EXAM 4 Adaptive Immune Disease

Question 1

autoimmune diseases are loss of ___, leading to ___ reactions

Answer 1

• tolerance
• hypersensitivity

Question 2

describe autoimmune diseases

Answer 2

• adaptive immune targeting of self
• humoral or cell mediated
• often chronic and life long
• loss of self-tolerance
• hypersensitivity reactions - type II, III, and IV

Question 3

what are mechanisms that contribute to immunological self-tolerance?

Answer 3

Question 4

autoimmune disorders are caused by ___, ___, or ___

Answer 4

genetics, the environment, or both

Question 5

there are more than ___ autoimmune diseases

Answer 5

80

Question 6

___% of the US population is affected by autoimmune disorders

Answer 6

3%

Question 7

autoimmune diseases are among the 10 leading causes of death among what population?

Answer 7

women under 65

Question 8

genetic predisposition to autoimmune diseases is important. only ___% of predisposed individuals get autoimmune disease

Answer 8

20%

Question 9

are there infectious and non-infectious causes of autoimmune diseases?

Answer 9

yes, both

Question 10

___ subtype influences autoimmune disease development

Answer 10

HLA

Question 11

how do HLA subtypes influence autoimmune disease development?

Answer 11

• HLA genes associated with susceptibility in 50% of autoimmune diseases
• class II alleles most frequently implicated
• CD4 T cells closely tied to autoimmune disease development
• susceptibility does not always lead to disease

Question 12

type II hypersensitivity is mediated by what immunolobulins?

Answer 12

IgG or IgM

Question 13

type II hypersensitivity reactions target ___

Answer 13

cell surface proteins

Question 14

in type II hypersensitivity, are antibodies agonistic or antagonist?

Answer 14

they can be both

Question 15

rheumatic fever is caused by ___

Answer 15

molecular mimicry

Question 16

describe the pathogenesis of rheumatic fever

Answer 16

• staph pyogenes throat infection
• s. pyogenes cell wall shares human epitopes
• transient due to lack of T cell help
• demonstrates T cell necessity for prolonged autoimmunity

Question 17

describe graves disease

Answer 17

• antibody binding causes metabolic dysfunction
• antibodies function as a TSH agonist
• CD4 Th2 response
• excessive thyroid hormone release
• antibodies do not cause overt tissue damage
• hyperthyroid condition - weight loss, heat intolerance, anxiety and irritability, exophthalmos
• thyroid ablatement

Question 18

describe how antibody-mediated autoimmune disorders can be temporarily transferred to newborns

Answer 18

Question 19

what is hashimotos disease?

Answer 19

• destruction of normal thyroid tissue
• CD4 Th1 response
• hypothyroidism
• ectopic lymphoid tissue formed in the thyroid
• enlarged thyroid present swallowing difficulty

Question 20

___ is a form of hypothyroidism, and ___ is a form of hyperthyroidism

Answer 20

• hashimotos disease
• graves disease

Question 21

___ is a disease that causes progressive destruction of the exocrine glands

Answer 21

sjogrens syndrome

Question 22

describe how sjogrens syndrome is one of the most common autoimmune disorders

Answer 22

• 0.5% to 5% prevalence
• 9 times more prevalent in women
• utah has one of the largest known patient populations

Question 23

sjogrens syndrome is a type ___ hypersensitivity

Answer 23

II

Question 24

what are some clinical manifestations of sjorgrens syndrome?

Answer 24

• dry eyes, dry mouth, and arthritis
  
  • dramatically reduced salivary flow, tongue scaling, diffuse submandibular swelling, prominent caries, oral candidiasis

Question 25

what are the initiating factors of sjogrens disease?

Answer 25

unknown

Question 26

type III autoimmune diseases are ___ mediated, form large ___ complexes, cause ___ and \_\_\_, and can lead to ___ diseases

Answer 26

* IgG * immune * rashes, kidney dysfunction * rheumatic

Question 27

describe systemic lupus erythematosus (SLE)

Answer 27

* widespread self-antigen targeting and complex deposition * deposits in the blood vessels, kidneys, and joints * epitope spreading leads to intracellular antigen targeting

Question 28

what is the cause of SLE?

Answer 28

unknown cause, potential environmental trigger

Question 29

what is the external and oral presentation of SLE during a flare-up?

Answer 29

* external - rash on the face that looks like a wolf * oral - mouth ulcers and plaques * not necessarily painful at onset

Question 30

\_\_\_ causes intermolecular epitope spreading

Answer 30

SLE * macromolecular complex presentation * slowly expanding adaptive response * loss of tolerance

Question 31

type IV hypersensitivity autoimmune diseases are ___ mediated, involve ___ hypersensitivity, and ___ is tied to increased autoimmune disease incidence

Answer 31

* CD4 and CD8 * contact * thymic involution

Question 32

\_\_\_ is an example of a type IV hypersensitivity autoimmune disease

Answer 32

celiac disease

Question 33

describe autoimmunity in type I diabetes

Answer 33

* HLA-DR3/4 linkage * CD4 and CD8 T cell resposne kills beta cells * viral cross-reactivity model * molecular mimicry * stress * epitope spreading - intraepitope and interepitope

Question 34

what are the oral manifestations of type I diabetes?

Answer 34

* reduced salivary flow * altered saliva composition * impaired wound healing * sweet breath