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Term 2 Flash Cards > immuno post midterm > Flashcards

immuno post midterm Flashcards

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1
Q

SLE

A

Systemic and multiorgan. IC are formed in serum and trapped in BM of glomeruli, skin/endothelium, synovia of joints, kidney. Unknown etiology

Immune-complex-mediated.
Ag/Ab - anti-ds-DNA, anti-phospholipids (can lead to spont abortion d/t increased coagulation), anti-leukocytes.
F/M - 10:1

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2
Q

RA

A

Excessive Type 1 cytokines. Rheumatoid factors IgM (or IgG/IgA) to the Fc of IgG. These are not essential for dz, may enhance IC. Both IL-! and TNFa are elevated in RA -> targets for therapy. Use anti-IL-1 and anti-TNFa (monoclonal Abs - eg adalimumab and fusion protein Enbrel/Enteracept). HLA DR1/DR4

Immune-complex and cell-mediated.
Ag/Ab - Fc of IgG/Ab is called rheumatoid factor
F/M - 3:1

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3
Q

Hashimoto’s thyroiditis

A

Thyroid. Goiter and/or hypothyroidism. (Hyperthyroidism first d/t dmg causing release of thyroid contents, then hypothyroidism) Peaks in ages 30s or 40s

Cell-mediated.
Ag/Ab - Ab released after gland destruction. Anti-thyroglobulin, anti-microsomal (proteins). Use Abs for dx.
F/M - 50:1

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4
Q

MS

A

Brain and spinal cord. Abs to MBP after cell death. Oligoclonal Ig bands in CSF (dx feature)

Cell-mediated. Delayed-type hypersensitivity (T cell mediated)
Ag/Ab - myelin basic protein (released after death)/anti-MBP and CNS oligoclonal Abs
F/M - 2:1

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5
Q

Goodpasture’s syndrome

A

Lungs and kidneys. Shared Ags between lung (alveolar) and GBM. Linear deposition of IgG and complement aids dx. HLA allele associated with HLA DR2

Abs to cell surface Ags
Ag/Ab - GBM/anti-GBM
F/M - 1:4, peaks in young and elderly

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6
Q

Pernicious anemia

A

Cell-specific - defective RBCs d/t malabsorption of vit B12. Abs bind cell surface Ags and destroy parietal gastric cells that secrete IF or Abs bind to IF and prevent binding of vit B12. Leads to megaloblastic anemia

Blocking Ab. Abs bind and destroy parietal cells
Ag/Ab - IF or surface antigens on parietal cells/anti-IF, anti-parietal cell

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7
Q

Graves’ dz

A

Thyroid. Stimulatory Abs mimic actions of ligand (thyroxin-stimulating hormone). Get unregulated secretion of thyroxin leading to hyperthyroidism

Stimulating Ab
Ag/Ab - TSHR/anti-TSHR
F/M - 8:1

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8
Q

MG

A

Neuromuscular transmission d/o. Abs are inhibitory and block ACh binding

Blocking Ab
Ag/Ab - ACH-R/anti-ACHR
F/M - 4:1

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9
Q

Cold agglutinin dz

A

Only manifests at temps below 37C. Occurs only at extremities (nose, fingers, toes) when pt is exposed to cold temps. Tx - keep patient warm and extremities well protected

Abs to cell surface Ags
Ag/Ab - glycophorin (Ii)/anti-Ii

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10
Q

Ankylosing spondylitis

A

Tissue specific w/systemic SE’s. HLA allele -> HLA B27. Joints - loss of lateral flexion of lumbar spine d/t stiffening if SI and spinal facet joints. Some evidence for prior infxn w/Klebsiella pneumoniae. NO rheumatoid factor!

F/M - 1:9, younger males more often affected

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11
Q

Wegener’s granulomatosis and Churg Strauss vasculitis

A

Similarities: anti-cANCA (against serum protease) and anti-PANCA Abs.

IgG and IgM Abs (IC formation, complement activation, phagocytosis)

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12
Q

Reticular dysgenesis

A

Defect: hematopoietic stem cells, autosomal recessive

Deficiencies/dysfxn: T cells, B cells, phagocytes. Anemic. Increased susceptibility to all infectious agents.

