^c i]Z adlZg
eVgi d[ i]Z VhXZcY^c\ a^bW#

='D CV @Zn lVaa ^beZgbZVWaZ id CV !
='D 8aÄ eZgbZVWaZ id lViZg

lVaa eZgbZVWaZ id CV !
^beZgbZVWaZ id lViZg

ADH and control of water loss ;^\jgZ &&#&, I]Z XdjciZg"XjggZci bZX]Vc^hb ^c i]Z adde d[ =ZcaZ Wj^aYh je V ]^\]
CV ^dc VcY 8a ^dc XdcXZcigVi^dc ^c i]Z i^hhjZ Ó j^Y d[ i]Z bZYjaaV#
"%) JT TFDSFUFE CZ UIF QPTUFSJPS
MPCF PG UIF QJUVJUBSZ HMBOE
JO UIF ê OF UVOJOH PG UIF XBUFS DPOUFOU PG UIF CMPPE CZ UIF DPMMFDUJOH EVDU BU
UIF CSBJO *G CMPPE WPMVNF JT B TMJHIUMZ MBUFS TUBHF
MPX BOE NPSF XBUFS JT OFFEFE
JO UIF CPEZ
"%) DBVTFT UIF 8BUFS MFBWFT UIF EFTDFOEJOH MJNC QBTTJWFMZ CZ PTNPTJT
XIJDI JT NBEF
QSPEVDUJPO PG NPSF DPODFOUSBUFE QPTTJCMF CZ UIF BDUJWF USBOTQPSU PG /B BOE $M JPOT PVU PG UIF BTDFOEJOH
VSJOF 0TNPSFDFQUPST JO UIF MJNC JOUP UIF UJTTVF ë VJE PG UIF NFEVMMB 5IF XBUFS FOUFST CMPPE DBQJMMBSJFT
IZQPUIBMBNVT NPOJUPS XBUFS MFWFMT UIBU TVSSPVOE UIF MPPQ PG )FOMF 5IF QSPDFTT JT TVNNBSJTFE JO 'JHVSF 11.17
JO UIF CMPPE BOE DPOUSPM UIF SFMFBTF
PG "%) %FTQJUF UIF MPTT PG XBUFS GSPN UIF MPPQ PG )FOMF
UIF ê MUSBUF UIBU FOUFST
UIF OFYU TFDUJPO PG UIF UVCVMF TUJMM IBT SFMBUJWFMZ IJHI XBUFS DPOUFOU
$BĄ FJOF
BMDPIPM BOE DPME
DPOEJUJPOT TVQQSFTT "%) I]Z Y^hiVa XdckdajiZY ijWjaZ VcY i]Z XdaaZXi^c\ YjXi
QSPEVDUJPO BOE DBO MFBE UP
EFIZESBUJPO JG UPP NVDI XBUFS JT *POT BSF FYDIBOHFE CFUXFFO UIF ê MUSBUF BOE UIF CMPPE JO UIF EJTUBM
MPTU JO VSJOF 4USFTT BOE OJDPUJOF DPOWPMVUFE UVCVMF /B
$M BOE $B JPOT BSF SFBCTPSCFE JOUP UIF CMPPE
JODSFBTF "%) QSPEVDUJPO XIJMF ) BOE , JPOT NBZ CF BDUJWFMZ QVNQFE JOUP UIF UVCVMF
QSPEVDJOH UIF PQQPTJUF FĄ FDU
5IF ê OBM QPSUJPO PG UIF OFQISPO JT UIF DPMMFDUJOH EVDU XIFSF UIF
"MUIPVHI UIF LJEOFZ DBO DPOTFSWF ê OBM BEKVTUNFOU PG XBUFS JT NBEF 'JHVSF 11.18
5IF QFSNFBCJMJUZ PG
XBUFS BMSFBEZ QSFTFOU JO UIF CPEZ
UIF EVDU EFQFOET PO UIF QSFTFODF PS BCTFODF PG antidiuretic hormone
POMZ JOUBLF PG XBUFS CZ ESJOLJOH PS (ADH) *G "%) JT QSFTFOU
UIF EVDU EFWFMPQT NFNCSBOF DIBOOFMT DBMMFE
JO GPPET DBO SFQMBDF XBUFS UIBU IBT aquaporins TP UIBU JU CFDPNFT NPSF QFSNFBCMF BOE XBUFS JT UBLFO CBDL
BMSFBEZ CFFO MPTU JOUP UIF CMPPE *G UIF XBUFS DPOUFOU PG UIF CMPPE JT IJHI
"%) JT OPU
QSPEVDFE TP UIF EVDU CFDPNFT JNQFSNFBCMF BOE XBUFS SFNBJOT JOTJEF UIF
',' OFQISPO
QSPEVDJOH NPSF EJMVUF VSJOF

5IF VSJOF OPX ë PXT GSPN UIF DPMMFDUJOH EVDUT
JOUP UIF SFOBM QFMWJT
BOE EPXO UIF VSFUFS UP UIF CMBEEFS

6 hjbbVgn d[ `^YcZn [jcXi^dc

5BCMF 11.1 DPNQBSFT UIF DPODFOUSBUJPO PG HMVDPTF
VSFB BOE QSPUFJO JO UIF
CMPPE QMBTNB UIBU FOUFST UIF HMPNFSVMVT
JOTJEF UIF HMPNFSVMBS ê MUSBUF BOE
JO VSJOF

Y^hiVa XdckdajiZY ijWjaZ

XdaaZXi^c\ YjXi

I]Z i^hhjZ YZZe ^c i]Z bZYjaaV bZYjaaV ='D 6h jg^cZ eVhhZh Ydlc i]Z
XdciV^ch V kZgn XdcXZcigViZY XdaaZXi^c\ YjXih! lViZg XVc
adde d[ ='D

hdaji^dc d[ CV ! 8aÄ VcY jgZV# =ZcaZ WZ gZVWhdgWZY# I]Z eZgbZVW^a^in

='D ='D d[ i]Z YjXi ^h XdcigdaaZY Wn
i]Z ]dgbdcZ 69=#

eZak^h jg^cZ

;^\jgZ &&#&- LViZg XVc WZ YgVlc dji d[ i]Z XdaaZXi^c\ YjXi Wn i]Z ]^\] hVai XdcXZcigVi^dc ^c i]Z hjggdjcY^c\ i^hhjZ Ó j^Y d[ i]Z bZYjaaV#

HjWhiVcXZ 8dciZci ^c WaddY eaVhbV$ 8dciZci ^c \adbZgjaVg Ò aigViZ$ 8dciZci ^c jg^cZ$b\ &%% ba &
b\ &%% ba & b\ &%% ba &

jgZV (% (% '%%%
\ajXdhZ .% .% %
egdiZ^ch ,*%
%%

IVWaZ &&#& I]Z XdcXZcigVi^dch d[ hdbZ `Zn hjWhiVcXZh ^c WaddY eaVhbV! \adbZgjaVg Ò aigViZ VcY jg^cZ#

1SPUFJO TIPVME OPU CF QSFTFOU JO UIF VSJOF PG B IFBMUIZ QFSTPO XIPTF
LJEOFZT BSF XPSLJOH QSPQFSMZ CFDBVTF QSPUFJO NPMFDVMFT BSF UPP MBSHF UP
ê U UISPVHI UIF NFNCSBOF ê MUFST JO UIF HMPNFSVMVT

6SFB JT UPYJD JO IJHI DPODFOUSBUJPOT BOE JUT DPOUFOU JODSFBTFT JO VSJOF
BT XBUFS JT BCTPSCFE GSPN UIF ê MUSBUF

(MVDPTF
ê MUFSFE GSPN UIF CMPPE
GPSNT QBSU PG UIF HMPNFSVMBS ê MUSBUF CVU
JT SFBCTPSCFE CZ BDUJWF USBOTQPSU BOE TIPVME OPU CF QSFTFOU JO UIF VSJOF PG
B IFBMUIZ QFSTPO (MVDPTF JO VSJOF JT GSFRVFOUMZ B TJHO PG VOUSFBUFE EJBCFUFT
(MVDPTF DPODFOUSBUJPO JO B EJBCFUJD QFSTPO T CMPPE SJTFT UP B IJHI MFWFM
CFDBVTF UIFJS CMPPE TVHBS MFWFM JT OPU SFHVMBUFE QSPQFSMZ CZ JOTVMJO )JHI
CMPPE HMVDPTF MFWFMT NFBO UIF QVNQT JO UIF QSPYJNBM DPOWPMVUFE UVCVMF
DBOOPU SFNPWF JU BMM GPSN UIF ê MUSBUF BOE SFUVSO JU UP UIF CMPPETUSFBN "T B
SFTVMU
TPNF HMVDPTF SFNBJOT JO UIF OFQISPO BOE JT MPTU JO UIF VSJOF CFDBVTF
JU DBOOPU CF SFBCTPSCFE JO BOZ PUIFS SFHJPOT PG UIF UVCVMF

+ 9ZÒ cZ i]Z iZgbh ÈZmXgZi^dcÉ VcY ÈdhbdgZ\jaVi^dcÉ#
, 9gVl VcY aVWZa i]Z [jcXi^dcVa hZXi^dch i]Vi bV`Z je i]Z cZe]gdc#
- Djia^cZ i]Z gdaZ d[ i]Z adde d[ =ZcaZ ^c gZ\jaVi^c\ i]Z XdciZci d[ jg^cZ#
. Djia^cZ i]Z gdaZ d[ i]Z Z[[ZgZci VcY V[[ZgZci VgiZg^daZh ^c jaigVÒ aigVi^dc#
&% :meaV^c i]Z gdaZ d[ b^Xgdk^aa^ ^c i]Z XZaah d[ i]Z egdm^bVa XdckdajiZY ijWjaZ#
&& A^hi i]Z aVnZgh i]gdj\] l]^X] V \ajXdhZ bdaZXjaZ eVhhZh Yjg^c\

jaigVÒ aigVi^dc#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> ',(

&' Djia^cZ i]Z gdaZ d[ 69= ^c Xdcigdaa^c\ i]Z lViZg XdciZci d[ jg^cZ#

&( Hj\\Zhi l]n V Y^VWZi^X eZghdc bVn egdYjXZ jg^cZ XdciV^c^c\ \ajXdhZ#

&&#) GZegdYjXi^dc

6hhZhhbZci hiViZbZcih

r "OOPUBUF B MJHIU NJDSPHSBQI PG UFTUJT UJTTVF UP TIPX UIF MPDBUJPO BOE GVODUJPO PG JOUFSTUJUJBM DFMMT -FZEJH DFMMT



HFSNJOBM FQJUIFMJVN DFMMT
EFWFMPQJOH TQFSNBUP[PB BOE 4FSUPMJ DFMMT

r 0VUMJOF UIF QSPDFTTFT JOWPMWFE JO TQFSNBUPHFOFTJT XJUIJO UIF UFTUJT
JODMVEJOH NJUPTJT
DFMM HSPXUI
UIF UXP EJWJTJPOT

PG NFJPTJT BOE DFMM EJĄ FSFOUJBUJPO

r 4UBUF UIF SPMF PG -)
UFTUPTUFSPOF BOE '4) JO TQFSNBUPHFOFTJT
r "OOPUBUF B EJBHSBN PG UIF PWBSZ UP TIPX UIF MPDBUJPO BOE GVODUJPO PG HFSNJOBM FQJUIFMJVN
QSJNBSZ GPMMJDMFT
NBUVSF

