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FOUNDATION MEDICINE > Immunology Cameron McCloskey > Flashcards

Immunology Cameron McCloskey Flashcards

1
Q

Physical and chemical barriers include ?

A

Skin and mucosa (Respiratory, Gastrointestinal, vrinary )

CHEMICAL BARRIERS

hydrochloric acid in the stomach

lysozymes in sweat and tears

lactic acid in the vagina

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2
Q

When would immunosuppression be utilitised?

A

Patients may be artificially immunosuppressed in the event of an autoimmune disease

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3
Q

Describe the properties of the skin as a physical barrier to infection

A

It is constantly renewed

It has a low pH

It has low oxygen tension

Sebaceous glands secrete hydrophobic oild whick make it hard for pathogens to bind

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4
Q

Mucous line all _____ ________ that come into contact with the ___________

A

Body cavities

Environment

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5
Q

Mucous contains many constitutes which can fight potential pathogens, what are these?

A
  • Secretory IgA
  • Lysozymes
  • Defensins
  • Antimicrobial peptides
  • Lactoferrin - starve invading bacteria of iron
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6
Q

What are commensal bacteria?

A

Bacteria that reside in the body and on epithelial surfaces naturally.

They have a symbiotic relationship with the body and can eradicate most normally infections

They ensure there is no undefended ecological niche

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7
Q

The components of the immune system can be split into which two categories?

A
  1. Cells
  2. Humoral immunity (soluble factors)
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8
Q

Which 3 main groups of cells are involved in the immune system?

A
  1. Phagocytes
  2. Lymphocytes
  3. Granular
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9
Q

When a cell is infected with a virus what will it secrete?

A

Interferons (alpha and beta)

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10
Q

The antiviral state inititiated by interferons achieves what?

A

It down regulates protein synthesis which slows virus production

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11
Q

What is an antigen?

A

An substance able to stimulate an adaptive immune response - it can be protein, carbohydrate, nucleic acid, lipid, metal etc

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12
Q

Where are T and B cells formed?

A

Bone marrow

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13
Q

Where do B cells mature?

A

Bone marrow

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14
Q

Where do T cells mature?

A

Thymus gland

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15
Q

In response to an infection Plasma cells will produce what?

A

Antibodies and differentiate to memory cells

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16
Q

What are the two types of T cell?

A

Helper T cell (CD4+)

Cytotoxic T cell (CD8+)

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17
Q

How does a virus evade the immune system?

A

It will usually hide within body cells

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18
Q

How can cytotoxic T cells discover viruses hiding in body cells?

A

The host cell constantly samples its cytoplasm and displays proteins on its surface - this is mediated by MHC class 1 proteins

These displayed proteins can “show” cytotoxic T cells which cells are infected

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19
Q

How do viruses evade the process of cytoplasm sampling mediated by MHC class I proteins?

A

They downregulate the production of MHC class I proteins

This reduced cytoplasm sampling

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20
Q

How do natural killer (NK) cells retaliate to viruses that downregulate MHC class I production?

A

NK cells can detect a lack of MHC class I proteins on a cell surface

They can then attack and destroy such cells

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21
Q

How are parastitic works (helminths) attacked by the immune system?

A

Antibodies and mast cells

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22
Q

What is the complement system and where is it produced?

A

Family of around 30 different proteins produced in the liver

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23
Q

How does the complement system function?

A

The complement cascade is a process where, once an antibody recognizes a foreign particle and binds to it, the component proteins become activated by each other in complex mechanisms, leading to the removal of the pathogen or foreign particle by phagocytosis at the end of the process.

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24
Q

When do monocytes differentitate into macrophages?

A

When they exit the blood and migrate to peripheral tissues

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25
Q

What are Kupffer cells?

A

Macrophages of the liver

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26
Q

What are mesangial مس انجيل cells?

A

Macrophages of the kidney

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27
Q

What are macrophages of the nervous sytem called?

A

Microglia مايكرو كليا

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28
Q

How can neutrophils be differentiated from macrophages?

A

Their multi-lobed nucleus

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29
Q

What is the role of dendritic cells?

A

They engulf pathogens, phagoytose and then present antigens on their surface to T cells. they are also release chemokines

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30
Q

What are the main functions of neutrophils?

A

Killing and degredation

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31
Q

What are the main functions of macrophages?

A

Killing, degregation, wound healing, anti-inflammatory and antigen presentation (source of inflammatoryF cytokines)

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32
Q

What is the main fucntion of dendritic cells?

