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Embryology Dev & Fxn > Immune Dev > Flashcards

Immune Dev Flashcards

1
Q

Precursor immune cells are located?

A

w/in the blood islands of the yolk sac

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2
Q

Where do B & T lymphocytes arise from?

A

Common lymphoid tissue

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3
Q

When do pre-B cells show in the Liver?

A

7-8 wks GA

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4
Q

By ____ wks the immature B lymphocytes (in the liver) have surface cell IgM receptors

A

10 wks

*they reach adult values by 15 wks

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5
Q

By ____ wks B-lymphocytes have both IgG & IgM receptors

A 
12 wks in:
Peripheral blood
Bone marrow
Liver
Spleen
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6
Q

When do Immunoglobulins Synthesize?

A

Begin 10-14 wks

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7
Q

When do IgG levels increase the most?

A

2nd & 3rd trimester

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8
Q

IgA is produced at _____ wks GA?

A

30 wks, increase after birth

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9
Q

Increased levels IgG in cord suggest?

A

Infection!

Consider Rubella, CMV, or Toxoplasmosis

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10
Q

When does the Thymus begin to develop?

A

6-7 wks

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11
Q

Where does the Thymus develop from?

A

3rd & 4th pharyngeal POUCHES. They form 2 rudimentary structures that grow toward midline. The 2 structures fuse by 8th wk & descend into the chest.

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12
Q

When do T-Lymphocytes appear in the Thymus?

In the blood?

A

7 wks GA

12 wks GA

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13
Q

When do CD4 & CD8 suface antigens differentiate?

A

10 wks GA

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14
Q

When can mature CD4 & CD8 T-Lymphocytes be seen in Liver & Spleen

A

14 wks and in fetal circulation by 15-16 wks

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15
Q

What are CD4 & CD8?

A

Transmembrane glycoproteins that serve as co-receptors for the T-cell recpeptor

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16
Q

Mid-gestation what Cytokines are formed?

A

Interleukins (2-6)
Tumor Necrosis Factor
Interferon
**w/infection, increased IL 6 is present in amniotic fluid

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17
Q

What are Cytokines?

A

Proteins important in cell signaling when an Antigen is present

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18
Q

Name some groups of Cytokines

A

Chemokines, Interferons, Interleukins, Lymphokines

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19
Q

What does IL 1 do?

A

regulates immature & inflammatory response to infections

*made up of 11 cytokines

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20
Q

What does IL 2 do?

A

Regulates the activities of WBC’s responsible for immunity.

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21
Q

What does IL 3 do?

A

Improves the body’s natural response to disease

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22
Q

What does IL 4 do?

A

Induces helper T cells that increase release of IL 4

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23
Q

What does IL 5 do?

Where is it produced?

A

Stimulates growth of B-Lymphocytes & increases Immunoglobulin secretion.

Produced by helper T-Cells & Mast cells

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24
Q

What does IL 6 do?

A

They are Pro-inflammatory & Anti-inflammatory Cytokines (secreted by T-cells and Macrophages)

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25
Q

Where do WBC’s come from initially?

A

the Yolk Sac

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26
Q

Neutrophils & Macrophages (colony-forming units as stem cells) are located?

A

In Bone Marrow

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27
Q

What is the most abundant Granulocyte?

A

Neutrophils

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28
Q

When are Granulocytes (Neutrophils) present in the fetal blood?

A

6-8 wks GA

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29
Q

After 20 wks, Neutrophils are produced at increasing amounts where?

A

Bone Marrow

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30
Q

Macrophages are seen at ____-____ wks GA in the ______ _____

A

3-4 wks GA

In the Yolk Sac

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31
Q

By ___-___ wks, 70 % of blood cells in the liver are Macrophages

A

4-5 wks. This decreases over time to 1-2% 6 wks later.

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32
Q

Monocytes are found in the blood by _____ months

A

5 months

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33
Q

Which IL is responsible for the inflammatory response to infection?

A

IL 1

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34
Q

Natural Killer Cells (NKC’s) are found in Liver and Blood by ____ wks.

When are they functional?

When do they increase in #?

