Applied Immunity Flashcards

1
Q

Immunity in the Oral Cavity

The oral cavity is the port of entry for many pathogens, food, and drugs which can trigger an immune response.

___t components: __ ___, ___, ___

____ components: ___ pathogens that colonize the oral cavity

A

Immunity in the Oral Cavity

The oral cavity is the port of entry for many pathogens, food, and drugs which can trigger an immune response.

Transient components: Dead pathogens, allergens, food

Persistent components: Live pathogens that colonize the oral cavity

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2
Q

Oral Cavity

Distinct locations:

Tooth surface, tongue, oral mucosa gingival crevices have selective immune responses

Distinct inductive sites: ___ ___

Two distinct effector sites:

  • ___ ___
  • ___ ___ ___

Pathogens have developed mechanisms to subvert or inactivate the host immune system

Unchecked growth of pathogens can lead to deterioration or loss of oral function

A

Oral Cavity

Distinct locations:

Tooth surface, tongue, oral mucosa gingival crevices have selective immune responses

Distinct inductive sites: Waldeyer’s ring

Two distinct effector sites:

Salivary glands

Gingival lamina propria

Pathogens have developed mechanisms to subvert or inactivate the host immune system

Unchecked growth of pathogens can lead to deterioration or loss of oral function

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3
Q

NALT: Inductive and Effector Sites

Inductor Sites represented by various tonsils. You have M cells to transport Ag to be processed by dendritic cells or macrophages. When those are activated, they migrate to the lymph nodes where they activate and cause differentiation of B and T cells.

They move to effector sites.

A

NALT: Inductive and Effector Sites

Inductor Sites represented by various tonsils. You have M cells to transport Ag to be processed by dendritic cells or macrophages. When those are activated, they migrate to the lymph nodes where they activate and cause differentiation of B and T cells.

They move to effector sites.

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4
Q

NALT Tissue: Waldeyer’s Ring

Named after the nineteenth century Heinrich Wilhelm Gottfried von Waldeyer-Hartz (German anatomist)

Consists of the lymphoid tissue on the __ of the tongue (___ tonsil), ___ (____) tonsils, the ____(____ tonsil), and the ___ tonsils (located bilaterally, where each Eustachian tube opens into the nasopharynx)

___ __in the lymphatic system that ___ and ___ to airborne and alimentary antigens

Tonsillectomies and/or adenoidectomies are indicated for children with impaired breathing through the ___ (i.e. sleep apnea), chronic upper __ __ infections, or recurrent ____

Ring of lymphoid tissue that surrounds ___ and ___ ___

A

NALT Tissue: Waldeyer’s Ring

Named after the nineteenth century Heinrich Wilhelm Gottfried von Waldeyer-Hartz (German anatomist)

Consists of the lymphoid tissue on the base of the tongue (lingual tonsil), two (palatine) tonsils, the adenoids (nasopharyngeal tonsil), and the tubal tonsils (located bilaterally, where each Eustachian tube opens into the nasopharynx)

First organs in the lymphatic system that analyze and react to airborne and alimentary antigens

Tonsillectomies and/or adenoidectomies are indicated for children with impaired breathing through the nose (i.e. sleep apnea), chronic upper respiratory tract infections, or recurrent earaches

Ring of lymphoid tissue that surrounds respiratory and alimentary tracts

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5
Q

Unique Defense Mechanisms in the Oral Cavity

In addition to normal tissue responses to infections, the oral cavity has two important biologic fluids which help prevent microorganisms from entering through the oral cavity:

  • ___
    • ___ ____ (Ab)
    • ___ Immunity
  • ___ __ __
    • ___ ___(Ab)
    • ___ Immunity
      *
A

Unique Defense Mechanisms in the Oral Cavity

In addition to normal tissue responses to infections, the oral cavity has two important biologic fluids which help prevent microorganisms from entering through the oral cavity:Saliva

Mucosal sIgA

Mucosal Immunity

Gingival Crevicular Fluid (GCF)

