IMM: Organ-Specific Autoimmune Disease

Question 1

• 3 types of autoimmune conditions (II, III, IV).
  
  • Discuss them.
  • Examples.

Answer 1

• Type II.
  
  • Myasthenia gravis.
  • Autoimmune haemolytic anemia.
• Type III.
  
  • Mixed essential cryoglobulinemia.
• Type IV - T cell mediated.
  
  • Diabetes mellitus.

Question 2

What is central tolerance and self tolerance?

Question 3

• CD4+ T cells are…..?
  
  • MHC Class _?
• CD8+ T cells are…..?
  
  • MHC Class _?
• Third type?

Answer 3

• CD4+ T cells are T helper cells.
  
  • MHC Class II.
• CD8+ T cells are cytotoxic T cells.
  
  • MHC Class I.
• Third type = T reg cells.

Question 4

Describe how T cells work.

Answer 4

T cells have to see something on the T-cell receptor. Need right kind os cytokine soup (cofactor activation).

Question 5

6 elements of confirmatory evidence that autoimmune response causes corresponding disease.

Question 6

• Young female.
• Double vision and upper arm weakness.
• Symptoms worsen throughout the day.
• Ex:
  
  • Complex ophthalmoplegia (eye weakness that can’t be explained by a single nerve), initial upper arm power was normal. Worsened on repeated testing.
• What is her diagnosis?
  
  • She would test positive for…..?

Answer 6

• Myasthenia gravis.
  
  • Acetylcholine-receptor antibodies (Ach-R Ab).

Question 7

• Discuss myasthenia gravis.
• Discuss the physiology of myasthenia gravis.

Answer 7

• Fatiguability and weakness of skeletal muscles due to dysfunction of the neuromuscular junction.

MECHANISM

• Antibodies bind to ACh receptor to cause receptor to disappear.
• Also BLOCKS the receptors.

Question 8

• What role do T cells play in antibodies?
• What are the two common thymic abnormalities in MG patients?
• How can MG be improved?

Answer 8

• T cells help B cells make better antibodies.
• Thymic hyperplasia and thymoma.
• Thymectomy removes thymoma.
  
  • Antibodies removed.
• Immunosuppressants - azathioprine, MTX.
• B cell medication - rituximab.

Question 9

Treatment for myasthenic crisis?

Answer 9

High dose immunoglobulins.

Question 10

What autoantibody crosses the placenta in the third trimester of pregnancy?

Answer 10

Active transfer of IgG autoantibodies across the placenta in the third trimester.

Question 11

Discuss the pathophysiology of Graves disease (how it affects the thyroid gland).

Answer 11

• Stimulating antibodies.
• Stimulates thyroid hormone production in the pituitary gland.

Question 12

6 points of evidence for autoimmunity in Graves disease.

Answer 12

Get off slides.

Question 13

Discuss the autoimmune condition of Hashimoto’s thyroiditis.

Question 14

• Man presents to the Emergency Department with abdominal pain, vomiting.
• Hx: 2 weeks of polyuria and polydipsia, 10kg weight loss, and blurred vision.
• Diagnosis?

Answer 14

• Type I diabetes mellitus.

Question 15

Discuss the autoimmune condition of diabetes mellitus.

Answer 15

Autoantibodies against islet B-cells appear months to years before clinical symptoms.

Question 16

Summary slide for basic and clinical immunology.

Answer 16