GPMMJDMF BOE TFDPOEBSZ PPDZUF

r 0VUMJOF UIF QSPDFTTFT JOWPMWFE JO PPHFOFTJT XJUIJO UIF PWBSZ
JODMVEJOH NJUPTJT
DFMM HSPXUI
UIF UXP EJWJTJPO PG

NFJPTJT
UIF VOFRVBM EJWJTJPO PG DZUPQMBTN BOE UIF EFHFOFSBUJPO PG UIF QPMBS CPEZ

r %SBX BOE MBCFM B EJBHSBN PG B NBUVSF TQFSN BOE FHH
r 0VUMJOF UIF SPMF PG UIF FQJEJEZNJT
TFNJOBM WFTJDMF BOE QSPTUBUF HMBOE JO UIF QSPEVDUJPO PG TFNFO
r $PNQBSF UIF QSPDFTTFT PG TQFSNBUPHFOFTJT BOE PPHFOFTJT
JODMVEJOH UIF OVNCFS PG HBNFUFT BOE UJNJOH PG UIF

GPSNBUJPO BOE SFMFBTF PG HBNFUFT

r %FTDSJCF UIF QSPDFTT PG GFSUJMJTBUJPO
JODMVEJOH UIF BDSPTPNF SFBDUJPO
QFOFUSBUJPO PG UIF FHH NFNCSBOF CZ B TQFSN

BOE UIF DPSUJDBM SFBDUJPO

r 0VUMJOF UIF SPMF PG )$( JO FBSMZ QSFHOBODZ
r 0VUMJOF FBSMZ FNCSZP EFWFMPQNFOU VQ UP UIF JNQMBOUBUJPO PG UIF CMBTUPDZTU
r &YQMBJO UIF TUSVDUVSF BOE GVODUJPOT PG UIF QMBDFOUB
JODMVEJOH JUT IPSNPOBM SPMF JO TFDSFUJPO PG PFTUSPHFO BOE

QSPHFTUFSPOF UP NBJOUBJO QSFHOBODZ

r 4UBUF UIBU UIF GFUVT JT TVQQPSUFE BOE QSPUFDUFE CZ UIF BNOJPUJD TBD BOE BNOJPUJD ë VJE
r 4UBUF UIBU NBUFSJBMT BSF FYDIBOHFE CFUXFFO UIF NBUFSOBM BOE GFUBM CMPPE JO UIF QMBDFOUB
r 0VUMJOF UIF QSPDFTT PG CJSUI BOE JUT IPSNPOBM DPOUSPM JODMVEJOH UIF DIBOHFT JO QSPHFTUFSPOF BOE PYZUPDJO MFWFMT

BOE QPTJUJWF GFFECBDL

HeZgbVid\ZcZh^h

Spermatogenesis JT UIF QSPEVDUJPO PG NBUVSF TQFSN DFMMT TQFSNBUP[PB

JO UIF UFTUJT .PSF UIBO NJMMJPO TQFSN DFMMT BSF QSPEVDFE FBDI EBZ JO
B QSPDFTT UIBU UBLFT QMBDF JO UIF OBSSPX TFNJOJGFSPVT UVCVMFT NBLJOH VQ
FBDI UFTUJT 'JHVSFT 11.19 BOE 11.20


4QFSN QSPEVDUJPO BOE EFWFMPQNFOU UBLFT QMBDF GSPN UIF PVUFS QBSU PG
UIF seminiferous tubules UPXBSET UIF DFOUSBM MVNFO
XIFSF TQFSN DFMMT
BSF FWFOUVBMMZ SFMFBTFE &BDI UVCVMF JT FODMPTFE JO B CBTFNFOU NFNCSBOF
CFOFBUI XIJDI JT BO PVUFS MBZFS PG HFSNJOBM FQJUIFMJVN DFMMT 5IFTF
EJQMPJE DFMMT n
EJWJEF SFHVMBSMZ CZ NJUPTJT UP QSPEVDF NPSF EJQMPJE DFMMT

XIJDI FOMBSHF BOE BSF LOPXO BT primary spermatocytes

1SJNBSZ TQFSNBUPDZUFT EJWJEF CZ NFJPTJT BOE UIFJS ê STU EJWJTJPO
QSPEVDFT UXP IBQMPJE n
DFMMT 5IF TFDPOE EJWJTJPO PG UIFTF UXP DFMMT
SFTVMUT JO GPVS TQFSNBUJET n


',)

%FWFMPQJOH TQFSN BSF BUUBDIFE UP Sertoli cells 'JHVSF 11.20

XIJDI heZgb \Zgb^cVa
BSF BMTP DBMMFE OVSTF DFMMT 5IFTF MBSHF DFMMT BTTJTU UIF EJĄ FSFOUJBUJPO PG Ze^i]Za^jb
JNNBUVSF TQFSNBUJET JOUP TQFSNBUP[PB BOE QSPWJEF OPVSJTINFOU GPS UIFN

4QFSNBUP[PB UIBU IBWF EFWFMPQFE UIFJS UBJMT 'JHVSF 11.21
PWFSMFBG

EFUBDI GSPN UIF 4FSUPMJ DFMMT BOE BSF DBSSJFE EPXO UIF MVNFO PG UIF
UVCVMF UP UIF FQJEJEZNJT PG UIF UFTUJT

=dgbdcZh VcY heZgb egdYjXi^dc ajbZc d[ V ^ciZghi^i^Va XZaah
hZb^c^[Zgdjh ijWjaZ
4QFSN QSPEVDUJPO JT DPOUSPMMFE CZ UISFF IPSNPOFT m GPMMJDMF TUJNVMBUJOH
IPSNPOF '4)
BOE MVUFJOJTJOH IPSNPOF -)
GSPN UIF QJUVJUBSZ HMBOE
;^\jgZ &&#&. A^\]i b^Xgd\gVe] d[ igVchkZghZ
BOE UFTUPTUFSPOF QSPEVDFE CZ UIF UFTUFT hZXi^dc d[ V iZhi^h h]dl^c\ hZb^c^[Zgdjh
ijWjaZh l^i] ^ciZghi^i^Va XZaah WZilZZc i]Zb
r FSH TUJNVMBUFT NFJPTJT JO TQFSNBUPDZUFT
UP QSPEVDF IBQMPJE DFMMT &,% #
r Testosterone TUJNVMBUFT UIF NBUVSBUJPO PG TFDPOEBSZ TQFSNBUPDZUFT

JOUP NBUVSF TQFSN DFMMT

r LH TUJNVMBUFT UIF TFDSFUJPO PG UFTUPTUFSPOF CZ UIF UFTUJT

:e^Y^Ynb^h! hZb^cVa kZh^XaZh VcY hZbZc egdYjXi^dc

4QFSN DFMMT BSF TUPSFE BOE NBUVSF JO UIF epididymis TFF 'JHVSF 6.29 PO
QBHF 158

XIFSF UIFZ BMTP EFWFMPQ UIF BCJMJUZ UP TXJN 4QFSN DFMMT BSF
SFMFBTFE BU FKBDVMBUJPO JO B OVUSJFOU SJDI ë VJE LOPXO BT semen 4FNFO JT
QSPEVDFE CZ UXP seminal vesicles BOE UIF prostate gland *U JT NJYFE
XJUI UIF TQFSN DFMMT BT UIFZ MFBWF UIF FQJEJEZNJT BOE NPWF BMPOH UIF

IZhi^h ^c hZXi^dc heZgb YjXi

XdccZXi^kZ i^hhjZ!
WaddY XVe^aaVg^Zh VcY
^ciZghi^i^Va XZaah

hZb^c^[Zgdjh ijWjaZh
Ä h^iZ d[ heZgb
egdYjXi^dc

<gdje d[ i]gZZ :caVg\ZY edgi^dc d[ i]Z lVaa d[ V hZb^c^[Zgdjh
hZb^c^[Zgdjh ijWjaZh ijWjaZ h]dl^c\ hiV\Zh ^c heZgb YZkZadebZci

WaddY XVe^aaVgn heZgb iV^a ^c
ajbZc XZcigVa heVXZ ajbZc d[
;^\jgZ &&#'% HigjXijgZ d[ i]Z iZhi^h# ijWjaZ

]ZVY d[ heZgb
ZbWZYYZY ^c
HZgida^ XZaa

heZgbVi^Yh

^ciZghi^i^Va XZaah \Zgb^cVa hZXdcYVgn
XZaah d[ AZnY^\ Ze^i]Za^jb heZgbVidXniZ

\Zgb^cVa Ze^i]Za^jb

hZb^c^[Zgdjh ijWjaZ heZgbVidXniZ eg^bVgn cjXaZjh d[ HZgida^ XZaa
Y^k^Y^c\ heZgbVidXniZ HZgida^ XZaa