Blood plasma IgG

Systemic Immunity

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6
Q

Anti-microbial Components in Saliva

Antibodies: ____ Defense

Bind Bacteria

Calprotectin: Innate Defense

Chelates Zn and Ca to inhibit growth

Cystatins: Innate Defense

Inhibit ___ ___

Defensins: Innate Defense

___ mediated disruption of membrane

Histatins: Innate Defense

____

Lactoferrin: Innate Defense

Binds __ to inhibit growth

Lysozyme: Innate Defense

___

Mucins: Innate Defense

___ and aggregate microbe

PRP: Innate Defense

__ Bacteria

Statherin: Innate Defense

___ Bacteria

A

Anti-microbial Components in Saliva

Antibodies: Acquired Defense

Bind Bacteria

Calprotectin: Innate Defense

Chelates Zn and Ca to inhibit growth

Cystatins: Innate Defense

Inhibit Cysteine proteases

Defensins: Innate Defense

Charge mediated disruption of membrane

Histatins: Innate Defense

Antifungal

Lactoferrin: Innate Defense

Binds Fe to inhibit growth

Lysozyme: Innate Defense

Lyses

Mucins: Innate Defense

Entrap and aggregate microbe

PRP: Innate Defense

Bind Bacteria

Statherin: Innate Defense

Bind Bacteria

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7
Q

Calprotectin

  • ___ ___
  • Bacterial ___ ____ depend on ___ for ___
    • àSensitivity to___
  • Abundant in ____
  • Sucks up Mn in environment so the SODs are inactive and bacteria more sensitive to ROS
  • Marker of____ in IBD
  • Increase Calprotectin à_____inflammation à Increased disease activity
    *
A

Calprotectin

Metal chelator

Bacterial superoxide dismutases (SODs) depend on Mn2+ for activityàSensitivity to ROS

Abundant in neutrophils

Sucks up Mn in environment so the SODs are inactive and bacteria more sensitive to ROS

Marker of inflammation in IBD

Increase Calprotectin à Increased inflammation à Increased disease activity

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8
Q

Specific Immune Components in Saliva

Secretory IgA (mucosal immune system)

  • Found as a dimer connected by a “J” chain
  • Contains a secretory component (“Sc” protein)
  • Secreted by __ ___ in ___ ____
  • Acts as a specific agglutinin of bacteria or fungus
  • Prevents bacterial ____ to host cells or salivary ____
  • Does not bind ___ and does not ___ bacteria well
    *
A

Specific Immune Components in Saliva

Secretory IgA (mucosal immune system)

Found as a dimer connected by a “J” chain

Contains a secretory component (“Sc” protein)

Secreted by Plasma cells in Salivary Glands

Acts as a specific agglutinin of bacteria or fungus

Prevents bacterial adhesion to host cells or salivary pellicle

Does not bind complement and does not opsonize bacteria well

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9
Q

Gingival Crevicular Fluid (GCF)

Is a __ ___or___ ___ derived from periodontal tissues that is found in the ___ ___

GCF contains molecules found in ___, the ___ ___, and in the ___

Contains:

___ Epithelial Cells

Leukocytes (predominately ____)

Host ____ (Collagenase, Elastase)

____ Components

_____ (IL-1, IL-8, TNF)

Immunoglobulins (IgG, IgA)

____ Acid metabolites

Prostaglandins

Leukotrienes

Other host proteins

A

Gingival Crevicular Fluid (GCF)

Is a serum transudate or inflammatory exudate derived from periodontal tissues that is found in the gingival sulcus

GCF contains molecules found in serum, the periodontal tissues, and in the sulcus

Contains:

Shed Epithelial Cells

Leukocytes (predominately Neutrophils)

Host Enzymes (Collagenase, Elastase)

Complement Components

Cytokines (IL-1, IL-8, TNF)

Immunoglobulins (IgG, IgA)

Arachidonic Acid metabolites

Prostaglandins

Leukotrienes

Other host proteins

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10
Q

The Gut is Bombarded by Foreign Antigens

A

The Gut is Bombarded by Foreign Antigens

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11
Q

Host needs to have a Balance between Respond and Don’t Respond

Respond: Fight and Eradicate Pathogens

Ignore: Self, Food

A

Host needs to have a Balance between Respond and Don’t Respond

Respond: Fight and Eradicate Pathogens

Ignore: Self, Food

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12
Q

Antigenic Challenge and Immune Responses in Mucosal Immunity

The context in which peptide antigen is presented to T lymphocytes in the mucosal immune system is important.