A

Antigen presentation

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33
Q

What is lymphodema and why may it result in infection?

A

It a condition characterised by a lack of draining of tissue fluid by the lymphatic system

The fluid builds up and is not cleaned as effectively leading, potentially, to infection

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34
Q

The immune system itself is composed of two halves - what are these halves and how are they connected?

A
  1. Innate immune system
  2. Adaptive immune system

Joined through the action of dendritic cells

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35
Q

What is meant by “direct contact” between immune cells and pathogens?

A

A receptor/ligand interaction

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36
Q

What is meant by “indirect contact” in the immune system?

A

Communication between cells and pathogens through the use of cytokines

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37
Q

What are autocrine signals?

A

Signals produced by a cell that lead to self-activation

Its important in inflammation e.g T cell in the immune system recognizes a foreign antigen, it secretes cytokines such as interleukin-2 (IL-2) that bind to receptors on its own surface. This binding triggers a signaling cascade that causes the T cell to proliferate and differentiate into effector T cells, which then attack and destroy the invading pathogen.

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38
Q

Interferons have the role of activating an _______ ______

A

Antiviral state

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39
Q

Which cells may secrete interferons?

A

Infected cells

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40
Q

Release of interferons by infected cells has two main outcomes, what are they?

A
  1. Protein synthesis is downregulated
  2. Employment of particlular mlcules into the cell membrane is upregulated such as MHC class I - allows for detection

Interferons can also instruct cells to undergo apoptosis

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41
Q

What are the signs of acute infammation?

A
  • Redness Rubor - vasodilation
  • Swelling - vascualr permeability
  • Heat Caro - high metabolic function
  • Pain
  • Loss of function
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42
Q

What are the three phases of the innate response?

A
  1. Recognition
  2. Activation
  3. Effector
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43
Q

Describe recognition as a phase in the innate response

A

Innate immune cells recognise pathogens due to the expression of PAMPs which bind to PRRs on innate immune cells

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44
Q

What are PAMPs?

A

Pathogen associated molecular patterns

These are ligands expressed on the surface of pathogens which allow them to be detected by immune cells

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45
Q

What are PRRs?

A

Pattern recognition receptors

Found on innate imune cells that are receptors for PAMPs found on pathogens

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46
Q

How do macrophages differentiate between apoptotic cells and normal cells?

A

Normally phospholids called phosphatidylserine فوسو تايديرين سيرين are held facing inward to the cytoplasm by the enzyme flippase فل بيس

In the event of apoptosis, phosphatidylserine is fliiped to face outwards by the action of the enzyme scramblase سكرام بليز

These outward facing phosphatidylserine lipids act as signals for macrophage engulfment

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47
Q

PAMPs have the ability to activate which three immune cells

A
  1. Macrophages
  2. Mast cells
  3. NK cells
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48
Q

Injured cells release which type of signals?

A

Danger signals

(e.g. IL 33)

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49
Q

What happens when macrophages cannot kill a pathogen?

A

Infected macrophages are walled off forming granulomas

The purpose of this is to prevent the spread of infection

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50
Q

What will be present on the surface of macrophages after engulfment of a pathogen?

A

Fragments of pathogen protein

This allows for recognition by antigen presentation

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51
Q

Interferon gamma (IFN gamma) can cause what change in a macrophage?

A

It will cause superactivation

This allows for expression of inducible nitric oxide synthase - an enzyme allowing for production of toxic oxygen and nitrogen species

The antigen presentation capacity of macrophages will also increase

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52
Q

Where are mast cells found most prominently?

A

Mucosal surfaces

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53
Q

Which two processes occur when a PRR on a mast cell is bound by a PAMP?

A
  • Degranulation - release of pre-formed pro-inflammatory mediators are released allowing for acute inflammation
  • Gene expression - production of new pro-inflammatory mediators commences within mast cells
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54
Q

Why do NK cells not kill normal helathy cells?

A

Normal cells have MHC class I protein on their surface which is bound to self proteins (antigens)

NK cells have a receptor on their surface that binds to the MHC class I protein and the antigen

When the antigen/MHC class I combination is of self-origin, inhibitory signals are sent to the NK cells

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55
Q

How do viruses evade cytotoxic T cell killing?

A

They cannot be detected by the antigen/MHC class I receptor system because they downregulate MHC class I production meaning it is more difficult for foreign antigens to be “seen”

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56
Q

How do NK cells kill cells in which viruses have downregulated MHC class I production?