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> ',*

b^idX]dcYg^V

VXgdhdbZ cjXaZjh [^aVbZci
XZcig^daZ

'#* Nb

]ZVY b^YYaZ e^ZXZ iV^a

;^\jgZ &&#'& HigjXijgZ d[ V ]jbVc heZgb XZaa# IdiVa aZc\i] ^h +% Nb#

5P SFNJOE ZPVSTFMG PG UIF TUSVDUVSF vas deferens TQFSN EVDU
'MVJE GSPN UIF TFNJOBM WFTJDMFT NBLFT VQ
PG UIF NBMF SFQSPEVDUJWF TZTUFN
BCPVU PG TFNFO *U JT SJDI JO GSVDUPTF
XIJDI QSPWJEFT FOFSHZ GPS UIF
MPPL CBDL BU 'JHVSF 6.29 PO QBHF TQFSN DFMMT UP TXJN
BOE JU BMTP DPOUBJOT QSPUFDUJWF NVDVT 5IF QSPTUBUF
158 HMBOE QSPEVDFT BO BMLBMJOF ë VJE UIBU IFMQT UIF TQFSN DFMMT UP TVSWJWF JO
UIF BDJEJD DPOEJUJPOT PG UIF WBHJOB

Dd\ZcZh^h

Oogenesis QSPEVDFT GFNBMF HBNFUFT
UIF ova 6OMJLF TQFSNBUPHFOFTJT

XIJDI UBLFT QMBDF JO BO BEVMU NBMF
PPHFOFTJT CFHJOT JO UIF PWBSJFT PG B
GFNBMF XIFO TIF JT TUJMM B GFUVT Oogonia
UIF HFSNJOBM FQJUIFMJBM DFMMT
XJUIJO UIF PWBSJFT PG UIF GFNBMF GFUVT
EJWJEF CZ NJUPTJT UP QSPEVDF NPSF
EJQMPJE n
DFMMT 5IFTF FOMBSHF UP GPSN primary oocytes
XIJDI BSF BMTP
EJQMPJE 1SJNBSZ PPDZUFT VOEFSHP UIF ê STU TUBHFT PG NFJPTJT CVU UIJT TUPQT
EVSJOH QSPQIBTF MFBWJOH UIF QSJNBSZ PPDZUF TVSSPVOEFE CZ B MBZFS PG
GPMMJDMF DFMMT JO B TUSVDUVSF LOPXO BT UIF primary follicle 'JHVSF 11.22


hZXdcYVgn [daa^XaZ \gdl^c\ eg^bVgn [daa^XaZ

[aj^Y cjXaZjh dd\dc^jb \Zgb^cVa Ze^i]Za^jb
eg^bVgn ddXniZ
hZXdcYVgn higdbV Å
ddXniZ bVijg^c\ [daa^XaZh XdciV^ch XdccZXi^kZ
i^hhjZ VcY WaddY kZhhZah
;H= dkVg^Vc [daa^XaZ XVjhZh hlZaa^c\
VcY A= Vi hjg[VXZ d[ dkVgn YZ\ZcZgVi^c\
gZfj^gZY Xdgejh ajiZjb
Xdgejh ajiZjb

[daa^XaZ XZaah aVg\Z [aj^Y"[^aaZY gjeijgZY
hjggdjcY^c\ heVXZ dkVg^Vc [daa^XaZ
i]Z ddXniZ

gZaZVhZ d[ hZXdcYVgn
ddXniZ 2 dkjaVi^dc

;^\jgZ &&#'' HiV\Zh ^c i]Z YZkZadebZci d[ dcZ [daa^XaZ ^c V ]jbVc dkVgn# I]Z Vggdlh h]dl i]Z hZfjZcXZ d[ ZkZcih#

',+

%FWFMPQNFOU OPX DFBTFT CVU UIF PWBSJFT PG B CBCZ HJSM DPOUBJO BSPVOE 5P SFNJOE ZPVSTFMG BCPVU UIF
QSJNBSZ GPMMJDMFT BU CJSUI 5IF SFNBJOJOH TUBHFT PG PPHFOFTJT BSF QSPEVDUJPO PG QSPHFTUFSPOF CZ
TIPXO JO 'JHVSF 11.22 UIF DPSQVT MVUFVN
MPPL CBDL BU
$IBQUFS 6
QBHF 161
"U QVCFSUZ
EFWFMPQNFOU PG UIF QSJNBSZ GPMMJDMFT DPOUJOVFT %VSJOH
FBDI NFOTUSVBM DZDMF
B GFX GPMMJDMFT QSPDFFE UP DPNQMFUF UIF ê STU EJWJTJPO
PG NFJPTJT 5XP IBQMPJE DFMMT n
BSF QSPEVDFE CVU UIF DZUPQMBTN EJWJEFT
VOFRVBMMZ TP UIBU POF DFMM JT NVDI MBSHFS UIBO UIF PUIFS 5IF MBSHFS DFMM
JT LOPXO BT UIF secondary oocyte n
BOE UIF TNBMMFS DFMM JT UIF polar
body n
5IF QPMBS CPEZ EFHFOFSBUFT BOE EPFT OPU EFWFMPQ GVSUIFS

5IF TFDPOEBSZ PPDZUF
QSPUFDUFE XJUIJO JUT GPMMJDMF
CFHJOT NFJPTJT ** CVU
TUPQT JO QSPQIBTF ** "U UIF TBNF UJNF
UIF GPMMJDMF DFMMT EJWJEF BOE QSPEVDF B
ë VJE UIBU DBVTFT UIF GPMMJDMF UP TXFMM "U UIF QPJOU PG ovulation
UIF GPMMJDMF
CVSTUT
SFMFBTJOH UIF TFDPOEBSZ PPDZUF
XIJDI ë PBUT UPXBSET UIF oviduct
GBMMPQJBO UVCF
"MUIPVHI PWVMBUJPO JT PGUFO EFTDSJCFE BT UIF SFMFBTF PG UIF
PWVN
UIF DFMM UIBU JT SFMFBTFE JT JO GBDU TUJMM B TFDPOEBSZ PPDZUF 5IF EFUBJMFE
TUSVDUVSF PG B TFDPOEBSZ PPDZUF JT TIPXO JO 'JHVSF 11.23
BOE 'JHVSF 11.24
PWFSMFBG
TIPXT TFDPOEBSZ PPDZUFT JO B SBCCJU PWBSZ JO TFDUJPO

"GUFS GFSUJMJTBUJPO
UIF TFDPOEBSZ PPDZUF DPNQMFUFT NFJPTJT **
CFDPNJOH
B NBUVSF PWVN
BOE FYQFMT B TFDPOE QPMBS CPEZ
XIJDI EFHFOFSBUFT 5IF
FNQUZ GPMMJDMF JO UIF PWBSZ EFWFMPQT UP CFDPNF UIF corpus luteum PS
ZFMMPX CPEZ
XIJDI QSPEVDFT UIF IPSNPOF QSPHFTUFSPOF

8dbeVg^c\ heZgbVid\ZcZh^h VcY dd\ZcZh^h

5IFSF BSF B OVNCFS PG TJNJMBSJUJFT BOE BMTP TFWFSBM EJĄ FSFODFT CFUXFFO UIF
QSPDFTTFT PG TQFSNBUPHFOFTJT BOE PPHFOFTJT #PUI JOWPMWF UIF EJWJTJPO PG
DFMMT JO UIF HFSNJOBM FQJUIFMJVN CZ NJUPTJT
BOE UIF HSPXUI PG DFMMT CFGPSF
UIFZ VOEFSHP NFJPTJT *O CPUI DBTFT
NFJPTJT QSPEVDFT IBQMPJE HBNFUFT
BT
TIPXO JO 'JHVSF 11.25 PWFSMFBG
5BCMF 11.2 QBHF 279
TVNNBSJTFT UIF
EJĄ FSFODFT BOE TJNJMBSJUJFT JO UIF UXP QSPDFTTFT

XnideaVhb XdciV^c^c\ hZXdcYVgn ddXniZ
dg\VcZaaZh WZXdbZh i]Z
dkjb V[iZg bZ^dh^h >>

cjXaZjh ]Vead^Y

anhdhdbZh Xdgi^XVa
\gVcjaZh

[^ghi edaVg WdYn a^e^Y YgdeaZih Ä
[ddY gZhZgkZ
&)% Nb
odcV eZaajX^YV Ä V _Zaan"a^`Z
aVnZg hZXgZiZY Wn i]Z
[daa^XaZ XZaah

[daa^XaZ XZaah XdgdcV gVY^ViV

;^\jgZ &&#'( HigjXijgZ d[ i]Z hZXdcYVgn ddXniZ VcY hjggdjcY^c\ higjXijgZh Vi dkjaVi^dc#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> ',,

bVijgZ dkVg^Vc [daa^XaZ hZXdcYVgn ddXniZ

;^\jgZ &&#') Adc\^ijY^cVa hZXi^dc d[ i]Z dkVgn d[ V gVWW^i h]dl^c\ V bVijgZ [daa^XaZ
''#* #

B^idh^h Y^ead^Y B^idh^h Y^ead^Y
heZgbVid\dc^V
dd\dc^V
egdYjXZY ^c ZbWgnd

\gdli] \gdli]

BZ^dh^h BZ^dh^h

eg^bVgn heZgbVidXniZ Y^ead^Y eg^bVgn ddXniZ Y^ead^Y
egdYjXZY ^c ZbWgnd
hide
hZXdcYVgn ddXniZ
hZXdcYVgn heZgbVidXniZ ]Vead^Y V[iZg ejWZgin ]Vead^Y

edaVg WdYn hide

heZgbVi^Y hZXdcYVgn ddXniZ
bVijgVi^dc d[ heZgb dcZ V bdci]

bVijgVi^dc d[ ddXniZ edaVg WdYn
V[iZg dkjaVi^dc

bVcn heZgbVidodV ]Vead^Y dcZ dkjb ]Vead^Y

;^\jgZ &&#'* 6 XdbeVg^hdc d[ heZgbVid\ZcZh^h VcY dd\ZcZh^h#

',-

Dd\ZcZh^h HeZgbVid\ZcZh^h

H^b^aVg^i^Zh Wdi] WZ\^c l^i] egdYjXi^dc d[ XZaah Wn b^idh^h
^c Wdi]! XZaah \gdl WZ[dgZ bZ^dh^h

^c Wdi]! ild Y^k^h^dch d[ bZ^dh^h egdYjXZ i]Z ]Vead^Y \VbZiZ

9^[[ZgZcXZh dcZ hZXdcYVgn ddXniZ ^h egdYjXZY eZg bZchigjVa XnXaZ b^aa^dch d[ heZgb XZaah VgZ egdYjXZY Xdci^cjdjhan

dcan dcZ aVg\Z \VbZiZ ^h egdYjXZY eZg bZ^dh^h [djg hbVaa \VbZiZh VgZ egdYjXZY eZg bZ^dh^h

dXXjgh ^c dkVg^Zh! l]^X] iZcY id VaiZgcViZ ddXniZ dXXjgh ^c iZhiZh! l]^X] Wdi] egdYjXZ heZgb XZaah
egdYjXi^dc

