Clinical Immunology

Question 1

Cancer therapy

Answer 1

Antibodies against regulators of the immune response turn the immune system into overdrive
T cells with genetically engineered antigen receptors that target them to cancer cells

Question 2

Autoinflammatory/autoimmune

Answer 2

Damage to self

Question 3

Immunodeficiency

Answer 3

Greater susceptibility to infection/cancer

Question 4

Two types of immunodeficiency

Answer 4

Primary
Secondary

Question 5

Primary immunodeficiency

Answer 5

From birth
Due to genetic mutations

Question 6

Secondary immunodeficiency

Answer 6

Generally not from birth
Due to environmental factors
-HIV/AIDS
-chemotherapy
-severe malnutrition

Question 7

Primary immunodeficiency patients

Answer 7

Human gene knockouts
Studied to reveal role of individual components of immune system

Question 8

Severe combined immunodeficiency

Answer 8

Bubble babies
No t or b cells
No adaptive immunity
One Cause is a loss of function muterions in RAG gene required for somatic recombination

Question 9

Neutropenia

Answer 9

Common clinical presentation
Type of secondary immunodeficiency
Neutrophils produced in bone marrow
Circulate for 8-24 hours
Can occur due to diseases of bone marrow, radiation, chemo, caused by certain infections and autoimmune diseases

Question 10

What is neutropenia associated with

Answer 10

Opportunistic infections
S. Aureus
E.coli
Pseudomonas aeruginosa
Aspergillus fumigatus

Question 11

Clinical presentation of neutropenia

Answer 11

Rapid onset fever and sometimes sepsis
Abscesses
Dental infections
Peri-anal infection
Sinusitis
Tonsillitis/pharyngitis
Pneumonia
Mild fever

Question 12

Acquired immunodeficiency syndrome

Answer 12

HIV hi jacks components of immune system in initial phase of infection
As it spreads, infection and destruction of CD4 T cell compartment contributed to persistence of infection and culminates in immunodeficiency
HIV infects host cell binding to CD4+ and CXCR4/CCR5 in mucosal tissue
Infected tissue dendritic cells and T cells migrate to lymph node where further viral replication and spread can occur

Question 13

How are CD4 T cells central controllers of adaptive immunity

Answer 13

Loss of T cell help via th1 and th17 limits effectiveness of innate immune
Loss of b cell help and control causes failure of antibody responses
Loss of help for anti-viral and anti-tumour CD8+ T cells
Loss of T cell regulation can result in autoimmunity

Question 14

Opportunistic infection presentation

Answer 14

Candida
CMV
Pneumocystis pneumonia
Toxoplasmosis
Cryptococcus
Cryptosporidiosis
Severe herpes zoster

Question 15

Loss of b cell function presentation

Answer 15

Pneumonia
Salmonella

Question 16

Loss of Th1 function

Answer 16

Mycobacterium

Question 17

Loss of T cell anti tumour function

Answer 17

Non-hodgkins lymphoma
Kaposis sarcoma

Question 18

Loss of T cell regulation presentation

Answer 18

Autoimmune disease e.g. ITP especially with HAART
High immunoglobulins

Question 19

Over activity of the immune system causing disease

Answer 19

Inappropriate activation (autoimmunity and allergy)
Failure to switch off (chronic inflammatory diseases)

Question 20

Autoimmune diseases

Answer 20

Adaptive targets self antigens leading to inflammation and tissue destruction of body’s tissues

Question 21

Examples of autoimmune diseases

Answer 21

Multiple sclerosis
Type 1 diabetes

Question 22

Polymorphisms and mutations in genes encoding components of innate immune systems link to disease

Answer 22

Failure of pattern recognition
Failure of early complement

Question 23

Failure of pattern recognition

Answer 23

NOD2 receptor defects lead to susceptibility to Crohns diseases

Question 24

Failure of early complement

Answer 24

Linked to systemic lupus erythrematosus and glomerulonephritis

Question 25

Immune mediated inflammatory diseases IMID

Answer 25

tissues are chronically inflamed The immune system damaged cells and Biomolecules

Question 26

Example of IMID

Answer 26

Rheumatoid arthritis

Question 27

Allergy

Answer 27

IgE antibodies are made against harmless antigens and then trigger acute response on re-exposure

Question 28

Acute allergic reaction process

Answer 28

Allergen specific IgE is pre-bound to FceR1 receptor on mast cells Circulating allergen binds IgE causing receptor cross linking and mast cell degranulation

Question 29

Symptoms of acute allergic reaction

Answer 29

Wheezing Urticaria Sneezing Rhinorrhea Conjunctivitis

Question 30

Chronic allergic reaction

Answer 30

Recruitment and activation of allergen specific T cells and other cells by mast cell derived mediators

Question 31

Causes of systemic low grade inflammation

Answer 31

Physical inactivity Chronic infections Obesity Dysbiosis Diet Isolation and chronic stress Disturbed sleep Xenobiotics

Question 32

Consequences of low grade inflammation

Answer 32

Metabolic syndrome,type 2 diabetes and NAFLD cardiovascular disease Cancer Depression Auto-immune diseases Neurodegenerative diseases Sarcopenia and osteoporosis Immunosenescence

Question 33

Diagnosing in lab

Answer 33

Look for antibodies in blood serum

Question 34

Antibodies against self

Answer 34

Autoimmunity

Question 35

CD4 T cell count dropped below threshold

Answer 35

AIDS

Question 36

Flow cytometry

Answer 36

Tag cells with fluorescent ly labelled antibodies and measure how many of each type there are Whether they are functional based on their cytokine and surface marker profiles

Question 37

Neutralising monoclonal antibody against COVID-19

Answer 37

Sotrovimab Neutralises spike protein on SARS CoV 2 and blocks entry into host cells For prevention and treatment of infection

Question 38

Manipulating cytokines INF alpha and hepatitis C

Answer 38

Interferons stimulate immune cells and turn on anti-viral mechanisms im infected cells For Hep C treatment, synthetic IFN alpha is typically given in combination with anti-viral ribavirin

Question 39

Manipulating cytokines TNF alpha and rheumatoid arthritis

Answer 39

TNF alpha is key coordinator of inflammation Blockade of TNF alpha signalling has revolutionised treatment of RA blockade of TNF alpha is used for other diseases, IBD

Question 40

What is given to some hospitalised covid patients

Answer 40

IL-6 inhibitor Tocilizumab

Question 41

Manipulating antigen presentation to treat autoimmunity

Answer 41

Modification of dendritic cells and re-administration to patients to induce tolerance to self antigen