In the absence of inflammation and co-stimulation, presentation of peptide to T cells by MHC molecules on antigen presenting cells induces ____

In the presence of inflammation and pathogenic microorganisms in the tissues, the maturation and expression of co-stimulatory molecules on antigen presenting cells is stimulated. Antigen presentation to T cells under these conditions favors development of a _____ ____ ____

A

Antigenic Challenge and Immune Responses in Mucosal Immunity

The context in which peptide antigen is presented to T lymphocytes in the mucosal immune system is important.

In the absence of inflammation and co-stimulation, presentation of peptide to T cells by MHC molecules on antigen presenting cells induces tolerance.

In the presence of inflammation and pathogenic microorganisms in the tissues, the maturation and expression of co-stimulatory molecules on antigen presenting cells is stimulated. Antigen presentation to T cells under these conditions favors development of a protective TH1 response.

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13
Q

Oral Tolerance

Oral tolerance is

A general _____ state in the oral mucosa to prevent reaction to ____ Ags such as commensals or foods

The generation of systemic immune unresponsiveness by feeding of ____

Necessary to prevent excessive response to normal flora and food antigens

A

Oral Tolerance

Oral tolerance is

A general immunosuppressive state in the oral mucosa to prevent reaction to harmless Ags such as commensals or foods

The generation of systemic immune unresponsiveness by feeding of antigen

Necessary to prevent excessive response to normal flora and food antigens

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14
Q

Biological variables that influence the immunophenotype

Many factors determine whether you have ___ ___ or __ __

A

Biological variables that influence the immunophenotype

Many factors determine whether you have immune response or oral tolerance

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15
Q

Protective Immunity Versus Tolerance

  • Protective Immunity ,Oral Tolerance
  • Ag:
    • Invasive Pathogens
    • Food, commensals
  • Ig Production
    • ___ ___, ___ Ab present in serum
    • ____ local IgA, ___ or ___ Ab serum
  • T Cell Response
    • Local and systemic ___ and___ T cells
    • ___ local effector T cell response
  • Response to Ag Reexposure
    • Enhanced (____) Response
    • __or __ response
      *
A

Protective Immunity Versus Tolerance

Protective Immunity

Oral Tolerance

Ag

Invasive Pathogens

Food, commensals

Ig Production

Intestinal IgA

Specific Ab present in serum

Some local IgA

Low or no Ab serum

T Cell Response

Local and systemic effector and memory T cells

No local effector T cell response

Response to Ag Reexposure

Enhanced (memory) Response

Low or no response

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16
Q

Experimental Demonstration of Oral Tolerance

Humoral Response

Mice fed Ag A. They were then challenged with that Ag via an injection 7 days later. Then mice were sacrified. Response to Ag was assessed via Ab production.

Fed nothing and challenged with Aà __ ___ response to A

Fed B and then challenged with Aà __ response

Fed A and then challenged with Aà ____ Ab response

Control: fed A and challenged with Bà ___ Ab response to A

A

Experimental Demonstration of Oral Tolerance

Humoral Response

Mice fed Ag A. They were then challenged with that Ag via an injection 7 days later. Then mice were sacrified. Response to Ag when assessed via Ab production.

Fed nothing and challenged with Aà Distinct Ab response to A

Fed B and then challenged with Aà Ab response

Fed A and then challenged with Aà reduced Ab response

Control: fed A and challenged with Bà no Ab response to A

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17
Q

Experimental Demonstration of Oral Tolerance

Did same experiment but wanted to look at CD4 T cell

Fed Ovalbumin. Challenge with Ovalbumin

Mice that were fed Ovalbumin and then challenged with Ovalbumin had ____ response.

If not fed Ovalbumin, you had ___ response (CD4 T cells ___to Ovalbumin)

A

Experimental Demonstration of Oral Tolerance

Did same experiment but wanted to look at CD4 T cell

Fed Ovalbumin. Challenge with Ovalbumin

Mice that were fed Ovalbumin and then challenged with Ovalbumin had a low response.

If not fed Ovalbumin, you had High response (CD4 T cells specific to Ovalbumin)

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18
Q

Oral Tolerance can be _____

Cell Mediated Portion of Response

Fed mouse with Ag A.