Tx: bone marrow transplant

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13
Q

Severe combined immunodeficiency disorder (SCID)

A

Defect: ADA deaminase (purine metabolism) deficiency, JAK-3 deficiency, CD132 defect, T-B SCID (Rag1, Rag2 defects)

Deficiencies/dysfxn: lymphocytes primarily. ADA - highest activity in lymphocytes, increased metabolites (deoxyATP and deoxyadenosine). These metabolites inhib RN reductase. CD132 is signaling molecule for cytokine recs (IL-2R, IL-4R, IL-7R, IL-9R, IL-15R)

Tx: ADA - polyethylene glycol-ADA (PEG-ADA), gene therapy for pts for whom PEG-ADA is ineffective and no bone marrow transplant is available

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14
Q

DiGeorge’s syndrome

A

Defect: Thymus. Most improve with age (may have activation of extrathymic maturation site)

Deficiencies/dysfxn: T cells (all phenotypes)

Tx: transplantation of fxn’l component of fetal thymus (in renal capsule), abx for milder cases

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15
Q

X-linked (Bruton’s) agammaglobulinemia (hypogammaglobulinemia)

A

Defect: developmental block in B cell differentiation from pro-B cell to pre-B cell due to signaling defect in btk. Manifests at 5-6 months (most of maternally-derived Abs degraded). Live vaccines contraindicated in pts w/this immunodeficiency. PE can reveal absent or hypoplastic tonsils in toddlers. More susceptible to autoimmune dz’s: inflammatory bowel disease, juvenile RA

Deficiencies/dysfxn: marked decrease in B cells and ALL antibody isotypes -> recurrent bacterial infxns, esp encapsulated pyogenic bacteria (Haemophilus influenzae, S. pneumoniae), and certain viral infxns (enterovirus, coxsackie virus)

Dx: serum protein electrophoresis, quantitative Igs, PHA stimulation test/candida hypersensitivity test

Tx: Igs (regular txt’s), abx, nutritional supplementation for pts w/recurrent abdominal infxns and subsequent malabsorption

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16
Q

Chronic mucocutaneous candidiasis

A

Defect: Hole in the T cell repertoire to Candida albicans. Nml B cell immunity to C. albicans

Deficiencies/dysfxn: CD4+ cells (especially)

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17
Q

Chediak Higashi syndrome

A

Defect: Abnormal fusion of cytoplasmic granules w/lysosomes (phagocytes and NK cells), LYST gene mutation

Deficiencies/dysfxn: phagocytes, CTL, NK cells

Tx: short-term: anti-fungal and anti-bacterial agents. Long-term: bone marrow transplant

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18
Q

Chronic granulomatous disease

A

Defect: NADPH oxidase

Deficiencies/dysfxn: phagocytosis -> recurrent and uncontrolled bacterial and fungal infections

Tx: short-term - anti-fungal and anti-bacterial agents; IFNy enhances production of ROIs. Long-term: bone marrow transplant

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19
Q

Paroxysmal nocturnal hemoglobinuria (PNH)

A

Defect: glycosylphosphatidylinositol (GPI) linkage for DAF (CD55) w/decreased protectin (CD59) in RBCs -> causes stabilized C3 convertase and activation of terminal pathway and formation of MAC -> lysis

Deficiencies/dysfxn: RBCs lysed by complement

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20
Q

Hereditary angio(neurotic)edema (HANE or HAE)

A

Defect: C1 esterase inhibitor protein

Deficiencies/dysfxn: uncontrolled activation of C1 -> proteolysis of C2/C4, enhanced production of C2b (vasoactive kinin), increased C4 (anaphylatoxin -> increased vascular permeability). CI inhibitor protein also inactivates kallikrein (that cleaves kininogen -> bradykinin, which increases vascular permeability). Life-threatening acute, intermittent attacks of skin and mucosal edema

Tx: infusion of C1 esterase inhibitor

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21
Q

Leukocyte adhesion deficiency

A

Defect: CD18 adhesion molecule (B2 integrin) - LAD 1. Defect in counter molecule for E selection - LAD2