A

If no ligand (MHC class I + antigen) is present, NK cells cannot be inhibited so the cell is killed regardless

NK cells take no chances

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57
Q

Upon activation NK cells secrete pro inflammatory mediators such as _________ gamma

A

Interferon

it activate macrophages to phagocyte the infected cell

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58
Q

In what two ways are NK cells activated?

A
  1. Detection of no/foreign MHC class I
  2. Interferon alpha and beta released from infected cells
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59
Q

Which pro-inflammatory mediator acts upon macrophages to superactivate them?

A

Interferon gamma

(produced from NK cells)

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60
Q

Which cytokines act on the hypothalamus to increase prostaglandin production?

A

Tumour Necrosis Factor alpha (TNF alpha) cytokine, IL-1 and IL-6

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61
Q

What is the function of prostaglandin production by the hypothalamus during an infection?

A

Induces fever

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62
Q

What effect do cytokines TNFalpha, IL-1 and IL-6 have on bone marrow?

A

Act on haematopoetic stem cells to drive production and differentiation of more neutrophils

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63
Q

What is increased production of neutrophils called?

A

Neutrophilia

opposite is neutropenia

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64
Q

Where is C reactive protein (CRP) produced and what increases its production?

A

Liver

Pro-inflammatory mediators TNFalpha, IL-1 and IL-6

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65
Q

Clinically, why are CRP levels usefult to monitor?

A

They are very indicative of the level and severity of inflammation

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66
Q

CRP has which two functions in the immune system?

A
  1. Promotes phagocytosis
  2. Activates complement
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67
Q

What are the symptos of the local effects of inflammation?

A
  • Rubor - redness
  • Calor - heat
  • Tumour - swelling
  • Dolor - pain
  • Loss of function
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68
Q

Pro-inflammatory mediators can cause systematic effects as well as local ones, what are these?

A
  • Neutrophilia
  • Fever
  • Activation of complement
  • Promotion of phagocytosis
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69
Q

How is vascular permeability brought about during acute inflammation?

A
  • Macrophages - TNFalpha, IL-1, Nitric Oxide (NO)
  • Mast cells - Histamine, TNFalpha, leukotrienes, prostaglandins
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70
Q

How is vasodilatation brought about during acute inflammation?(two signals which stimulate vasodilation)

A
  1. TNFalpha - mast cells and macrophages
  2. Histamine - mast cells
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71
Q

During acute inflammation, what can cause endothelial cells within vessels to become activated?

A
  • TNFalpha - macrophages
  • IL-1 - Macrophages
  • Chemokines - macrophages
  • Histamines - mast cells
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72
Q

What does endothelial cell activation involve?

A

Expression of receptors (selectins) and ligands (ICAM-1 and VCAM-1)

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73
Q

Which cell types can undergo transendothelial migration (Diapedesis)?(5)

A
  • Neutrophils
  • Monocytes
  • NK cells
  • Basophils
    • Eosinophils (FIGHT parasites)
  • T cells
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74
Q

What is white cell margination and how does it come about?

A

Due to vasodilatation (induced by TNFalpha and histamines), there is slower blood flow (stasis) which causes white cells to move closer to the endges of vessels

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75
Q

Why do neutrophils roll along the endothelial walls after white cell margination instead of sticking tightly to it ?

A

They bind via carbohydrate ligands to selectins on the endothelial walls

This attraction has low affinity meaning bonds are continually made and broken so the white cells roll along the walls

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76
Q

What causes there to be strong attraction between neutrophils and the endothelial cell walls?

A

The release of chemokines from macrophages can activate neutrophils

This allows receptors on the neutrophil surface (integrins) to form strong bonds with the ICAM-1 and VCAM-1 on the endothelial cell walls

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77
Q

After binding between integrins and ICAM-1/VCAM-1 occurs what occurs next to the neutrophil?

A

It will come to a halt and undergo diapedesis - the process where neutrophils squeeze through the spaces between endothelial cells and into the extracellular space

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78
Q

How do neutrophils migrate to the site of inflammation after diapedesis?

A

Chemotaxis

Locomotion along a chemokine gradient

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79
Q

What are the two basic functions of neutrophils?

A
  1. Kill extracellular pathogens
  2. Produce pro-inflammatory cytokines
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80
Q

During phagocytosis, what are the two main ways that pathogens will be destroyed within a phagosome?