Took ___ ___ from the cells and transferred it to another mouse

Wanted to see if immune response/tolerance could be transferred by immune cell

Challenged second mouse with A

Conclusion: if you transferred T cells from mouse that were previously fed the Ag, the T cell oral tolerance could be transferred along with the cells.

A

Oral Tolerance can be Transferred

Cell Mediated Portion of Response

Fed mouse with Ag A.

Took bone marrow from the cells and transferred it to another mouse

Wanted to see if immune response/tolerance could be transferred by immune cell

Challenged second mouse with A

Conclusion: if you transferred T cells from mouse that were previously fed the Ag, the T cell oral tolerance could be transferred along with the cells.

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19
Q

Oral Tolerance can be ___ / ____

Depends on microenvironment around it

Feed mouse Ag with IFN Gamma (____ ____), it would ____tolerance.

Feed mouse Ag with IL10 or TGFB (____ ___), it would ____ your tolerance

A

Oral Tolerance can be Enhanced/ Reduced

Depends on microenvironment around it

Feed mouse Ag with IFN Gamma (pro-inflammatory cytokine), it would reduce tolerance.

Feed mouse Ag with IL10 or TGFB (anti-inflammatory cytokine), it would increase your tolerance

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20
Q

Oral Tolerance Mechanism

____

Induction of ___ ___

Induction of ____ ___

Induction of ___ ___ ___ which produce_____ cytokines

A

Oral Tolerance Mechanism

Ignorance

Induction of clonal anergy

Induction of clonal deletion

Induction of T regulatory cells which produce suppressor cytokines

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21
Q

Ignorance

  • There are T cells and B cells specific for _____ present in circulation.
  • These cells are quite ___ of making a response but are ____ of the presence of their auto-antigen.
  • Why?
  • 1.Antigen____ is too ___-lymphocytes have a threshold for receptor occupancy which is required to trigger a response
  • 2.Antigens are ____ from the immune system in locations which are not freely____ to surveillance- immunologically ____ sites Barriers
  • a)Potential____ ramifications if barriers disrupted
    *
A

Ignorance

There are T cells and B cells specific for auto-antigens present in circulation.

These cells are quite capable of making a response but are unaware of the presence of their auto-antigen.

Why?

  1. Antigen concentration is too low-lymphocytes have a threshold for receptor occupancy which is required to trigger a response
  2. Antigens are sequestered from the immune system in locations which are not freely exposed to surveillance- immunologically privileged sites Barriers
    a) Potential autoimmune ramifications if barriers disrupted
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22
Q

High vs. Low Dose Tolerance

That will influence how mechanism of tolerance works

High Dose: Induce ___ or ____ of T cell that recognizes that ___

Low Dose: Favor product of __ _____ (______)

A

High vs. Low Dose Tolerance

That will influence how mechanism of tolerance works

High Dose: Induce Anergy or deletion of T cell that recognizes that Ag

Low Dose: Favor product of T regulatory cells (immunosuppressive)

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23
Q

Oral Tolerance Summary

Oral tolerance is a specific mechanism

Clonal deletion and regulatory T cells are the primary mechanisms

Breakdown of tolerance can lead to _____ disorders.

A

Oral Tolerance Summary

Oral tolerance is a specific mechanism

Clonal deletion and regulatory T cells are the primary mechanisms

Breakdown of tolerance can lead to autoimmune disorders.

24
Q

Mucosal Immunity: Commensals

  • Microbiota communities affected by
    • Age
    • Location
    • Environmental cues (i.e. antibiotics, diet)
      • Therapy
    • Genetics predisposition
    • Disease vs. health
    • Dynamic communityà Changes thruout life
  • ___ ___ ___ play role in regulating response to commensals
    • IECs deficient in _____ (____ regulator of ____s) show ____cytokines, ____ susceptibility to intestinal inflammation
  • Immune status of host also influences makeup of commensal flora, thereby affecting immune system function
  • IgA-deficient mice have different microbial spp
  • Tbet KO/scid mice have increased “_____” bacteria and ___ symptoms
    *
A

Mucosal Immunity: Commensals

Microbiota communities affected by

Age

Location

Environmental cues (i.e. antibiotics, diet)

Therapy

Genetics predisposition

Disease vs. health

Dynamic communityà Changes thruout life

Intestinal epithelial cells play role in regulating response to commensals

IECs deficient in SIGGIR (negative regulator of TLRs) show increased cytokines, increased susceptibility to intestinal inflammation