Deficiencies/dysfxn: impaired trafficking of leukocytes to sites of infection, defective adhesion and margination. Increased susceptibility to fungal and bacteria infxns

Tx: bone marrow transplantation

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22
Q

Recurrent Neisseria infections

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A

Defect: C5-C9

Deficiencies/dysfxn: no effective MAC

Tx: abx

23
Q

Multiple myeloma

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A

Defect: Plasma cell

Deficiencies/dysfxn: Plasma cell neoplasm

24
Q

Immunodysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (IPEX)

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A

Defect: FOXP3 mutation -> autoimmune rxns

Deficiencies/dysfxn: defective development of nTregs, links immunodeficiency with autoimmunity

25
Transient hypogammaglobulinemia of infancy
Defect: lack of Th cells help (cytokines). Manifests at 5-6 months, normal number of B cells in blood. NOT X-linked. Recurrent infxn w/pyogenic bacteria. Deficiencies/dysfxn: IgG, IgA, IgE. Tx: pts usually recover w/abx, but use IgG for particular infxns in severe cases. Improves w/age
26
Common variable hypogammaglobulinemia
Defect: immature B cells or lack of Ag-induced differentiation. Normal numbers of peripheral blood B cells. Increased susceptibility to viral and fungal infxns. In males and females of all ages Deficiencies/dysfxn: all Igs -> defective Ab production following infxn. Tx: injection of Ig
27
Selective IgA deficiency
Defect: Unknown. Common in Caucasians. Increased incidence of recurrent sinopulmonary infxn Deficiencies/dysfxn: IgA Tx: abx (not passive Ig, bc there are only low levels of IgA in serum -> it does not get to target sites, and recipients quickly form Abs to donor IgA)
28
Ig Deficiency w/increased IgM/hyper IgM syndrome
Defect: Isotype switching d/t lack of CD40/CD40L interaction. X-linked disorder. Many IgM Abs are autoAbs Deficiencies/dysfxn: IgG, IgA, IgE
29
C3 deficiency
Enhanced susceptibility to ALL bacterial infxns. Chronic nephritis (d/t complement activation and deposition of C3 nephritic factor, an autoAb that binds C3 and stabilizes alternative pathway C3 convertase to prevent its degradation) -> accumulate complement debris in the glomeruli. C3 defect predisposes to failure to activate alternate or classical pathways Tx: abx
30
Cytokine rec defects
Mutations or defects in recs for cytokines that are needed for differentiation of Th0 to Th1 cells -> similar to having deficiency of Th1 cells
31
Waldenstrom's macroglobulinemia
Monoclonal gammopathy
32
Type I hypersensitivity
Immediate. Occurs when Ag crosslinks IgE on mast cells/basophils -> release histamine. Local effects - asthma or allergic rhinitis, systemic effects - anaphylaxis for acute. Require pre-existing Abs (primary exposure can't trigger this response) Late response - sustained inflammation, involves Th2 cells (secrete IL-5), eosinophils, and basophils. Dx: RAST (measures amt of allergen-specific IgE in serum, false negative because IgE bound to mast cells is not estimated or IgG may compete for allergen) Tx: antihistamine (H1 and H2-histamine rec antagonist), sodium cromoglycate -> stabilize mast cell and basophil mems, epi (30-90 minutes), steroids (4-8 hours), allergy shots, antileukotrienes, anti-IgE
33
Type II hypersensitivity
Ab-mediated. Production of IgG and IgM Abs for cell surface Ag, destroy Ag-expressing cells via classical complement -> osmotic lysis or opsonin-mediated phagocytosis; OR ADCC when NK cells expressing FcyR bind IgG Manifestations - transfusion rxns, hemolytic dz of the newborn (prevent with RhoGam), Goodpasture's syndrome, autologous cell death, chronic idiopathic urticaria
34
Type III hypersensitivity
Immune complexes d/t persistent immune challenge (autoimmune dz or chronic Ag exposure). Effector phase - xs ICs deposited in capillary walls -> neutrophils try to phagocytose, but end up secreting inflammatory mediators, dmging endothelium and exposing sub endothelium -> activation of intrinsic coagulation pathway, generating kallikrein and bradykinin Manifestations: SLE, RA, farmer's lung, serum sickness (pts immunized w/horse serum), arthus rxn