A
  1. Anti-microbial proteins
  2. NADPH oxidase dependent mechanisms
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81
Q

Describe how anti-microbial proteins will kill pathogens within a phagosome

A

The phagosome fuses with azurophilic granules raising pH

This activates the antimicrobial response - pH of the phagosome decreases, lysosomes fuse and acid hydrolases enter to break down bacteria

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82
Q

Describe how NADPH oxidase dependent mechanisms kill bacteria

A

Neutrophils can become activated by cytokines or PAMPs which forms the NADPH complex

This means that a highly reactive oxygen species (ROS) can now be produced and released into the phagolysosome

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83
Q

What is degranulation?

A

The release of anti-microbial proteins into the extracellular space instead of within a phagolysosome

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84
Q

What is the downside to degranulation an how is this negative aspect partly counteracted?(which protein inhibitor)nase

A

Release of anti-microbial proteins into extracellular space is damaging to surrounding tissues

This is counteracted by upregulation of proteinase inhibitors produced during the acute phase response

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85
Q

What are NETs?

A

Neutrophil extracellular traps

Intracellular structures release by neutrophils into extracellular spaces - they function as nets to prevent spread and facilitates phagcytosis

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86
Q

What is pus?

A

Collection of neutrophils, NETs, dead bacteria and cellualr debris

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87
Q

What is the term given to a collection of pus within an enclosed space?

A

Abscess

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88
Q

What is sepsis?

A

Blood poisoning brough about by infection

Uncontrolled inflammation causes sepsis and it can lead to septic shock due to a drop in blood pressure organ failure occurs

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89
Q

What are examples of complement proteins?

A
  • Kinins
  • Coagulation factors
  • Fibrinolytic system
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90
Q

How many complement proteins are there and where are they produced?

A

30

Liver

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91
Q

In simple terms what activates complement?

A

Pathogens

(directly or indirectly)

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92
Q

What are the three pathways in which a cascade can occur involving complement?

A
  1. Mannose-binding lectin pathway ; Microbial sugars (e.g. mannose, glucose) in micro-organisms lack the enzymes to hide their terminal sugars like the host, and therefore the host is able to identify the foreign antigen
  2. The alternative pathway
  3. The classical pathway
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93
Q

Describe the classical pathway of complement activation

A
  • C1 complex is activated upon binding to an immune complex involving either IgG or IgM
  • C1 splits to C4 and C2
  • C4 becomes C4a and C4b, whilst C2 becomes C2a and C2b
  • Both C4b and C2a complex to form C4b2a (C3 convertase)
  • This enzyme allows for C3 to be cleaved into C3a and C3b
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94
Q

Describe the mannose-binding lectin pathway for complement activation

A

Mannose - a bacterial carbohydrate

Mannose binding lectin is produced in the liver and binds to mannose

This initiates the breakdown of C3 to C3a and C3b

C3b contributes to an amplification loop

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95
Q

Describe the alternative pathway for complement activation

A

C3 spontaneously breaks down

C3b binds to the pathogen surface and acts in amplification of the response

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96
Q

How is the membrane attack complex formed and how is this achieved?

A

C3b causes breakdown of C5 into C5a and C5b

C5b binds to the surface of the pathogen

C6, 7, 8 and 9 assemble around C5b forming the membrane attack complex

This created a funnel shaped hole in the pathogen allowing for death by osmotic cell lysis

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97
Q

What is opsonisation?

A

The coating of pathogens by humoral factors (opsonins) to facilitate phagocytosis

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98
Q

Give some examples of opsonins (3)

A
  • C3b
  • C-reactive protein (CRP )
  • IgG and IgM
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99
Q

C5a and C3a are _____________ which can act on which two things?

A

Anaphylatoxins

Acts on mast cells and blood vessels

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100
Q

What effects do the anaphylatoxins C3a and C5a have on mast cells and blood vessels?

A
  • Activate mast cells to produce pro-inflammatory mediators and chemokines which function to increase vascular permeability and increase recruitment of macrophages, neutrophils and lymphocytes
  • Act directly on blood vessles to have the same effect as activated mast cells - increased vascular permeability and immune cell recruitment
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101
Q

Why does a small signal from the complement system result in a large effect?

A

The amplification loop

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102
Q

How is the amplification loop controlled in the complement system?

A
  • Only cleaved proteins are active
  • Active proteins have a short half life
  • Some complement proteins cannot bind to human cells
  • Complement inhibitors and regulatory proteins can limit the effects of complement where necessary
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103
Q

In the mature state, what do dendritic cells do?