A

5-6 wks

Functional at 20 wks

32 wks

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35
Q

What do Natural Killer Cells do?

A

They survey for Viral infections. They are a type of WBC.

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36
Q

What does Complement do?

A

It’s role is host-rejection of tumors & virally infected cells.
It “complements” Antibodies or Phagocytes to clear pathogens from an organism.

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37
Q

What are Complements?

A

Small proteins synthesized by the Liver that circulate in the blood as inactive precursors to Cytokine production.

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38
Q

What is the process if an infection is present?

A

Complement activates release of Cytokines which stimulates Phagocytes to come to the area and clear foreign matter/particles.

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39
Q

When is Complement synthesized in Liver?

A

6 wks GA

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40
Q

When is Complement seen in the blood?

A

20-22 wks GA

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41
Q

When does Complement rapidly increase?

A

26-28 wks GA

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42
Q

Why are Preterm infants especially vulnerable to infection?

A

Immature immune system
Decreased levels IgG
Disruption of skin barrier

43
Q

How is an infants skin initially colonized?

A

Through maternal genital tract during birth. (can be good or bad colonization)

Maternal skin

Environmental bacteria

44
Q

What is the Sequence of Colonization?

A
  1. Skin
  2. Umbilical Cord
  3. Genitals
  4. Mucous Membranes of eyes, ears, throat, & nares
45
Q

What is the time frame of Stage 1 Intestinal Colonization?

A

Birth-1 wk

46
Q

What is the time frame of Stage 2 Intestinal Colonization?

A

1-4 wks, by diet

47
Q

What is the protective mechanism of intestinal colonization?

A

Acidity of Gastric Secretions. It is affected by Immaturity of gut Epithelium.

48
Q

We want the intestines to be colonized by __________ bacterial

A

Good Bacteria

49
Q

Breastmilk maintains Acidic/Alkaline environment?

A

Acidic-(protective environment)

50
Q

Breastmilk PREVENTS growth of?

It PROMOTES growth of?

A

Prevents Gram Neg species

Promotes Lactobacillus & Bifidobacterium
low protein & phosphate, high Lactose

51
Q

Breastmilk stimulates secretion of which Immunoglobulin?

A

IgA

52
Q

Breastmilk __________ epithelial tight junctions & modifies intenstinal ___________ & _____ ____________.

A

Strengthens

inflammatory & allergic responses

53
Q

Formula has more/less acid than breastmilk?

A

Less acid (higher buffering)

54
Q

Formula has more/less Bifidobacterial content?

A

Less

55
Q

In formula fed infants, gram +/- enterococci become the dominant gut flora?

A

Gram Negative

56
Q

__________ might stimulate the development of intestinal flora similar to breastfed babies.

A

Prebiotics

57
Q

Decreased intestinal motility leads to?

A

Bacterial overgrowth

58
Q

VLBW, Intubated, or those fed via Transpyloric tubes have increased susceptability to _____ __________ infection.

A

Gram Negative

59
Q

Perinatal antimicrobial drugs do what to colonization?

A

They suppress colonization of good bacteria.

60
Q

What 3 things does Delayed oral feedings do:

A
  1. Toxins have a profound effect on intestinal mucosa (breaks tight junctions)
  2. Fewer Lymphoid cells in gut
  3. Alters gut immune responses
61
Q

In terms of ELBW’s, the evidence shows we should/should not use Probiotics?

A

Not yet a recommendation for ELBW’s.

62
Q

How are defense mechanisms altered in the Neonate?

A

Limitations of PMN’s (fewer Neutrophils-the primary response)
Decreased Opsonization, Phagocytosis, Macrophage activity, Natural Killer Cells & unable to increase Neutorphil production

63
Q

What is the result of low defense mechanisms?

A

Inability to localize infection leading to general septicemia.

64
Q

B-lymphocytes develop in?
Require signaling from?
Are a type of _______ cell that produce ________.

A

Bone marrow
Helper-T-cells
White blood cell, produce Antibodies

65
Q

Are B-cells involved in antigen specific binding?

A

Yes, forming an antibody response.

66
Q

________ &________ are needed to enhance B cell function.

A

T-cell activity and Cytokines

67
Q

Decreased Immunoglobulin production is due to?