ZVgan hiV\Zh dXXjg Yjg^c\ [ZiVa YZkZadebZci egdXZhh WZ\^ch Vi ejWZgin

gZaZVhZY Vi dkjaVi^dc Yjg^c\ i]Z bZchigjVa XnXaZ gZaZVhZY Vi Z_VXjaVi^dc

dkjaVi^dc XZVhZh Vi bZcdeVjhZ heZgb egdYjXi^dc Xdci^cjZh i]gdj\]dji Vc VYjai bVaZÉh
a^[Z

IVWaZ &&#' Dd\ZcZh^h VcY heZgbVid\ZcZh^h XdbeVgZY#

;Zgi^a^hVi^dc 5P SFNJOE ZPVSTFMG PG UIF TUSVDUVSF
PG UIF GFNBMF SFQSPEVDUJWF TZTUFN

%VSJOH TFYVBM JOUFSDPVSTF
NJMMJPOT PG TQFSN DFMMT BSF FKBDVMBUFE JOUP UIF MPPL CBDL BU 'JHVSF 6.30 PO QBHF
WBHJOB BOE TPNF PG UIFN NBLF UIFJS XBZ UISPVHI UIF DFSWJY BOE VUFSVT 160
UPXBSET UIF PWJEVDUT 0OMZ B WFSZ TNBMM OVNCFS PG UIF FKBDVMBUFE TQFSN
XJMM DPNQMFUF UIF KPVSOFZ
XIJDI JT B DPOTJEFSBCMF EJTUBODF GPS UIF UJOZ )$( JT FYDSFUFE JO UIF VSJOF
DFMMT 'PS GFSUJMJTBUJPO UP CF TVDDFTTGVM
NBOZ TQFSN DFMMT NVTU CF QSFTFOU UP PG B QSFHOBOU XPNBO BOE JU JT
QFOFUSBUF UIF PVUFS MBZFST PG GPMMJDMF DFMMT DPWFSJOH UIF TFDPOEBSZ PPDZUF UIJT IPSNPOF UIBU JT EFUFDUFE JO
0OMZ POF TQFSN DFMM XJMM CSFBL UISPVHI BOE SFBDI UIF QMBTNB NFNCSBOF B QSFHOBODZ UFTU XJUI UIF VTF PG
BOE FOUFS JU 'FSUJMJTBUJPO VTVBMMZ PDDVST JO POF PG UIF PWJEVDUT BOE JT UIF NPOPDMPOBM BOUJCPEJFT
NPNFOU XIFO POF TQFSN DFMM GVTFT XJUI UIF TFDPOEBSZ PPDZUF UP GPSN
B zygote && =JB6C =:6AI= 6C9 E=NH>DAD<N >> ',.

5IF TFRVFODF PG FWFOUT JT TVNNBSJTFE JO 'JHVSF 11.26 PWFSMFBG


EgZ\cVcXn

"QQSPYJNBUFMZ IPVST BGUFS GFSUJMJTBUJPO
UIF [ZHPUF CFHJOT UP EJWJEF CZ
NJUPTJT .JUPTJT DPOUJOVFT BOE
BGUFS BCPVU ê WF EBZT PG EJWJTJPO
QSPEVDFT
CBMM PG BSPVOE DFMMT LOPXO BT B blastocyst
BT TIPXO JO 'JHVSF 11.27
PWFSMFBG
"T UIFTF EJWJTJPOT BSF PDDVSSJOH
UIF CBMM PG DFMMT JT NPWFE EPXO
UIF PWJEVDU UPXBSET UIF VUFSVT "GUFS BCPVU TFWFO EBZT
JU SFBDIFT UIF
VUFSVT BOE TFUUMFT JO UIF endometrium MJOJOH
XIFSF JU JNQMBOUT JUTFMG BOE
DPOUJOVFT UP EJWJEF BOE EFWFMPQ JOUP BO embryo

0ODF UIF CMBTUPDZTU IBT CFDPNF FTUBCMJTIFE JO UIF FOEPNFUSJVN
JU
CFHJOT UP TFDSFUF UIF IPSNPOF human chorionic gonadotrophin
HCG
)$( USBWFMT JO UIF CMPPETUSFBN UP UIF PWBSZ
XIFSF JUT SPMF JT
UP NBJOUBJO UIF DPSQVT MVUFVN
UIF NBTT PG DFMMT UIBU EFWFMPQFE GSPN UIF
FNQUZ GPMMJDMF 5IF DPSQVT MVUFVN QSPEVDFT QSPHFTUFSPOF BOE PFTUSPHFO

XIJDI m JO B OPO QSFHOBOU XPNBO m NBJOUBJO UIF FOEPNFUSJVN VOUJM
UIF FOE PG UIF NFOTUSVBM DZDMF
XIFO UIF DPSQVT MVUFVN EFHFOFSBUFT
%VSJOH QSFHOBODZ
JU JT JNQPSUBOU UIBU UIF MJOJOH SFNBJOT JO QMBDF )$(
TUJNVMBUFT UIF DPSQVT MVUFVN TP UIBU JU HSPXT BOE DPOUJOVFT UP QSPEVDF JUT

& BVcn heZgb XZaah [^ghi edaVg WdYn hZXdcY edaVg WdYn
Vgg^kZ Vi i]Z bVn WZ egZhZci [daa^XaZ XZaah
odcV eZaajX^YV
hZXdcYVgn heZgb W^cY^c\
gZXZeidg
ddXniZ#
VXgdhdbZ

' HeZgb eVhh i]gdj\] cjXaZjh d[ hZXdcYVgn ddXniZ dg Z\\

i]Z [daa^XaZ XZaah# Z\\ Xdgi^XVa hZXdcYVgn ddXniZ
\gVcjaZ dg Z\\
bZbWgVcZ
heVXZ Z\\
( HeZgb gZVX] i]Z XnideaVhb
odcV eZaajX^YV
VcY W^cY id ^i# heZgb
cjXaZjh

) I]Z VXgdhdbZ gZVXi^dc dXXjgh# - L]Zc i]Z heZgb VcY dkjb cjXaZ^
:conbZh [gdb ^ch^YZ i]Z VXgdhdbZ ]VkZ bZg\ZY! i]Z dkjb ^h [Zgi^a^hZY
VgZ gZaZVhZY VcY egdiZVhZh Y^\Zhi VcY `cdlc Vh V on\diZ#
V eVi]lVn i]gdj\] i]Z odcV eZaajX^YV#
, I]Z hZXdcYVgn ddXniZ XdbeaZiZh
* I]Z bZbWgVcZh d[ i]Z heZgb VcY bZ^dh^h >> VcY V hZXdcY edaVg WdYn
ddXniZ [jhZ! ig^\\Zg^c\ i]Z Xdgi^XVa ^h ZmeZaaZY#
gZVXi^dc! VcY i]Z heZgb cjXaZjh ZciZgh#
+ 8dgi^XVa \gVcjaZh [jhZ l^i] i]Z eaVhbV bZbWgVcZ
;^\jgZ &&#'+ I]Z hiV\Zh d[ [Zgi^a^hVi^dc# VcY gZaZVhZ i]Z^g XdciZcih# :conbZh XVjhZ i]Z odcV eZaajX^YV
id ]VgYZc hd i]Vi cd [jgi]Zg heZgb XVc ZciZg#

WaVhidXnhi

'"XZaa hiV\Z -"XZaa hiV\Z WVaa d[ XZaah

dk^YjXi

[Zgi^a^hZY
Z\\ XZaa

Z\\ XZaa [aj^Y"[^aaZY ^ccZg XZaa
hjggdjcYZY Wn
[daa^XaZ XZaah WaVhidXnhi bVhh bVhh
bVn WZ
dkjaVi^dc ^beaVciZY
dXXjggZY ]ZgZ
]ZgZ

dkVgn

YZkZade^c\ Xdgejh

[daa^XaZ ajiZjb

;^\jgZ &&#', I]Z WaVhidXnhi Xdch^hih d[ Vc djiZg aVnZg d[ XZaah ZcXadh^c\ Vc ^ccZg XZaa bVhh VcY V Ó j^Y"Ò aaZY heVXZ# I]Z djiZg aVnZg [dgbh
eVgi d[ i]Z eaVXZciV VcY i]Z ^ccZg XZaa bVhh YZkZadeh id WZXdbZ i]Z WdYn d[ i]Z ZbWgnd#

IPSNPOFT GPS UIF ê STU UISFF NPOUIT trimester
PG QSFHOBODZ 5IFSFBGUFS

UIF QMBDFOUB JT GVMMZ GPSNFE BOE QSPEVDFT QMBDFOUBM QSPHFTUFSPOF BOE
PFTUSPHFO
TP UIF DPSQVT MVUFVN EFHFOFSBUFT

5IF FNCSZP HSPXT BOE EFWFMPQT "GUFS BCPVU POF NPOUI
JU JT POMZ
NN MPOH CVU IBT B CFBUJOH IFBSU BOE UIF CFHJOOJOHT PG B OFSWPVT TZTUFN