A

Enter secondary lymphoid tissues and play a role in antigen presentation to CD4+ cells

104
Q

Which “arm” of the immune system is rapid, non-specific and inborn

A

Innate

105
Q

Which “arm” of the immune system is slow, specific and acquired?

A

Adaptive

106
Q

Which cells can communicate between both “arms” of the immune system?

A

Dendritic cells

107
Q

What are the types of cells in the aquired immune system?

A
  • B cells
  • CD4+ T cells (helper)
  • CD8+ T cells (cytotoxic)
  • Memory T cells
  • Memory B cells
108
Q

How is the interaction between PAMPs and PRRs different from the interaction between antigens and antibodies?

A

The interaction between antigen and antibody is far more specific and they are not at all interchangable

109
Q

How are T cells recognised?

A

Membrane bound heterodimer (composed of alpha and beta chains)

110
Q

How are B cells recognised?(with which two antibodies

A

Membrane bound antibody (IgM or IgD)

111
Q

What are antibodies composed of?

A

Two heavy and two light polypeptide chains which are held together by di sulphide bridges

112
Q

How do heavy and light chains confer variability?

A

Each heavy and light chain has a variable region at the end and a constant domain on the rest of the chain

113
Q

What type of heavy chain does IgM have?

A

μ heavy chain ( Mu heavy chain )

114
Q

What type of heavy chain does IgG have?

A

γ heavy chain

115
Q

What type of heavy chain does IgA have?

A

α heavy chain

116
Q

What type of heavy chain does IgE have?

A

ε heavy chain

117
Q

What type of heavy chain does IgD have?

A

𝛿 heavy chain

118
Q

In an antibody, what is the antigen binding site composed of?

A

The hypervariabe regions Ig light and heavy chains

119
Q

How is it possible that there are more antibodies than genes in the body?

A

The light and heavy chain are coded for by segmented genes in the germline genome of haematopoetic stem cells

120
Q

How are the segmented genes from the germline genome of haematopoetic stem cells arranged within B cells as they go through development?

A

They are randomly rearranged

121
Q

How is genertic material arranged during the development of T cells?

A

It is randomly rearranged

122
Q

The gene rearrangement process in the development of both T and B cells gives rise to two important factors:

A
  1. Populations of B cells and T cells that are hugely diverse: During development, B and T cells undergo a process of V(D)J recombination, in which segments of genes that encode the antigen receptor are randomly recombined to generate a diverse repertoire of receptors capable of recognizing a wide range of potential pathogens. This diversity allows the immune system to respond to a wide variety of pathogens and provides the basis for adaptive immunity.
  2. Potential for generation of autoreactive cells: Since the gene rearrangement process is random, there is a potential for the generation of B and T cells that recognize and attack the body’s own cells and tissues. However, the immune system has mechanisms to eliminate or regulate such cells, and failure of these mechanisms can lead to autoimmune diseases.
123
Q

How do naive T cells and B cells enter lymph nodes from high endothelial venules (HEVs)?

A

Transendothelial migration /Diapedesis

124
Q

What is the function list of an immature dendritic cell?

A

Ability to phagocytose antigens, cell debris and particles

125
Q

Where do mature dendritic cells migrate to and what do they do there?

A

Secondary lymphoid tissues (lymph nodes)

Display antigens to T cells

126
Q

Which cytokine will activate immature dendritic cells?

A

TNFalpha

Induces expression of co-stimulatory molecules (B7)

(dendritic cells mature)

127
Q

How do dendritic cells present antigens?

A

In complex with MHC class I proteins on their cell surface

128
Q

Where do dendritic cells go that are presenting foreign antigens?

A

Local lymph nodes

T cells can easily recognise the foreign antigens here

129
Q

Stromal cells have what function in lymph nodes?

A

They are connective tissue cells that can bind to opsonised antigens

130
Q

For B cells to be activated, how many signals do they require?

A

2

131
Q

What signals can activate B cells?(3)

A

The B cell receptor + antigen must always be one signal

The other signal can be any of the following:

  • TFH (helper T cell)
  • PRR + PAMP
  • Multiple BCR + antigens - repetitive antigens with multiple epitopes (areas antibodies can bind to antigen)
132
Q

What are the two classes of MHC proteins and their functions?

A

Class 1 - expressed on all nucleated cells - present peptide antigens to CD8+ T cells

Class 2 - only expressed on professional antigen presenting cells (APCs) such as dendritic cells, macrophages and B cells - they present the peptide antigen to CD4+ T cells

133
Q

What two signals do T cells require to become activated?

