Immu 3: Immune Modulation Therapies 1 Flashcards

(40 cards)

1
Q

Describe Clonal expansion in T cells?

A

If an antigen is presented to a T cell receptor which has high specificity for it, the T cell proliferates and differentiates into T helper, Cytotoxic and memory cells

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2
Q

List 3 vaccines given to the elderly aged over 65?

A

Pneumococcal vaccine (Pneum PPV)
Flu vaccine
Shingles

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3
Q

Describe clonal expansion in B cells ?

A

If the B cell receptor has high specificity for the antigen presented, the B cell will become activated and undergo proliferation and differentiation into IgM secreting plasma cells and B memory cells

Then undergo

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4
Q

list 3 types of APC

A

dendritic cells
macrophages
B lymphoctes

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5
Q

3 aims of vaccines

A
  • MEMORY: generate protective, long-lasting immune response
  • No adverse reactions
  • Practical considerations e.g. one vaccine, easy storage, inexpensive
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6
Q

Immunological memory is mediated by

A

B and T lymphocytes

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7
Q

Where do B cells undergo Isotype switching ?

A

Germinal centres

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8
Q

Where do plasma cells reside ?

A

Bone marrow

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9
Q

which bacteria is in the BCG vaccine ?

What does this vaccine protect against?

A

Bovine tuberculosis

Progression to active tuberculosis

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10
Q

Give 5 examples of live attenuated vaccines ?

Does pt get Sx?

A
  • MMR
  • BCG
  • Yellow fever
  • Typhoid (oral)
  • Polio (oral)

Pt gets mild Sx

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11
Q

6 examples of inactivated vaccines

A
  • Influenza
  • Cholera
  • Bubonic plague
  • Polio (Salk)
  • Hepatitis A
  • Pertussis, Rabies
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12
Q

Give 2 examples of Toxoid vaccines (Inactive toxins) ?

A

Diphtheria
Tetanus

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13
Q

Give 3 examples of subunit vaccines ?

Which sort of infections is this usually for?

A
  • Hep B (HBsAG)
  • HPV (capsid)
  • Influenza (HA)

Usually for vaccines (vaccine contains a component/subunit of the vaccine)

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14
Q

Give 3 advantages of a live vaccine compared to a component/inactivated vaccine ?

A
  • Longer lasting immunity (life long)
  • Immunity is broader (protects against more strains)
  • activate ALL phases of the immune system: T cells, B cells, with local IgA, humoral IgG
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15
Q

Give 3 advantages of a component/inactivated vaccine compared to a live vaccine ?

A
  • Can be given to immunocompromised patients
  • Storage easier
  • Lower cost
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16
Q

Why might conjugate vaccines be better than inactivated/component vaccines?

A
  • To help avoid the problems of inactivated/ component vaccines, you can put on a protein carrier with a polysaccharide
  • So conjugate vaccine has a protein carrier on top of a polysaccharide (NB inactivated ONLY has polysaccharide), which promotes T cell immunity which enhances the B cell/ antibody response
  • Polysaccharide ALONE induces a transient T cell independent B cell response (particularly in children) and does NOT stimulate a good T cell response (this is in inactivated/component vaccines)
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17
Q

Give 3 examples of conjugate vaccines ?

A

HiB (haemophilus influenza B)
Meningococcus
Pneumococcus

18
Q

List 2 indications for Haematopoeitic stem cell transplantation ?

A

SCID
Haematological malignancy

19
Q

List 3 primary immunodeficiency diseases in which Antibody replacement (pool of antibodies to variety of organisms) is indicated ?

A

Bruton’s X-linked agammaglobulinaemia
X-linked hyper IgM syndrome
Common variable immunodeficiency

20
Q

In which 2 Haematological malignancies is Antibody replacement indicated ?

A

CLL
Multiple myeloma

21
Q

List 3 diseases in which IgG immunoglobulin therapy can be used ?

What is MoA?

A

Shingles infection (varicella zoster)
Rabies (post exposure)
Hepatitis B

MoA: post-exposure prophylaxis (passive immunisation)

22
Q

Give one example of an infection in which adoptive cell transfer (ACT) can be used to infuse a donor’s T cells ?