'-%

'SPN UXP NPOUIT POXBSET
JU JT LOPXO BT B fetus 5IF GFUVT BU UIJT TUBHF Prenatal testing m
JT m NN MPOH BOE IBT SFDPHOJTBCMF MJNCT XJUI EFWFMPQJOH CPOFT 5IF amniocentesis and CVS
VUFSVT MJOJOH QSPWJEFT OPVSJTINFOU GPS UIF FBSMZ FNCSZP CVU UIF QMBDFOUB
TPPO GPSNT GSPN UIF FOEPNFUSJVN BOE GFUBM NFNCSBOFT BOE CZ BCPVU "NOJPDFOUFTJT JT POF PG B OVNCFS
XFFLT JU JT GVMMZ GVODUJPOJOH 5IF GFUVT JT DPOOFDUFE UP UIF QMBDFOUB PG UFDIOJRVFT VTFE JO QSFOBUBM
CZ UIF umbilical cord BOE JT TVSSPVOEFE CZ B ë VJE ê MMFE TBD DBMMFE UIF UFTUJOH UP DIFDL IVNBO GFUVTFT
amnion
XIJDI DPOUBJOT amniotic fluid 5IF GFUVT JT TVQQPSUFE JO UIJT GPS BCOPSNBMJUJFT " ê OF OFFEMF
ë VJE UISPVHIPVU JUT EFWFMPQNFOU BOE JT QSPUFDUFE CZ JU GSPN CVNQT BOE JT JOTFSUFE UISPVHI UIF NPUIFS T
LOPDLT
BT UIF ë VJE JT BO FĄ FDUJWF TIPDL BCTPSCFS "NOJPUJD ë VJE BMTP BCEPNFO JOUP UIF BNOJPUJD TBD BOE
FOBCMFT UIF HSPXJOH GFUVT UP NPWF BOE EFWFMPQ JUT NVTDMFT BOE TLFMFUPO B TNBMM TBNQMF PG BNOJPUJD ë VJE
JT UBLFO 5IF ë VJE DPOUBJOT GFUBM
I]Z eaVXZciV DFMMT
XIJDI DBO CF DVMUVSFE GPS
m XFFLT VOUJM UIF DFMMT EJWJEF
5IF EFWFMPQJOH GFUVT EFQFOET PO JUT NPUIFS GPS BMM JUT OVUSJFOUT BOE BOE DISPNPTPNFT CFDPNF WJTJCMF
PYZHFO BOE GPS UIF EJTQPTBM PG JUT XBTUF DBSCPO EJPYJEF BOE VSFB 5IF 5IF DISPNPTPNFT BSF TUBJOFE UP
placenta BMMPXT UIFTF NBUFSJBMT UP CF FYDIBOHFE CFUXFFO UIF NPUIFS QSPEVDF B LBSZPHSBN
XIJDI DBO
BOE UIF GFUVT BOE BMTP BDUT BT BO FOEPDSJOF HMBOE
QSPEVDJOH FTUSPHFO
CF DIFDLFE GPS NVUBUJPOT
QSPHFTUFSPOF BOE PUIFS IPSNPOFT UIBU NBJOUBJO UIF QSFHOBODZ
"O BMUFSOBUJWF QSPDFEVSF
XIJDI
5IF QMBDFOUB JT B EJTD TIBQFE TUSVDUVSF
BCPVU NN JO EJBNFUFS DBO CF EPOF FBSMJFS JO UIF
BOE XFJHIJOH BCPVU LH XIFO JU JT GVMMZ EFWFMPQFE *U JT NBEF VQ PG UIF QSFHOBODZ
JT DIPSJPOJD WJMMVT
NBUFSOBM FOEPNFUSJVN BOE TNBMM QSPKFDUJPOT
PS WJMMJ
GSPN UIF PVUFS MBZFST TBNQMJOH $74
*O UIJT DBTF

PG UIF chorion
XIJDI TVSSPVOET UIF FNCSZP 5IFTF chorionic villi
B TBNQMF PG DFMMT JT UBLFO GPS
XIJDI BSF SJDI JO DBQJMMBSJFT
HSPX PVU JOUP UIF FOEPNFUSJVN UP QSPEVDF B FYBNJOBUJPO GSPN UIF DIPSJPOJD
WFSZ MBSHF TVSGBDF BSFB GPS UIF FYDIBOHF PG HBTFT BOE PUIFS NBUFSJBMT 'FUBM WJMMJ
WJB UIF DFSWJY .PSF GFUBM DFMMT
CMPPE SFNBJOT JOTJEF UIFTF DBQJMMBSJFT
XIJDI QFOFUSBUF UIF FOEPNFUSJVN BSF PCUBJOFE JO UIJT XBZ BOE UIF
UJTTVF VOUJM UIFZ BSF TVSSPVOEFE CZ NBUFSOBM CMPPE ë PXJOH JOUP CMPPE SFTVMUT BSF QSPEVDFE NPSF RVJDLMZ
TJOVTFT TQBDFT
BSPVOE UIFN *O UIJT XBZ
UIF NPUIFS T CMPPE JT CSPVHIU BT )PXFWFS
$74 EPFT IBWF B HSFBUFS
DMPTF BT QPTTJCMF UP UIF GFUBM CMPPE UP BMMPX GPS Fą DJFOU EJĄ VTJPO XJUIPVU SJTL PG JOEVDJOH B NJTDBSSJBHF UIBO
UIF UXP FWFS NJYJOH 5IFTF GFBUVSFT BSF TIPXO JO 'JHVSF 11.28 PWFSMFBG
BNOJPDFOUFTJT

:mX]Vc\Z d[ bViZg^Vah -PPL CBDL BU QBHF 76 JO $IBQUFS 4
UP TFF IPX UIF UFDIOJRVFT PG
'FUBM CMPPE JT DBSSJFE UP UIF QMBDFOUB JO UXP VNCJMJDBM BSUFSJFT
XIJDI EJWJEF BNOJPDFOUFTJT BOE $74 BSF DBSSJFE
UP GPSN DBQJMMBSJFT JO UIF WJMMJ /VUSJFOUT BOE PYZHFO GSPN UIF NPUIFS T PVU
CMPPE EJĄ VTF JOUP UIF GFUBM DBQJMMBSJFT BOE BSF DBSSJFE CBDL UP UIF GFUVT JO B
TJOHMF VNCJMJDBM WFJO 8BTUF QSPEVDUT BOE DBSCPO EJPYJEF BSF DBSSJFE UP UIF && =JB6C =:6AI= 6C9 E=NH>DAD<N >> '-&
QMBDFOUB JO UIF UXP VNCJMJDBM BSUFSJFT BOE EJĄ VTF JOUP UIF NPUIFS T CMPPE

.BOZ NBUFSJBMT QBTT UP UIF GFUVT GSPN JUT NPUIFS 4PNF PG UIFTF m TVDI
BT ESVHT CPUI QSFTDSJQUJPO BOE JMMFHBM

OJDPUJOF BOE BMDPIPM m IBWF UIF
QPUFOUJBM UP TFSJPVTMZ IBSN UIF GFUVT
XIJDI JT XIZ QSFHOBOU XPNFO BSF
FODPVSBHFE OPU UP TNPLF PS ESJOL BMDPIPM EVSJOH QSFHOBODZ BOE UP CF
DBSFGVM XJUI BOZ NFEJDJOFT UIFZ NBZ UBLF

4VCTUBODFT UIBU QBTT GSPN NPUIFS UP GFUVT JODMVEF

r PYZHFO
r OVUSJFOUT JODMVEJOH HMVDPTF
BNJOP BDJET
WJUBNJOT
NJOFSBMT
r XBUFS
r IPSNPOFT
r BMDPIPM
OJDPUJOF BOE PUIFS ESVHT
r TPNF WJSVTFT
JODMVEJOH SVCFMMB BOE TPNFUJNFT )*7

4VCTUBODFT UIBU QBTT GSPN GFUVT UP NPUIFS JODMVEF

r DBSCPO EJPYJEF
r VSFB
r XBUFS
r TPNF IPSNPOFT
TVDI BT )$(

;Zijh ^c i]Z jiZgjh! h]dl^c\ eaVXZciV VcY jbW^a^XVa XdgY EaVXZciV! h]dl^c\ X]dg^dc^X k^aa^ VcY [ZiVa VcY bViZgcVa WaddY hjeea^Zh

bjhXaZ d[ jbW^a^XVa XdgY WaddY id bdi]ZgÉh bjhXaZ d[ jiZgjh lVaa jiZgjh
jiZgjh lVaa ]ZVgi
ZcYdbZig^jb lVaa
&' lZZ`h WaddY [gdb
[Zijh bdi]ZgÉh ]ZVgi

XZgk^m X]dg^dc Å YZkZadeh X]dg^dc^X k^aa^ Å bVcn
[gdb [Zijh [^c\Zg"a^`Z egd_ZXi^dch
Vbc^di^X Vbc^dc eaVXZciV ^cid i]Z jiZgjh lVaa Å
[aj^Y [ZiVa kZ^c XVggn^c\ i]Zn XdciV^c i]Z [ZiVa
ZcYdbZig^jb dmn\ZcViZY WaddY XVe^aaVg^Zh
[gdb eaVXZciV id
]ZVgi d[ [Zijh WaddY"[^aaZY heVXZ
[dgbZY Wn
jbW^a^XVa XdgY ZcaVg\ZbZci d[
bdi]ZgÉh WaddY
' [ZiVa VgiZg^Zh XVggn^c\ kZhhZah Å XdciV^ch
YZdmn\ZcViZY WaddY [gdb bdi]ZgÉh WaddY
[ZiVa ]ZVgi id eaVXZciV

dmn\ZcViZY WaddY
YZdmn\ZcViZY WaddY

9ZiV^a d[ X]dg^dc^X k^aa^ h]dl^c\ XVe^aaVg^Zh

[ZiVa kZ^c bdi]ZgÉh
[ZiVa VgiZgn kZ^c

X]dg^dc^X k^aa^
bdi]ZgÉh
VgiZgn

WaddY"[^aaZY heVXZ [ZiVa XVe^aaVg^Zh
X]dg^dc
ZcYdbZig^jb
;^\jgZ &&#'- I]Z eaVXZciV#
'-' bjhXaZ d[
jiZgjh lVaa

=dgbdcVa X]Vc\Zh VcY X]^aYW^gi]

'PS UIF ê STU XFFLT PG QSFHOBODZ
UIF DPSQVT MVUFVN QSPEVDFT
QSPHFTUFSPOF UP NBJOUBJO UIF VUFSVT MJOJOH FOEPNFUSJVN
"GUFS UIJT

UIF QMBDFOUB UBLFT PWFS BOE QSPEVDFT QSPHFTUFSPOF BOE FTUSPHFO
XIJDI
TVQQSFTT UIF NFOTUSVBM DZDMF BOE QSPNPUF UIF HSPXUI PG CSFBTU UJTTVF GPS
lactation NJML QSPEVDUJPO