A

Decrease in T-cell activity & Cytokine production

68
Q

What 2 things are important to kill GBS that the preterm infant has less of?

A

Less Immunoglobulins and Complement proteins = decreased Opsonization

69
Q

Which 2 immunoglobulin types cross the placenta in the 3rd month & increase at term?

A

IgG 1 & IgG 3

They are non-specific (Opsonization)

70
Q

Does IgA cross the placenta?

A

No.

71
Q

When is IgA present in the fetus?

It is also found in?

A

30 wks GA.

Colostrum/human milk

72
Q

What is IgA important for?

Where is it found?

A

Localizing immunity in the GI & Respiratory tract.

Secretory-found in tears, saliva, intestinal mucosa by 2-3 wks of age.

73
Q

What 2 immunoglobulins are directly responsible for Antibodies against most common organisms causing neonatal sepsis?

A

IgM & IgA

74
Q

Does IgE cross the placenta?

A

No.

75
Q

What is the major Ig produced in the 1st month of life?

A

IgM

76
Q

A fetus can produce IgM to TORCH infections after _____-_____ wks

A

19-20 wks.

77
Q

When do IgM levels increase rapidly?

A

2-4 days after birth in response to environmental antigens

78
Q

Preterm babies have less ____________ , limiting recognition of a pathogen as foreign.

A

specificity

79
Q

IgG = immunity from?

A

gram negative organisms and viruses

80
Q

IgM = protection from?

A

Blood-born infections

81
Q

IgE = protection against?

A

Allergies

82
Q

IgA = provides localized immunity in the?

A

GI & Respiratory tract

83
Q

Does cell-mediated immunity involve antibodies?

A

No. Phagocytes, Antigen-specific cytotoxic T-Lymphocytes, & various Cytokines.

84
Q

What is a T-Lymphocyte?

A

type of WBC. It scans and I.D.’s infections, stimulates T-Lymphokines–>recruit Phagocytes to contain organisms–>& stim’s Lymphocytes and Macrophages & inhibits viral replication.

85
Q

T-Lymphocytes develop in?

A

bone marrow

86
Q

Where do T-Lymphocytes mature?

A

Thymus

87
Q

How do T-Lymphocytes recognize foreign invaders?

A

By interacting with MHC’s antigens in the Thymus.

88
Q

What are MHC’s?

A

Cell surface protein that helps T-lymphocytes recognize foreign molecules.

89
Q

Name 2 types T-Lymphocytes.

A
  1. Helper T-cells (helps B Lymph’s)

2. Killer T-cells (cytotoxic)

90
Q

What do Suppressor T-cells do?

A

Shut down immune response after invading organism is destroyed (they regulate the immune response)

91
Q

What is the name of the T-Lymphocyte that recruits Phagocytes to the site of an infection?

A

Helper T-cells

92
Q

In premature infants suppressor cell activity is_________?

A

Dormant

93
Q

What happens in NEC and BPD?

A

Unregulated Cytokine production

94
Q

Immunity can take ___-___ wks after birth

A

4-6 wks post-birth

95
Q

Complement is the backup to _________?

A

Immunoglobulins

96
Q

Complements attach to an antibody _____ after contact with an ___________.

A

tail,

Antigen

97
Q

Complement assists in producing _________&__________ of IgG1 & IgG3

A

Inflammation & Opsonization

98
Q

The smaller the baby, the _________ complement present.

A

Less

99
Q

Newborns have less Complement protein components leading to (3 things)

A
  1. decreased Opsonization
  2. decreased Chemotactic activity
  3. decreased cell lysis
100
Q

By 1 yr/age, total Ig levels are ____% of adult values

A

60%

101
Q

Complement increases to adult values by ___-___ months

A

6-12 months age

102
Q

T-cell function is mature by ___-___ months

A

3-6 months age

103
Q

Chemotaxis and Neutrophils are decreased until?

Monocyte chemotaxis is decreased until?

A

2 years

6-12 months

104
Q

In general, the risk of infection decreases after?

A

2-3 months of age

Embryology Dev & Fxn (3 decks)

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