A

EBV infection in immunocompromised patients.

T cells from a donor are isolated and exposed to EBV antigen to stimulate Clonal expansion of specific T cells. These T cells are infused into the immunocompromised recipient to treat EBV infection.

23
Q

what is TCR and CAR T cell therapy

  • T cell receptor T cells (TCR-T cell therapy)
  • Chimeric antigen receptor T cells (CAR-T cell therapy)
A

TCR (T cell receptor T cells therapy)

  • T cells taken from patient
  • viral/non-viral vectors are used to insert fragments of genes into these T cells
  • these gene fragments encode receptors
  • for TCR therapy - insert a gene that encodes a specific TCR against a tumour cell antigen

CAR-T therapy (Chimeric antigen receptor T cells)

  • for CAR therapy, stead of putting a vector with a TCR in, a chimeric antigen receptor (which is a mix of an antibody and T cell receptor) is inserted

used in ALL and NHL

24
Q

In CAR-T therapy, against CD is it effective against?

A
  • most common use of this method is for a TCR expressing CD19 variable antibody fragment (so the antibody recognises CD19) which is put onto the end of CD28 and CD3z (which is the signalling domain)
25
Which conditions are CAR-T therapy useful against? (2)
* Used for Acute Lymphoblastic Leukaemia in kids * Used for some form of non-Hodgkin lymphoma
26
Ipilimumab targets which 2 immune checkpoints?
* CTLA4 (INHIBITORY signal) * CD28 (STIMULATORY signal)
27
How does Ipilimumab work in treatment of advanced melanoma ?
Ipilimumab blocks CTLA4 which is an inhibitory receptor on T cells This causes increased T cell activation and boosts the immune response T cells have CD28 (activator receptor) and CTLA4 (inhibitory receptor). CD80 and CD86 on APCs can bind to either to activate/inhibit T cells
28
Pembrolizumab and Nivolumab are used for which 2 conditions?
* Advanced melanoma * Metastatic renal cell cancer
29
How does Pembrolizumab and nivolumab work in the treatment of advanced melanoma ?
They inhibit PD-1 receptors on T cells. This causes increased T cell activation because PD-1 is an inhibitory pathway. PD-1 receptors on T cells cause an inhibition of T cells when activated by PD-ligand 1 or 2 on APC or tumour cells
30
What side effects are more common in patients receiving monoclonal antibodies for advanced melanoma (Pembrolizumab and Nivolumab)?
Auto-immune diseases (arthritis, thyroid disease, Diabetes) Because the T cell response is over stimulated
31
what happens when B cells with appropriate specificity get selected
proliferate differentiate into T cell independent IgM plasma cells undergo germinal centre reaction and differentiate into T cell dependent IgG producing memory and plasma cells
32
features of memory B and T cells
memory T - different pattern of expression of cell surface proteins involved in chemotaxis and cell adhesion, allowing rapid access to non-lymphoid tissues memory B - circulating pre-formed high-affinity IgG antibodies present
33
name the membrane fusion glycoprotein of influenza virus
haemagglutinin (HA) target for antibodies
34
what is tumour infiltration T cell therapy
* remove tumour * stimulate T cells within the tumour with cytokines in the presence of the tumour so they develop resistance to it * select and expand tumour infiltrating lymphocytes and reinfuse into the patient
35
how can we block immune checkpoints (2)
* Iplimumab - antibody specific to CTLA4 - advanced melanoma * Pembrolizumab and Nivolumab - antibodies specific to PD1 - activates T cells - advanced melanoma
36
Which IL is CD8 T cell response dependent on?
IL-2
37
What is a common adjuvant that can be added to vaccines to increase immune response without altering its specificity?
Aluminium salts
38
Use of IFN alpha cytokine therapy (4)
* Hairy cell leukaemia * CML * Multiple myeloma * Used as an adjunct for: HBV, HCV, Kaposi sarcoma
39
Use of IFN beta cytokine therapy (2)
* Behcet’s * relapsing MS
40
Use of IFN gamma cytokine therapy (1)
Stimulates phagocytes in patients with Chronic granulomatous disease