A
  1. Antigen + MHC protein
  2. B7 - peripheral membrane protein on APCs for co-stimulation, and CD28 - protein expressed on T cells that provides co-stimulatory signals for T cell activation (B7 and CD28 bind)
134
Q

What happens upon cell (T/B) activation?

A

Undergoes clonal expansion and differentiation into effector or memory cells

135
Q

Plasma cells are characterised by which physical feature?

A

Huge amounts of endoplasmic reticulum for protein (antibody) production

136
Q

How and why does antibody affinity for antigens vary over time after production?

A

Initially affinity of antibodies is low

After entering the germinal centre (secondary centre within B-cell area of lymph nodes) the plasma cells become long life plasma cells

They now excrete high affinity antibodies

137
Q

Antibodies are classified by the type of _______ chain they use

A

Heavy

138
Q

Which transmembrane antibody classes are initially expressed as BCRs on the mature B cell surface

A

The first antigen receptors expressed by B cells are transmembrane B-cell receptors, of which there are two types - IgM and IgD, which have specific transmembrane domains. They are co-expressed and bound to the membrane.

  • All naïve B cells express IgM and IgD on their surfaces

(Naïve cells don’t fight infection, they simply wait to be activated by a T cell or an antigen-presenting cell (APC).)

139
Q

Which pathway for complement activation does IgM activate?

A

Classical

140
Q

How does IgM aid in the activation of the classical pathway of complement?

A

Upon binding to antigens of the pathogen surface it will undergo conformational change

This change provides a binding site for C1 the first component of the pathway

141
Q

As well as IgM which other antibody class can activate the classical complement activation pathway?

A

IgG

142
Q

What is the first antibody produced?

A

IgM

143
Q

What is the most abundant antibody?

A

IgG

144
Q

Which maternal antibody class will protect a growing foetus and why is this important?

A

IgG

The foetus does not have a fully developed immune system

145
Q

Describe how IgG antibodies make good opsonins and aid phagocytic cells and their detection of pathogens

A

Phagocytic cells express a Fc gamma receptor on their surface for the gamma heavy chain

This can make pathogens visible to neutrophils

146
Q

IgG antibodies are good activators of NK cells - why?

A

NK cells have receptors on their surface that interact with the gamma heavy chain of the IgG antibody

This interaction can instruct NK cells to destroy pathogens attached to IgG

147
Q

Where is IgD commonly found?(2)

A
  • On the surface of B cells
  • In the circulatory system
148
Q

What is the role of IgD thought to be?

A

Recruitment of basophils into areas of inflammation

149
Q

What is the second most abundant antibody type?

A

IgA

Found in the digestive, respiratory, urogenital tracts and system

150
Q

Secretory IgA is what form of IgA?

A

Dimeric form

151
Q

Secretory IgA is involved in which two main areas?

A
  1. Neonatal defence - in breast milk
  2. Neutralisation - at muscosal sites such as GI tract and in tears
152
Q

Which antibody class is involved in allergic responses?

A

IgE

153
Q

How does IgE trigger allergic responses?

A

Activates mast cells which then release pro-inflammatory mediators

154
Q

Why can mast cells and basophils be activated by IgE?

A

They have FcE receptrs for IgE on their surfaces

155
Q

Why does the level of antibodies remain elevated for an extended period of time after an encounter with a pathogen?

A

In case the body re-encounters this pathogen

156
Q

Cytokine environments can cause B cells to switch what?

A

Heavy chains

Based on the pathoehn experienced

157
Q

Which cells influence the type of helper T cell that differentiates from a CD4+ T cell?

A

Cytokines present that dendritic cells secrete

The cytokines released by dendritic cells is influeced by the type of PAMP, danger and inflammatory signals

158
Q

Effector TH cells can stimulate which other immune cells?(4)

A
  • B cells (TFH)
  • Macrophages (TH1)
  • CD8+
  • CD4+
159
Q

Antigen activated CD4+ T cells secrete what cytokine when they proliferate in reponse to the antigen and co-stimulation?

A

IL-2

160
Q

IL-2 can stimulate which type of immune cell to do what?

A

CD8+ to differentiate into cytotoxic T cells

161
Q

How do TH1 cells enter inflamed tissue?

A

Trans-endothelial migration

162
Q

TH1 cells will express what cytokine in inflamed tissue and what is its purpose?