35
Type IV hypersensitivity
Cell-mediated. Chronic - re-exposure to Ag topically or intradermally, or persistent intracellular existence of microbe, and activation of memory Th1 cells Chronic - granulomatous inflammation - microorganisms persist in macrophage, where they have escaped intracellular enzymatic and biochemical destruction after phagocytosis (ex: M. leprae and M. tuberculosis). Infected macrophages fuse to form multinucleated giant cells, surrounded activated immune cells form granuloma (tuberculosis, sarcoidosis) Acute: Mantoux run - intradermal PPD test for tuberculosis. PPD presented to Th1 cells by APCs after previous exposure. Memory Th1 cells secrete IFNy, TNF -> activate macrophages -> local cytokine-induced erythema (non-pitting edema) for 24-48 hours. Called delayed type hypersensitivity run Contact - poison ivy dermatitis d/t activation of specifically sensitized memory Th1 cells in response to urshiol hapten. Effector phase after second exposure -> erythema, swelling
36
MAGE-1, MAGE-3
Melanoma, normal testicular protein
37
Surface IgG
Lymphoma, normal B cell receptor
38
NY-ESO-1
Breast cancer, normal testicular protein
39
GAGE
Melanoma
40
BAGE, PRAME, caspase-8
Squamous cancer
41
Carcinoembryonic antigen (CEA)
Oncofetal Ag. Colon, lung, breast, stomach tumors. Monitor early recurrence of treated tumors. Present in nonmalignant tissues (cigarette smokers, alcoholic cirrhosis, COPD)
42
Alpha fetoprotein Ag
Oncofetal Ag. Liver, testicular, pancreatic, gastric, lung tumors. Nmlly synthesized by fetal liver, yolk sac, and GI cells. Present in viral and alcoholic cirrhosis of the liver
43
Beta chorionic gonadotrophin
Gonadal germ cell tumors. Adenocarcinomas of the ovary, pancreas, stomach. Hepatomas. Used to monitor efficacy of therapy. Produced by trophoblast epithelium of placenta
44
HER2
Member of ErbB protein family, gene on chromosome 17. Corec of tyrosine kinase-associated growth factors, involved in signal transduction and cell growth and differentiation. Amplification seen in breast, ovarian, endometrial cancers. HER2+ breast cancer leads to marked overexpression of HER2 on the cell surface altering normal signaling fxn. Increased susceptibility for recurrence and worse prognosis
45
Bence Jones proteins
Serum free light chains with exposed hidden areas. Seen in myeloma cells
46
Prostate specific antigen (PSA)
Screen for prostate cancer and follow for treatment. May be falsely elevated in prostatitis
47
Non-specific immunosuppressants
Cyclosporin and FK506, anti-CD3 Abs, prednisone
48
Specific immunosuppresion
Block CD40-CD40 ligand interaction, CTLA4 to block CD80-CD28, CD200-CD200R
49
Live, virulent vaccine
For natural infxn (buttock exposure to Leishmania). "Controlled" development of sterile immunity; safety a concern
50
Live, attenuated vaccine
Sabin polio virus Mycobacterium tuberculosis (BCG) MMR In rare cases, attenuated organisms revert to WT
51
Inactivated/killed vaccine
Salk polio virus Rabies virus Influenza virus (moderately effective) Cholera bacteria (moderately effective) Safer, but less effective than live or attenuated organisms Killed pertussis vaccine is toxic w/risk of dmg to CNS, contamination w/endotoxin (the vaccine itself is a bacterial product)
52
Inactivated toxin and toxoid vaccine
Bacterial vaccines for tetanus and diphtheria Carrier molecule for vaccination w/malaria organism Most successful vaccines yet tested
53
Recombinant vaccines
Ag peptide, eg Hep B, Salmonella proteins Fewer SE's than other vaccines. Advantage of ability to manipulate (add/subtract) epitopes of importance
54
DNA vaccines
Plasmid-containing genes encoding pathogen Main fxn is for immunity to pathogens that will infect cells. Used to generate Ag-specific CTLs for life-threatening pathogens that infect cells

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