Immune status of host also influences makeup of commensal flora, thereby affecting immune system function

IgA-deficient mice have different microbial spp

Tbet KO/scid mice have increased “colitogenic” bacteria and UC symptoms

25
Q

Microbiota changes with life stage

Normal weight, Obese, Gastric Bypass

Pregnancy

Fecal transplant to mice from pregnant women

1st trimester: mouse___ weight

3rd trimester: mouse ____ and developed ___ ___

A

Microbiota changes with life stage

Normal weight, Obese, Gastric Bypass

Pregnancy

Fecal transplant to mice from pregnant women

1st trimester: mouse normal weight

3rd trimester: mouse fatter and developed insulin desensitization

26
Q

Specific commensals determine ___ vs. ____

Differentiation of lamina propria T cells into ____ vs ____cells is determined by flora

Bacterial DNA signals through TLR9 to suppress Treg conversion, acts as a “natural adjuvant” (Hall, Immunity 2008)

Specific types of flora promote Th17 vs Treg development in the intestine (Ivanov, Cell Host & Microbe, 2008)

A

Specific commensals determine inflammation vs. suppression

Differentiation of lamina propria T cells into Treg vs Th17 cells is determined by flora

Bacterial DNA signals through TLR9 to suppress Treg conversion, acts as a “natural adjuvant” (Hall, Immunity 2008)

Specific types of flora promote Th17 vs Treg development in the intestine (Ivanov, Cell Host & Microbe, 2008)

27
Q

Breakdown of oral tolerance

Immune responses to food leads to__ ___

e.g. celiac disease

Immune responses to___ ___eads to ___ ___ ___

Crohn’s disease

Ulcerative colitis

A

Breakdown of oral tolerance

Immune responses to food

leads to food intolerance

e.g. celiac disease

Immune responses to commensal bacterialeads to inflammatory bowel disease (IBD)

Crohn’s disease

Ulcerative colitis

28
Q

Diseases of the Intestinal Immune System

Caused by:

Failure to ____ oral tolerance or

Food Allergies

Failure to ____ oral tolerance

A

Diseases of the Intestinal Immune System

Caused by:

Failure to establish oral tolerance or

Food Allergies

Failure to maintain oral tolerance

29
Q

Food Allergies

Failure to establish tolerance

Production of __ to an antigen (allergen) which is then encountered again

2-4% of children and fewer adults suffer

Sensitive patients are usually atopic

Treatment is simple; avoidance and replacement

A

Food Allergies

Failure to establish tolerance

Production of IgE to an antigen (allergen) which is then encountered again

2-4% of children and fewer adults suffer

Sensitive patients are usually atopic

Treatment is simple; avoidance and replacement

30
Q

Classification of adverse reactions to foods

Non immune mediated (___ ___) and immune mediated (___ ___)

A

Classification of adverse reactions to foods

Non immune mediated (food intolerance) and immune mediated (food allergy)

31
Q

Common Food Allergies

Allergen Source

Antigen M Codfish

Tropomysin Shrimp

_____ Peanuts

Trypsin inhibitor Soybean

A

Common Food Allergies

Allergen Source

Antigen M Codfish

Tropomysin Shrimp

Peanut I Peanuts

Trypsin inhibitor Soybean

32
Q

Allergic Responses

_____ of IgE on cells by food ___

Activation of ___ ___ ___

Release of____ mediators which cause

  • Transepithelial __ ____
  • ____ muscle ____
  • ___ and ___
  • ____
A

Allergic Responses

Crosslinking of IgE on cells by food Ag

Activation of mucosal mast cells

Release of inflammatory mediators which cause

Transepithelial fluid loss

Smooth muscle contraction

Vomiting and diarrhea

Anaphylaxis

33
Q

Celiac Disease (Gluten-Sensitive Enteropathy)

Hypersensitivity to ___ ___, especially gliadin of wheat gluten

1 to 35 people affected per 10,000

Geographical differences

Genetic predisposition (_____ allele in ~90% of patients; HLA DQ8 allele in ~8%)

Villous atrophy in ___ ___

Mal_____

Treatment is modified diet and avoidance

A

Celiac Disease (Gluten-Sensitive Enteropathy)