A

Interferon gamma

(as well as other co-stimulatory molecules)

This is to induce expression of nitrous oxide synthase in the macropage allowing the pathogen to be destroyed

This is superactivation of macrophages - similar to how NK cells do this

163
Q

What is the full process of B cell activation involving TFH cells?

A
  • Initially B cells encounter opsonised antigen and become partially activated
  • The antigen/antibody complex is internalised
  • The antigen is presented by MHC class II on the surface
  • T cells complex with the MHC class II/antigen complex which allows B cells to become fully activated
164
Q

How do TFH cells stimulate B cells to clonally proliferate?

A

Via CD40L (on TFH cell) and CD40 interactions

Effector TFH cells secrete cytokines the further activate B cells and stimulate the Germinal centre response
germinal center response is a critical mechanism by which the adaptive immune system generates a robust and long-lasting response to foreign antigens.

165
Q

What does the germinal response entail?(5)

A
  • B cell proliferation
  • Antibody heavy chain switching
  • Generation of high affinity antibodies
  • Differentiation into plasma cells
  • Differentiation into memory B cells
166
Q

What is the overall aim within the germinal centre and how is it brought about?

A

To produce high affinity antibodies by inducing mutations into heavy and light Ig chains

This is mediated by activation induced deaminase (AID) which can mutate antibodies

The downside to this is that it can cause lymphoma

167
Q

Cytotoxic T cells bind to what on infected cells?

A

MHC class I and the presenting antigen

168
Q

What do cytotoxic T cells do to infected cells?

A

Introduce pore-like structures causing osmotic lysis or by initiating apoptosis

They can express Fas ligand whcih results in the release of cytochrome c - a pro-apoptotic protein

169
Q

When there is no longer inflammation, what cytokine is released from macrophages? (anti inflammatory cytokine)

A

IL-10

This stops the inflammatory response and initiates tissue repair.

IL-10 is an anti-inflammatory cytokine which helps to counterbalance the effects of inflammation. IL-10 can inhibit the synthesis of pro-inflammatory cytokines.

170
Q

What is the mechanism of Typ1 Anaphylactic ?

A

Antigen react with IgE bound to mast cells

171
Q

an example of anaphylactic ?

A

anaphylaxis

atopy (e.g asthma , eczema and hayfever )

172
Q

Type II - cell bound mechanism ?

A

IgM or IgG bind to antigen on cell surface.

173
Q

Type II - cell bound example ?

A

autoimmune haemolytic anaemia

ITP

Goodpasture’s syndrome

Pernicious anaemia

Acute haemolytic transfusion reaction

Rheumatic fever

Pemphigus vulgaris / bullous pemphigoid

174
Q

Type III immune complex ?

A

free antigen and antibodies (IgG , IgM) combine

175
Q

Type III immune complex example ?R

A

serum sickness

systemic lupus erythematosus (SLE)

Rheumatoid arthritis

post streptococcal glomerulonephritis

extrinsic allergic alveolitis(especially acute phase)

176
Q

mechanism of Type IV delayed hypersensitivity ?

A

T cell mediated

177
Q

Type IV hypersensitivity delay examples

A

tuberculosis / tuberculin skin infection

Graft verses host disease

allergic contact dermatitis

scabies

exterinsic allergic alveolitis ( espically chronic phase )

Multiple sclerosis

Guillain - Barre syndrome

178
Q

Type V mechanism ?

A

Antibodies that recognise and bind to the cell surface receptors. this either stimulate them or block ligand binding

179
Q

Examples of Type V ?

A

Graves’ disease

Myasthenia gravis

180
Q

What is the structure composition of an antibody

A

1 Fc fragment region (heavy chain ) determine the Ig type and 2 Fab fragment regions (light chains ) which are specific for the antigen they are required to bind

181
Q

An X-linked mutation in the common gamma chain is one of the many genetic defects that can lead to the development of Severe Combined Immunodeficiency (SCID).

Approximately what proportion of SCID cases are due to this mutation?

A

Approximately 40% of SCID cases are due to a mutation in the X-linked common gamma chain. This mutation affects the receptors used by many interleukins used in the immune response

182
Q

Once a person has been exposed to an infection and responded, they build up what is known as immunity. What differs in a secondary immune response compared to a primary one?