"T UIF FOE PG QSFHOBODZ BQQSPBDIFT
UIF MFWFM PG QSPHFTUFSPOF QSPEVDFE
CZ UIF QMBDFOUB GBMMT 'JHVSF 11.29
BOE UIJT TJHOBMT UIF POTFU PG UIF VUFSJOF
DPOUSBDUJPOT LOPXO BT labour "U UIJT UJNF
UIF IPSNPOF oxytocin JT
TFDSFUFE CZ UIF QPTUFSJPS MPCF PG UIF QJUVJUBSZ HMBOE
JO UIF CSBJO 0YZUPDJO
TUJNVMBUFT UIF VUFSVT NVTDMFT UP DPOUSBDU "U ê STU UIF DPOUSBDUJPOT BSF
NJME BOE JOGSFRVFOU CVU PYZUPDJO JT B IPSNPOF UIBU JT DPOUSPMMFE CZ
positive feedback " TNBMM DPOUSBDUJPO PG UIF VUFSVT NVTDMF TUJNVMBUFT
UIF SFMFBTF PG GVSUIFS PYZUPDJO
XIJDI JO UVSO TUJNVMBUFT NPSF BOE TUSPOHFS
DPOUSBDUJPOT "T UIF VUFSVT DPOUSBDUT
UIF DFSWJY XJEFOT BOE UIF BNOJPUJD
TBD CSFBLT
SFMFBTJOH UIF BNOJPUJD ë VJE $POUSBDUJPOT DPOUJOVF GPS TFWFSBM
IPVST BOE UIF CBCZ JT QVTIFE UISPVHI UIF DFSWJY BOE PVU PG UIF NPUIFS T
CPEZ EPXO UIF WBHJOB (FOUMF DPOUSBDUJPOT DPOUJOVF VOUJM UIF QMBDFOUB

OPX LOPXO BT UIF BGUFSCJSUI
JT BMTP FYQFMMFE GSPN UIF VUFSVT

"GUFS CJSUI
CMPPE MFWFMT PG UIF IPSNPOF prolactin
GSPN UIF BOUFSJPS
QJUVJUBSZ HMBOE
JODSFBTF 5IJT IPSNPOF TUJNVMBUFT NJML QSPEVDUJPO CZ
UIF NBNNBSZ HMBOET "T B CBCZ TVDLMFT
QSPMBDUJO TFDSFUJPO JT NBJOUBJOFE
BOE PYZUPDJO JT BMTP SFMFBTFE GSPN UIF QPTUFSJPS QJUVJUBSZ HMBOE 0YZUPDJO
DBVTFT NJML UP CF SFMFBTFE GSPN NJML EVDUT

W^gi]

dkjaVi^dc =8<
[Zgi^a^hVi^dc
8dcXZcigVi^dc d[ ]dgbdcZ ^c i]Z WaddY Zhigd\Zc

egd\ZhiZgdcZ egdaVXi^c

% ) - &' &+ '% ') '- (' (+ )% ) - &' &+ '% ')
LZZ`h d[ egZ\cVcXn LZZ`h V[iZg W^gi]

;^\jgZ &&#'. 8]Vc\Zh ^c i]Z aZkZah d[ ]dgbdcZh Yjg^c\ egZ\cVcXn VcY W^gi]#

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '-(

&) Djia^cZ i]Z gdaZ d[ i]Z HZgida^ XZaah ^c heZgbVid\ZcZh^h#
&* HiViZ i]Z gdaZ d[ iZhidhiZgdcZ ^c heZgbVid\ZcZh^h#
&+ :meaV^c l]n jcZfjVa Y^k^h^dch d[ XnideaVhb VgZ cZXZhhVgn ^c dd\ZcZh^h#
&, Djia^cZ i]Z gdaZ d[ i]Z egdhiViZ \aVcY ^c hZbZc egdYjXi^dc#
&- A^hi i]gZZ Y^[[ZgZcXZh WZilZZc heZgbVid\ZcZh^h VcY dd\ZcZh^h#
&. 9ZhXg^WZ i]Z gdaZ d[ i]Z Vbc^dc ^c i]Z YZkZadebZci d[ i]Z [Zijh#
'% 9ZhXg^WZ i]Z gdaZ d[ dmnidX^c Vi W^gi]#

:cY"d["X]VeiZg fjZhi^dch

1 8IJDI PG UIF GPMMPXJOH TUBUFNFOUT BCPVU EFGFODF JT DPSSFDU


" %VSJOH UIF QSPDFTT PG CMPPE DMPUUJOH
UISPNCJO DBVTFT UIF SFMFBTF PG DMPUUJOH GBDUPST
GSPN UIF QMBUFMFUT

# "DUJWF JNNVOJUZ PDDVST BT B SFTVMU PG UIF CPEZ CFJOH DIBMMFOHFE CZ BOUJHFOT
$ .POPDMPOBM BOUJCPEJFT BSF QSPEVDFE CZ GVTJOH B IZCSJEPNB DFMM XJUI B NZFMPNB DFMM
% "T B SFTVMU PG WBDDJOBUJPO
UIF QSJNBSZ SFTQPOTF PG UIF CPEZ XJMM CF HSFBUFS XIFO JU

JT JOWBEFE CZ BO BOUJHFO

2 8IJDI PG UIF GPMMPXJOH TUBUFNFOUT BCPVU NVTDMFT BOE NPWFNFOU JT DPSSFDU


" %VSJOH NVTDMF DPOUSBDUJPO
UIF EJTUBODF CFUXFFO ; MJOFT EFDSFBTFT
BOE UIF EBSL CBOET
HFU XJEFS CVU UIF MJHIU CBOET HFU OBSSPXFS

# #POFT BSF IFME UPHFUIFS BU B KPJOU CZ UFOEPOT
XIJDI BMTP QSPUFDU UIF KPJOU
$ 4ZOPWJBM ë VJE
TFDSFUFE CZ UIF DBSUJMBHF
MVCSJDBUFT UIF KPJOU UP QSFWFOU GSJDUJPO
% 5IF FMCPX JT BO FYBNQMF PG B CBMM BOE TPDLFU KPJOU

3 8IJDI PG UIF GPMMPXJOH TUBUFNFOUT BCPVU UIF LJEOFZ JT DPSSFDU


" 0TNPSFHVMBUJPO JT UIF NBJOUFOBODF PG UIF DPSSFDU DPODFOUSBUJPO PG XBUFS JO UIF VSJOF
# 6MUSBê MUSBUJPO PDDVST JO UIF #PXNBO T DBQTVMFT TJUVBUFE JO UIF NFEVMMB SFHJPO PG

UIF LJEOFZ
$ (MVDPTF JT TPNFUJNFT QSFTFOU JO UIF VSJOF PG QFPQMF XJUI EJBCFUFT CFDBVTF UIF MBDL

PG JOTVMJO QSFWFOUT JUT SFBCTPSQUJPO JO UIF MPPQ PG )FOMF
% )VNBO VSJOF DBO CFDPNF NPSF DPODFOUSBUFE UIBO CMPPE QMBTNB BT B SFTVMU PG XBUFS

SFBCTPSQUJPO EVF UP UIF SFMFBTF PG "%) GSPN UIF QJUVJUBSZ HMBOE

'-)

4 8IJDI PG UIF GPMMPXJOH TUBUFNFOUT BCPVU SFQSPEVDUJPO JT DPSSFDU


" 5IF IPSNPOFT -) BOE '4) GSPN UIF QJUVJUBSZ HMBOE BOE UFTUPTUFSPOF GSPN UIF
4FSUPMJ DFMMT BSF JOWPMWFE JO TQFSNBUPHFOFTJT

# %VSJOH PPHFOFTJT QPMBS CPEJFT BSF GPSNFE CZ NFJPTJT JO UIF GPMMJDMF DFMMT PG UIF
HFSNJOBM FQJUIFMJBM MBZFS PG UIF PWBSZ

$ 5IF SPMF PG UIF IPSNPOF )$( FBSMZ JO QSFHOBODZ JT UP QSFWFOU GVSUIFS PWVMBUJPO CZ
CMPDLJOH UIF QSPEVDUJPO PG PFTUSPHFO

% %VSJOH UIF QSPDFTT PG GFSUJMJTBUJPO TVCTUBODFT SFMFBTFE GSPN UIF DPSUJDBM HSBOVMFT
SFTVMU JO UIF GPSNBUJPO PG UIF GFSUJMJTBUJPO NFNCSBOF

5 &YQMBJO BOUJCPEZ QSPEVDUJPO


6 0VUMJOF IPX UIF ë VJE JO UIF QSPYJNBM DPOWPMVUFE UVCVMF JT QSPEVDFE CZ UIF QSPDFTT PG VMUSBê MUSBUJPO


7 &YQMBJO IPX UIF DFMMT PG UIF QSPYJNBM DPOWPMVUFE UVCVMF BSF BEBQUFE UP DBSSZ PVU TFMFDUJWF SFBCTPSQUJPO


8 0VUMJOF IPX NVTDMF DPOUSBDUJPO JT CSPVHIU BCPVU
TUBSUJOH XJUI UIF BSSJWBM PG B OFSWF JNQVMTF BU UIF NVTDMF


9 0VUMJOF UIF QSPDFTT PG CJSUI
JODMVEJOH IPSNPOBM DPOUSPM


10 5IF TFOTF PG UBTUF JT OPSNBMMZ DBVTFE CZ UIF TUJNVMBUJPO PG DIFNPSFDFQUPST JO UIF UBTUF CVET PG UIF UPOHVF
5IFSF BSF GPVS NBJO AUBTUFT TXFFU
TBMUZ
CJUUFS BOE TPVS 5IF UPOHVF BMTP IBT SFDFQUPST GPS UFNQFSBUVSF *U JT
LOPXO UIBU UIF UBTUF PG GPPE DBO WBSZ BDDPSEJOH UP XIFUIFS JU JT DPME
XBSN PS IPU 4DJFOUJTUT EJTDPWFSFE UIBU
KVTU XBSNJOH PS DPPMJOH QBSUT PG UIF UPOHVF
FWFO XIFO OP GPPE XBT QSFTFOU
BMTP DBVTFE B TFOTBUJPO PG UBTUF

4DJFOUJTUT FYQFSJNFOUFE XJUI B HSPVQ PG QFPQMF 5IFZ HSBEVBMMZ DPPMFE UIF UJQT PG UIFJS UPOHVFT BOE
NFBTVSFE UIF JOUFOTJUZ PG UIF UBTUF GFMU CZ FBDI NFNCFS PG UIF HSPVQ 5IF FYQFSJNFOU XBT SFQFBUFE
UIJT
UJNF XBSNJOH UIF UJQ PG UIF UPOHVF 5IF HSBQIT TIPX UIF BWFSBHF WBMVFT GPS UIF HSPVQ