Hypersensitivity to cereal grain, especially gliadin of wheat gluten

1 to 35 people affected per 10,000

Geographical differences

Genetic predisposition (HLA DQ2 allele in ~90% of patients; HLA DQ8 allele in ~8%)

Villous atrophy in small intestine

Malabsorption

Treatment is modified diet and avoidance

34
Q

Inflammatory Bowel Disease

  • _____ of oral tolerance
  • Chronic ____ and remitting inflammatory disorders of ____ etiology
  • ___ ___ (UC) affects colon
    • To treat, remove the colon
  • ___ ___ (CD) affects entire GI
    • Incidence of 1 in 600 and ____
      • >8,000 new cases of IBD /year
      • >130,000 affected people in UK.
  • Age range 15-35
  • Symptoms include pain, ___ diarrhea, ____
  • Some ___ manifestations
    • Egzma or Alzheimer
  • No___ for CD
    *
A

Inflammatory Bowel Disease

Breakdown of oral tolerance

Chronic relapsing and remitting inflammatory disorders of unknown etiology

Ulcerative colitis (UC) affects colon

To treat, remove the colon

Crohn’s disease (CD) affects entire GI

Incidence of 1 in 600 and increasing

>8,000 new cases of IBD /year

>130,000 affected people in UK.

Age range 15-35

Symptoms include pain, bloody diarrhea, ulcers

Some extraintestinal manifestations

Egzma or Alzheimer

No cure for CD

35
Q

IBD is a complex disease

Has influences from ____, ___ of the host, ___ and defective immune ____

A

IBD is a complex disease

Has influences from microbiome, genetics of the host, environment and defective immune regulation.

36
Q

Immunopathogenesis of IBD

____ disorder,_____ inflammatory response

Mechanisms of epithelial cell injury unknown

____T cell-mediated

___ __ ___are an initiating stimulus

A

Immunopathogenesis of IBD

Autoimmune disorder, uncontrolled inflammatory response

Mechanisms of epithelial cell injury unknown

CD4+T cell-mediated

Commensal gut flora are an initiating stimulus

37
Q

Autophagy in Crohn’s Disease

2 genes implicated in chrons are ATG16L1 and NOD 2. These are important for ___ ___ in the host. In CD, they don’t recognize bacteria as well

A

Autophagy in Crohn’s Disease

2 genes implicated in chrons are ATG16L1 and NOD 2. These are important for sensing bacteria in the host. In CD, they don’t recognize bacteria as well

38
Q

Oral Manifestations of UC and CD

___ of ___

____

___ ___

A

Oral Manifestations of UC and CD

Swelling of Lips, Ulcers and Mucosal Tags

39
Q

Antibiotic induced Gastrointestinal Disease

Be careful taking Ab:

Ab resistance and affecting host system

Can kill off commensals

A

Antibiotic induced Gastrointestinal Disease

Be careful taking Ab:

Ab resistance and affecting host system

Can kill off commensals

40
Q

ANTIBIOTICS PREDISPOSE GI DISEASAE

FREQUENTLY

____

___

RARELY

___

___

A

ANTIBIOTICS PREDISPOSE GI DISEASAE

FREQUENTLY

Ampicillin “cillins”

Cephalosporin

RARELY

Aminoglycosides

METRONIDAZOLE

41
Q

Important Diseases involving the Oral Cavity Infections

Bacterial (>___% of oral disease)

Periodontal Disease

Dental Caries

Viral

Herpes

Herpes labalis

Herpetic gingivostomatiis

Kaposi’s Sarcoma

Epstein-Barr

  • “Oral ___ ____” in immunodeficient patients

HIV

FungalOral Candidiasis

Common in immunocompromised patients

A

Important Diseases involving the Oral Cavity

Infections

Bacterial (>95% of oral disease)

Periodontal Disease

Dental Caries

ViralHerpes

Herpes labalis

Herpetic gingivostomatiis

Kaposi’s Sarcoma

Epstein-Barr

“Oral Hairy leukoplakia” in immunodeficient patients

HIV

FungalOral Candidiasis

Common in immunocompromised patients

42
Q

Periodontal Disease: Immune Component

____ in host or establishment of ____ pathogen in the gum lining cause an inflammatory response that’s started by ___ and ____ that are recruited to the site and then release chemokines IL8, L1, TNF alpha

A

Periodontal Disease: Immune Component

Predisposition in host or establishment of ketone pathogen in the gum lining cause an inflammatory response that’s started by neutrophils and macrophages that are recruited to the site and then release chemokines IL8, L1, TNF alpha

43
Q

Periodontal Disease: RANKL vs. OPG

Initiation of RANKL-RANK pathway promotes ____

Osteoprotegerin (OPG) is a ___ ___ of RANK( Receptor for Rank Ligand)

When RANK ligand binds RANK it causes preosteoclasts to differentiate into activeosteoclasts which promote___ ___

___ cells release ___. This increases amt of RANKL which will promote tissue destruction and ___ ___

Balance bw RANKL and OBG controls bone resorption in perio disease

A

Periodontal Disease: RANKL vs. OPG

Initiation of RANKL-RANK pathway promotes osteoclastogenesis

Osteoprotegerin (OPG) is a competitive inhibitor of RANK( Receptor for Rank Ligand)

When RANK ligand binds RANK it causes preosteoclasts to differentiate into activeosteoclasts which promote bone breakdown

Th17 cells release RANKL. This increases amt of RANKL which will promote tissue destruction and bone loss

Balance bw RANKL and OBG controls bone resorption in perio disease

44
Q

Cytokines and Periodontal Disease

___ and ___ promote expression of RANKL

___ and ___ secrete IL4 and IL10 that block this effect.

A

Cytokines and Periodontal Disease

Th1 and Th17 promote expression of RANKL

Th2 and Treg secrete IL4 and IL10 that block this effect.

45
Q

Clodronate liposome ___ macrophages (Mj) by inducing ___

Experimental techniques to study macrophages

Clodronate is toxic chemical. When macrophages phagocytose the clodronate, they die.

A

Clodronate liposome deplete macrophages (Mj) by inducing apoptosis

Experimental techniques to study macrophages

Clodronate is toxic chemical. When macrophages phagocytose the clodronate, they die.

46
Q

Inject mice with P. gingivalis and looked at response of macrophages in oral tissue

Experiment 1

Give mice Pg in oral cavity. Get ___ in macrophages in oral cavity

Intraoral infection with P. gingivalis attracts ____

Experiment 2

Clodronate ___ Mj response to P. gingivalis infection

What happens if you clodronate to remove macrophages.

Treat with clodronate liposomes and Pg, you don’t get ___ in macrophages (Same for IV or S.C treatment)

A

Inject mice with P. gingivalis and looked at response of macrophages in oral tissue

Experiment 1

Give mice Pg in oral cavity. Get increase in macrophages in oral cavity

Intraoral infection with P. gingivalis attracts Mj

Experiment 2

Clodronate subverts Mj response to P. gingivalis infection

What happens if you clodronate to remove macrophages.

Treat with clodronate liposomes and Pg, you don’t get increase in macrophages (Same for IV or S.C treatment)

47
Q

Bone resorption ___ with Mj (Macrophage) depletion

When macrophages die/deplete there is less bone resorption

NO PGING –> ___ bone resporbtion

PGINGIVITIS –> bone resorbtion

If you eliminate the macrophages with clodronate, you ___ get the bone resorption

MACROPHAGES NORMALLY ____ ___ ____

A

Bone resorption decreased with Mj (Macrophage) depletion

When macrophages die/deplete there is less bone resorption

NO PGING à no bone resporbtion

PGINGIVITIS à bone resorbtion

If you eliminate the macrophages with clodronate, you don’t get the bone resorption

MACROPHAGES NORMALLY STIMULATE BONE RESORBTION

48
Q

Bone resorption correlates with ___ ___

Greater Bacterial load you have, the ___ BR you have

A

Bone resorption correlates with bacterial load

Greater Bacterial load you have, the greater BR you have

49
Q

P. gingivalis infection promotes ___ Mj accumulation

Remember you have multiple subtypes of macrophages

M1:______

A

P. gingivalis infection promotes M1 Mj accumulation

Remember you have multiple subtypes of macrophages

M1: Pro-inflammatory

50
Q

While the Arachidonic Pathway drives Inflammation,___ ____, and ____mediate ____ of Inflammation

R, L and P discourage___ ___n but encourage ___ ____

Knock out any of these and you can get failed ____ and continued ____

A

While the Arachidonic Pathway drives Inflammation, Resolvins, Lipoxins, and Protectins mediate Resolution of Inflammation

R, L and P discourage neutrophil infiltration but encourage monocyte recruitment

Knock out any of these and you can get failed resolution and continued inflammation

51
Q

Resolvins can ____ Periodontitis

Skin ligatures tied around teeth of rabbit. Then inoculate with Pg in vehile or Pg in resolvin.