8dda^c\ i]Z idc\jZ i^e LVgb^c\ i]Z idc\jZ i^e

bdYZgViZ

IVhiZ ^ciZch^in [Zai lZV`
$ VgW^igVgn jc^ih
_jhi
YZiZXiVWaZ

(*➝'* (*➝'% (*➝&* (*➝&% (*➝* '%➝'* '%➝(% '%➝(* '%➝)%

9ZXgZVhZ ^c iZbeZgVijgZ [gdb (*•8 >cXgZVhZ ^c iZbeZgVijgZ [gdb '%•8

@Zn hVain W^iiZg hlZZi hdjg

hdjgXZ/ bdY^[^ZY [gdb 8gjo VcY <gZZc '%%( DWjkh[! )%(! e# --.

a *EFOUJGZ XIJDI UBTUF XBT GFMU NPTU TUSPOHMZ XIFO UIF UJQ PG UIF UPOHVF XBT

i DPPMFE
i i XBSNFE

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '-*

b $PNQBSF UIF FĄ FDUT PO UIF UBTUF PG TXFFUOFTT
PG XBSNJOH BOE DPPMJOH UIF UJQ PG UIF UPOHVF


c *U JT JNQPSUBOU UIBU TVDI FYQFSJNFOUT VTF B QPQVMBUJPO TBNQMF UIBU JT SFQSFTFOUBUJWF 4VHHFTU two

CJPMPHJDBM DSJUFSJB UIF TDJFOUJTUT XPVME IBWF VTFE UP TFMFDU UIF QFPQMF UP CF UFTUFE

d &YQMBJO XIFUIFS DPPMJOH PS XBSNJOH UIF UJQ PG UIF UPOHVF IBT UIF HSFBUFS FĄ FDU PO UIF TFOTBUJPO PG UBTUF


5IF TDJFOUJTUT EJTDPWFSFE UIBU UIFSF XFSF UXP UZQFT PG DIFNPSFDFQUPS JO UIF UPOHVF UJQ 5IFZ DBMMFE UIFTF " BOE
# 5IFZ UFTUFE UIFTF DIFNPSFDFQUPST VTJOH TPMVUJPOT PG TVDSPTF UP ê OE PVU UIF UZQF PG UBTUF BOE UIF JOUFOTJUZ GFMU
5IF SFTVMUT BSF TIPXO JO UIF CBS DIBSU

bdYZgViZ

IVhiZ ^ciZch^in [Zai lZV`
$ VgW^igVgn jc^ih
_jhi YZiZXiVWaZ

HlZZi YZiZXiZY Hdjg YZiZXiZY
@Zn 6 7

e $PNQBSF UIF FĄ FDUT PG TVDSPTF PO UIF " BOE # DIFNPSFDFQUPST CZ HJWJOH two TJNJMBSJUJFT BOE

two EJĄ FSFODFT

(total 10 marks)
¥ *# 0SHBOJ[BUJPO

11 3FTFBSDI JOUP IPX UIF MVOHT QFSGPSN EVSJOH HFOFSBM BOBFTUIFTJB IBT JODSFBTFE CFDBVTF UIFSF BSF TP NBOZ
QVMNPOBSZ DPNQMJDBUJPOT EVSJOH PQFSBUJPOT *U JT CFMJFWFE UIBU NBOZ JOIBMFE BOBFTUIFUJDT BĄ FDU QVMNPOBSZ
FQJUIFMJBM QFSNFBCJMJUZ

1VMNPOBSZ DMFBSJOH JT BO JOEJDBUJPO PG XIFUIFS UIF BMWFPMBSmDBQJMMBSZ CBSSJFS IBT CFFO EBNBHFE *U DBO CF
NFBTVSFE BT UIF SBUF BU XIJDI SBEJPBDUJWJUZ EFDSFBTFT JO MVOHT BGUFS JOIBMBUJPO PG B SBEJPBDUJWF BFSPTPM 5IF
HSFBUFS UIF DMFBSJOH SBUF
UIF HSFBUFS UIF EBNBHF UP UIF BMWFPMBSmDBQJMMBSZ CBSSJFS 4NPLJOH BOE MVOH EJTFBTFT
TVDI BT DBODFST BOE BTUINB
BMTP TJHOJê DBOUMZ JODSFBTF UIF DMFBSJOH SBUF PG SBEJPBDUJWF BFSPTPMT

*O BO FYQFSJNFOU
EPDUPST XBOUFE UP UFTU UIF FĄ FDU PG JOIBMFE BOBFTUIFUJDT PO UIF QFSNFBCJMJUZ CFUXFFO UIF
BMWFPMJ BOE DBQJMMBSJFT 1BUJFOUT XFSF UFTUFE CZ JOIBMJOH B SBEJPBDUJWF BFSPTPM POF EBZ CFGPSF UIFJS PQFSBUJPO
BOE POF IPVS BGUFS UIFJS PQFSBUJPO

5ISFF HSPVQT PG QBUJFOUT FBDI SFDFJWFE B EJĄ FSFOU UZQF PG BOBFTUIFUJD
(SPVQ IBMPUBOF JOIBMFE BOBFTUIFUJD

(SPVQ JTPë VPSBOF JOIBMFE BOBFTUIFUJD

(SPVQ QIFOUBOZM BOE QSPQPGPM JOUSBWFOPVT BOBFTUIFUJD


'-+

@Zn 9Zk^Vi^dc BZVc
'#%
'#% '#%

&#* &#* &#*
8aZVg^c\ gViZ $ b^cÄ&
8aZVg^c\ gViZ $ b^cÄ&
8aZVg^c\ gViZ $ b^cÄ&
&#% &#% &#%

%#* %#* %#*

%#% V[iZg %#% V[iZg %#% V[iZg
WZ[dgZ VcVZhi]Zi^X WZ[dgZ VcVZhi]Zi^X WZ[dgZ VcVZhi]Zi^X

VcVZhi]Zi^X VcVZhi]Zi^X VcVZhi]Zi^X

<gdje & <gdje ' <gdje (

hdjgXZ/ 8]Vc\ AV^ [j Wb# '%%% H[if_hWj_ed! Kda >>! (! ee# '%'Ä'%+

a $PNQBSF UIF FĄ FDU PG FBDI JOIBMFE BOBFTUIFUJD PO UIF QFSNFBCJMJUZ PG UIF BMWFPMJ


b 6TJOH UIF EBUB GSPN UIF HSBQIT
FYQMBJO XIFUIFS PS OPU JOIBMFE BOBFTUIFUJDT BSF NPSF EBOHFSPVT UIBO

JOUSBWFOPVT BOBFTUIFUJDT

(total 5 marks)
¥ *# 0SHBOJ[BUJPO

&& =JB6C =:6AI= 6C9 E=NH>DAD<N >> '-,

Dei^dc 6 =jbVc cjig^i^dc VcY ]ZVai]

>cigdYjXi^dc

The food we eat keeps us alive and provides the nourishment we need to grow, repair our bodies
and stay active.A balanced diet gives us all the essential substances that we need in just the right
quantities. Our needs differ depending on our age, activities and lifestyles. Some people who do not
get the balance right may become overweight, underweight or even seriously ill. Choices people
make about what to eat depend on where they live but are also influenced by social issues. Being
a vegetarian, whether to breastfeed or bottle-feed infants and taking account of food miles and the
environment all have an impact on human nutrition.

6& 8dbedcZcih d[ i]Z ]jbVc Y^Zi

6hhZhhbZci hiViZbZcih

r Define ‘nutrient’.
r List the types of nutrients that are essential in the human diet, including amino acids, fatty acids, minerals, vitamins

and water.

r State that non-essential amino acids can be synthesised in the body from other nutrients.
r Outline the consequences of protein deficiency malnutrition.
r Explain the causes and consequences of phenylketonuria (PKU) and how early diagnosis and a special diet can reduce

the consequences.

r Outline the variation in the molecular structure of fatty acids, including saturated fatty acids, cis and trans unsaturated

fatty acids, monounsaturated and polyunsaturated fatty acids.

r Evaluate the health consequences of diets rich in the different types of fatty acid.
r Distinguish between ‘minerals’ and ‘vitamins’ in terms of their chemical nature.
r Outline two of the methods that have been used to determine the recommended daily intake of vitamin C.
r Discuss the amount of vitamin C that an adult should consume per day, including the level needed to prevent scurvy,

claims that higher intakes give protection against upper respiratory tract infections, and the danger of rebound
malnutrition.

r List the sources of vitamin D in human diets.
r Discuss how the risk of vitamin D deficiency from insufficient exposure to sunlight can be balanced against the risk of

contracting malignant melanoma.

r Explain the benefits of artificial dietary supplementation as a means of preventing malnutrition, using iodine as an example.
r Outline the importance of fibre as a component of a balanced diet.

Nutrient a chemical substance Cjig^Zcih
found in food that is used by
the human body for growth or Nutrients are chemical substances, found in foods, that are used in the
metabolism human body.We need a number of nutrients to build our bodies and to
stay healthy.We obtain these from the foods we eat. Essential nutrients
are those that cannot be made in the body and must therefore be included
in the diet. Essential nutrients are:

r essential amino acids

'--

r essential fatty acids ;^\jgZ 6#& @lVh]^dg`dg ^h V egdiZ^c
r vitamins YZÒ X^ZcXn Y^hZVhZ hZZc ^c ndjc\ X]^aYgZc!
r minerals gZhjai^c\ [gdb V Y^Zi adl ^c egdiZ^c! ZcZg\n
r water. VcY di]Zg cjig^Zcih# I]Z X]^aYgZc Yd cdi
\gdl egdeZgan VcY hj[[Zg [gdb dZYZbV!
Carbohydrates are not included as essential nutrients because they are l]^X] XVjhZh i]Z hldaaZc VeeZVgVcXZ d[
present in most human diets and there are no specific carbohydrates that i]Z^g VWYdbZc#
are essential. Some diets do not include carbohydrates at all, see page 298.
Malnutrition, starvation or
Minerals and vitamins are both needed in very small quantities.Their deficiency?
chemical structures are quite different – vitamins are organic compounds,
whereas minerals are usually derived from their ions. For example, sodium Malnutrition occurs when a
in the diet is available as Na+ ions. person does not eat a balanced diet.
The diet may mean the person is
6b^cd VX^Yh VcY egdiZ^c deficient in one or more nutrients,
or suffers an imbalance from
To synthesise all the proteins in a human body, 20 different amino acids eating an excess of a particular
are needed.We can make some of these in our cells by converting certain nutrient. Malnutrition is defined
nutrients into amino acids, but there are nine that cannot be synthesised as the insufficient, excessive or
and must be taken in as part of a healthy diet.These are known as imbalanced consumption of
essential amino acids. nutrients, which leads to health
problems.A person can eat a lot of
Protein deficiency malnutrition can occur if an individual does food but still be malnourished.
not have enough of one or more of these essential amino acids. Protein
deficiency can lead to poor growth and lack of energy, as well as loss of Starvation is different from
body mass. One of the most common conditions associated with protein malnutrition – it occurs when an
deficiency is swelling of the abdomen (Figure A.1).A lack of protein in the individual simply does not have
diet prevents blood plasma proteins being produced properly. Blood plasma enough to eat.
protein assists with the reabsorption of tissue fluid into blood capillaries
and without it fluid remains in the tissues causing oedema (swelling). A deficiency occurs when a
person does not have enough of
E]Zcna`Zidcjg^V one particular nutrient and suffers
health problems as a result.
Phenylketonuria (PKU) is a rare genetic metabolic disorder. In the USA,
PKU occurs in 1 in 15 000 births. It is caused by a mutation to a gene
on chromosome 12. People who suffer from PKU lack an enzyme that is
needed to process the amino acid phenylalanine.They are unable to make
the liver enzyme tyrosine hydroxylase, which converts phenylalanine into
another non-essential amino acid called tyrosine. Phenylalanine is essential
for normal growth but if too much builds up in the blood, brain damage
can result.The condition is treatable if it is diagnosed soon after birth. Babies
and children with untreated PKU develop serious physical and mental
health problems as levels of phenylalanine in their blood rise. In many
parts of the world, a simple blood test at birth is used to identify babies
with PKU. Children who are identified as having PKU must be given
a special diet that is low in protein and especially low in the amino acid
phenylalanine.They must avoid many common, high protein foods such as
milk and dairy products, nuts, fish and meat. PKU only affects children until
puberty.After this, they can have a normal diet.

DEI>DC 6 =JB6C CJIG>I>DC 6C9 =:6AI= '-.

;Viin VX^Yh

All fatty acids are composed of a chain of carbon atoms to which
hydrogen atoms are bonded, with a carboxyl group (–COOH) at one end
and a methyl group (CH3) at the other (Figure A.2).The arrangement of
carbon and hydrogen atoms in the hydrocarbon chain varies in different
types of fatty acids and this gives each type their particular properties.

HVijgViZY [Viin VX^Yh

Saturated fatty acids get their name from the fact that all the carbon
atoms in the hydrocarbon chain are bonded to the maximum number
of hydrogen atoms and so are saturated with hydrogen (Figure A.2).
These fatty acids have straight molecules with up to 20 carbon atoms in
the chain.There are no double bonds between any of the carbon atoms.
Saturated fatty acids in the human diet come mainly from animal products
such as meat, butter, ghee, cream and hard cheese, and a few plant sources
such as coconut and palm oils.

JchVijgViZY [Viin VX^Yh

Unsaturated fatty acids have one or more double bonds in the
hydrocarbon chain, which means they contain less than the maximum
number of hydrogen atoms.

Monounsaturated fatty acids have one double bond and when
compared with a saturated fatty acid with the same number of carbon
atoms, they have two ‘spaces’ where hydrogen atoms could bond.These
two spaces may be on the same side of the hydrocarbon chain, or on
opposite sides (Figure A.3). If they are on the same side of the chain,
the fatty acid is said to be a cis fatty acid, and the chain has a kink in it.
When the spaces are on opposite sides of the hydrocarbon chain, it is a
trans fatty acid and the chain is straight.

Polyunsaturated fatty acids have more than one double bond in the
hydrocarbon chain.They tend to be liquids at 20 °C and are mainly derived
from plant sources. Examples are sunflower oil, corn oil and olive oil.

One type of cis fatty acid is the omega-3 group.These have a double
bond at the third bond from the omega end (CH3 end) of the molecule.
Omega-3 fatty acids are obtained from eating fish. Omega-6 fatty acids

bZi]na
\gdje

= == = = = = = = = = = = = D

8888888
8 8 8 8 8 8 8 D=

=

dbZ\V = = = = = = = = = = = = XVgWdmna
ZcY \gdje

V [Viin VX^Y bdaZXjaZ

;^\jgZ 6#' ;Viin VX^Y bdaZXjaZh VgZ ]nYgdXVgWdc X]V^ch# Bng^hi^X VX^Y! h]dlc ]ZgZ! ^h
V hVijgViZY [Viin VX^Y#

'.%

==== ==== ==== ===
8888 8888
=== 88888888
===
=== ====

WZci Y_i [Viin VX^Y Ä ild ]nYgd\Zc Vidbh VgZ higV^\]i jhWdi [Viin VX^Y Ä dcZ ]nYgd\Zc Vidb ^h
VWhZci [gdb i]Z hVbZ h^YZ d[ i]Z ]nYgdXVgWdc X]V^c VWhZci [gdb ZVX] h^YZ d[ i]Z ]nYgdXVgWdc X]V^c

;^\jgZ 6#( 6 [Viin VX^Y bVn WZ ^c i]Z Y_i dg jhWdi [dgb! YZeZcY^c\ dc l]ZgZ i]Z Èb^hh^c\ ]nYgd\Zc heVXZhÉ dXXjg#

have a double bond at the sixth position from the omega end. Most
omega-6 fatty acids in the diet come from vegetable oils.

=ZVai] VcY [Viin VX^Yh

The relative amounts of different types of fatty acid in a person’s diet can,
in many cases, be correlated with health issues. Diets in societies around
the world are very different and so is the incidence of coronary heart
disease (CHD) and other diet-related illnesses.

HVijgViZY [Viin VX^Yh
Eating a diet that is high in saturated fatty acids has been shown to have
a positive correlation with an increased risk of CHD. Saturated fatty acids
can be deposited inside the arteries, and if the deposits combine with
cholesterol they may lead to atherosclerosis, which reduces the diameter of
the lumen and leads to high blood pressure (Figure A.4).

Reliable evidence suggests that in countries where the diet is high
in saturated fatty acids and many high-fat foods, animal products and
processed foods are eaten there is likely to be a high incidence of CHD.
Since all fatty acids are high in energy, an excess of these foods in the diet
can also lead to obesity, which places a further strain on the heart.

WaddY ^c ajbZc eaVfjZ V eaVfjZ ^h g^\^Y

VgiZgn lVaa egdiZXi^kZ ^ccZg cdgbVa VgiZgn WaddY Xadih
a^c^c\ d[ i]Z VgiZgn lVaa ^h ZaVhi^X

YVbV\Z id lVaa

& EVgi d[ i]Z a^c^c\ d[ ' <gVYjVaan! dkZg i^bZ! ( :mZgX^hZ dg higZhh XVc
i]Z VgiZgn ^h YVbV\ZY# XZaah Y^k^YZ ^c i]Z VgiZgn bV`Z i]Z eaVfjZ WgZV`#
lVaa VcY i]ZgZ ^h V 7addY ZciZgh i]Z XgVX`#
Wj^aY"je d[ a^e^Yh# EaViZaZih ^c i]Z WaddY VgZ
VXi^kViZY VcY V Xadi [dgbh#
EVgi d[ i]Z Xadi bVn
WgZV` d[[#

;^\jgZ 6#) I]Z YZkZadebZci d[ Vi]ZgdhXaZgdh^h ^c Vc VgiZgn#

DEI>DC 6 =JB6C CJIG>I>DC 6C9 =:6AI= '.&

8dggZaVi^dc VcY XVjhZ FjZhi^dch id Xdch^YZg

When studying the occurrence of medical Think about how the evidence for correlation
conditions that may be related to diet, it is important between diet and health is gathered and what other
to distinguish between correlation and cause.A factors may be important.
correlation between two variables, such as a high
incidence of CHD and a high intake of saturated fatty & How can lifestyle indicators be taken into
acids, does not mean that the CHD is caused by the fat account?
intake.
' What is the importance of genetics and family
Read more about correlation and cause in Chapter 1, history?
page 8.
( Can it ever be possible to say that one type of
diet is good and another is bad for health?

There are some exceptions to this general rule.The Masai people of
East Africa have a very low incidence of heart disease despite the fact
that most of their traditional diet is derived from milk and meat and
the blood of goats and cows.The Masai consume few vegetables so one
explanation of their low incidence of CHD could be that they have a low
energy intake together with a very active life. Genetic factors may also be
important in protecting them from heart disease.

JchVijgViZY [Viin VX^Yh
People who eat a Mediterranean-style diet, rich in unsaturated fatty
acids from olive oil and fresh vegetables, tend to have a low incidence of
CHD.These fats do not combine with cholesterol to form plaques and so
arteries tend to remain unblocked and healthy.

Some polyunsaturated fats are modified or ‘hydrogenated’ so they can
be used in processed foods.These hydrogenated fats become trans fatty
acids.There is a positive link between the intake of these trans fatty acids
and CHD.

Omega-3 fatty acids found in fish are used to synthesise long-chain
fatty acids found in the nervous system. It has been suggested that a lack
of omega-3 fatty acids could affect brain and nerve development but no
conclusive evidence has yet been found.

K^iVb^ch VcY b^cZgVah

Vitamins and minerals are usually listed together in diet information
because, although they are both vital for good health, they are both
needed only in very small quantities.Vitamins are chemically quite
different from minerals and the two nutrient groups come from many
different sources. Some key differences are shown in Table A.1.

K^iVb^ch B^cZgVah

bVYZ ^c eaVcih VcY Vc^bVah hjWhiVcXZh YZg^kZY [gdb gdX`h dg [djcY Y^hhdakZY ^c lViZg
XdbedjcYh ZaZbZcih ^c ^dc^X [dgb! Z#\# e]dhe]ViZ ED(
dg\Vc^X Z#\# k^iVb^c 8 8+=-D+ ^cdg\Vc^X! Z#\# ^gdc ;Z' ! XVaX^jb 8V' ! ^dY^cZ >
IVWaZ 6#& 8dbeVg^c\ k^iVb^ch VcY b^cZgVah#

'.'