Vehicle: ___ ___ and ___ ___

Resolvin: ___ ____

Step further

Started with periodontal disease in the rabbits and then treated them to see if it had a therapeutic effect in addition to the preventative effect

Resolvin: ___ periodontal health

A

Resolvins can Prevent Periodontitis

Skin ligatures tied around teeth of rabbit. Then inoculate with Pg in vehile or Pg in resolvin.

Vehicle: bone loss and gum disease

Resolvin: No periodontitis

Step further

Started with periodontal disease in the rabbits and then treated them to see if it had a therapeutic effect in addition to the preventative effect

Resolvin: improved periodontal health

52
Q

Chronic Inflammation increases Risk of ___

A

Chronic Inflammation increases Risk of Cancer

53
Q

Important Diseases with Oral Cavity Manifestations

  • Autoimmune
  • IBD
    • Aphthous Ulcers and other oral lesions
  • Desquamative gingivitis
    • Benign Mucous Membrane Pemphigoid
    • Lichen planis
    • Pemphigus
  • Sjogren’s Syndrome
  • Oral Mucositis
  • Wound Healing
  • Implants and Grafts
    *
A

Important Diseases with Oral Cavity Manifestations

Autoimmune

IBD

Aphthous Ulcers and other oral lesions

Desquamative gingivitis

Benign Mucous Membrane Pemphigoid

Lichen planis

Pemphigus

Sjogren’s Syndrome

Oral Mucositis

Wound Healing

Implants and Grafts

54
Q

Mucositis

Can occur anywhere along the mucosal surface

Stomatitis

  • Any ____ of oral tissue

Oral mucositis

  • Oral tissue inflammation due to ___ ____ therapies (chemotherapy or radiotherapy)

Oral Mucositis Grading

___with _ being more severe

A

Mucositis

Can occur anywhere along the mucosal surface

Stomatitis

Any inflammation of oral tissue

Oral mucositis

Oral tissue inflammation due to cytotoxic anticancer therapies (chemotherapy or radiotherapy)

Oral Mucositis Grading

0-4 with 4 being more severe

55
Q

Hypersensitivity Reactions

  • Antibody-mediated
    • Type I (immediate or ____ hypersensitivity)
      • ___anaphylaxis
      • Mediated by ___ and __
      • ___ Ag
      • Ex) Allergicenitis or anaphylaxis
    • Type II (____ hypersensitivity)
      • Drug induced Thrombocytopenia or Graves’ disease
      • Mediated by ___ and___ and ____
      • ___ or ___ ___ Ag
    • Type III (___ ___hypersensitivity)
      • ___ diseases
        • SLE
      • Mediated by ___ and ____
      • ___ Ag
  • Cell-mediated
    • Type IV (cell mediated or ___ type hypersensitivity)
    • Contact Dermitis
      • Latex Allergy
      • Nickel Allergy (metal crowns)
    • Mediated by _____
    • Takes the___
    • ________ Ag
      *
A

Hypersensitivity Reactions

Antibody-mediated

Type I (immediate or anaphylactic hypersensitivity)

Systemic anaphylaxis

Mediated by IgE and IgG

Soluble Ag

Ex) Allergicenitis or anaphylaxis

Type II (cytotoxic hypersensitivity)

Drug induced Thrombocytopenia or Graves’ disease

Mediated by IgG and IgM and Complement

Cell or mucosal Associated

Type III (immune complex hypersensitivity)Autoimmune diseases

SLE

Mediated by IgG and Complement

Soluble Ag

Cell-mediated

Type IV (cell mediated or delayed type hypersensitivity)Contact Dermitis

Latex Allergy

Nickel Allergy (metal crowns)

Mediated by cytotoxic T cells

Takes the longest

Solube or Cell Associated Ag