A

The secondary immune response is distinct from the primary immune response, as it is much faster and more effective at clearing pathogens. The reason for this speed is that there is a memory response, with differentiation and maturation of memory cells remaining in the circulation following primary antigen exposure. Additionally, there is faster class switching and affinity maturation of antibodies. The aim of the immune response is to respond before the infection can cause tissue damage. In the secondary immune response, IgG levels increase much more than in the primary immune response, whereas IgM levels increase to the same extent in both the primary and secondary immune responses.

  • IgG and IgM are present in both primary and secondary
  • IgG last longer
183
Q

what is a spleen ?

A

The spleen is the largest secondary lymphoid organ in the body and facilitate low-probability interactions between antigen-presenting cells (APCs) and cognate lymphocytes.

  • When the spleen is dysfunctional (as in adult patients with SCA or post-splenectomy), presentation of antigen to B cells is impaired, leading to decreased production of IgM.
184
Q

Which class of maternal antibodies transfers to the fetus across the placenta?

A

IgG antibodies can transfer across the placenta from the mother to the foetus.

for example This means that the IgG autoantibodies that cause symptoms in Myasthenia Gravis and Graves disease can transfer to the foetus in pregnancy, resulting in newborns presenting with mild symptoms until their own antibody production commences

185
Q

why do active B cells have to switch ?

A
  • In order to produce a strong antibody response, activated B cells go through class switching and somatic hypermutation.
  • Activated B cells switch from producing IgM and IgD to instead expressing IgA, IgE or IgG
186
Q

Which Ig is found in mucosa

A

IgA also known as secretory IgA

187
Q

What is the most abundant antibody ?

A

IgM

188
Q

Before positive and negative selection takes place, describes the nature of T cells development

A

Prior to positive and negative selection in the thymus, T-lymphocytes are classed as ëdouble positiveí CD4+/CD8+, as they express both CD4 and CD8 molecules on their surface. Once they pass through positive and negative selection, they will specialise into either CD8+ or CD4+ T cells

189
Q

What is the function of somatic hypermutation?

A

is another component of the germinal centre response. It involves introducing mutations in antibody genes in order to diversify the antibodies that B cells produce. B cells then undergo a selection process for those that produce the highest affinity antibodies for that specific infection. These are the only B cells that survive.

190
Q

Rheumatoid arthritis

A

is an autoimmune condition that targets the citrullinated proteins within the synovial fluid of joints. It particularly affects peripheral joints, including those of the hands, feet and limbs.

191
Q

Addisons disease

A

is an autoimmune condition in which autoantibodies attack the adrenal glands. The adrenal glands are located on the top of the kidneys and are a vital endocrine organ for hormone production.

192
Q

Type 1 diabetes

A

Mellitus, autoantibodies are produced against these b-cells, and as a result blood glucose levels remain abnormally high due to the loss of insulin production.

193
Q

Hashimotos

A

thyroiditis is an autoimmune condition in which autoantibodies are produced against the thyroid peroxidase enzyme required to produce thyroid hormones.

194
Q

Graves disease

A

is the most common cause of hyperthyroidism. It is an autoimmune condition in which autoantibodies are produced against the TSH receptor lead to higher production of TSH. It is a Gell and Coombs type 2 hypersensitivity reaction. Over-stimulation of the receptor results in excess thyroid hormone production. As a result, symptoms such as weight loss, hyperactivity, mood swings, heat sensitivity, sweating and muscle weakness can present. Infertility and loss of libido are also potential symptoms.

195
Q

Systemic Lupus Erythematosus (SLE)

A

can cause arthritis in the peripheral joints, renal involvement, rashes and photosensitivity

196
Q

What is the minimum percentage of children that need to be vaccinated successfully in order to achieve herd immunity in diptheria?

A

75%

197
Q

C3⇢——+—–

A

C3⇢ C3b+C3a

198
Q

what will enhance the classical pathway of the complement system ?

A

antigen antibody complexes (IgM/IgG), C1qrs, C2 and C4 will initiate it.

199
Q

C3, factor B, properdin and polysaccharide (in G- bacteria ) activate what class of the complement system

A

Alternative

Its ALSO ACTIVATED BY IgA

IgG act as opsonins

200
Q

Where within secondary lymphatic tissue are b cells found

A

peripheral of lymph node

Spleen or mucosa ASSOCIATED LYMPHOID TISSUE (MALT)

201
Q

Only mention the three roles of the complement system

A
  1. Opsonisation
  2. Chemotaxis movement toward inflammation site
  3. Cell lysis - destruction pathogenetic cells
202
Q

circulation of fluid through circulation system and lymph ?

A
  • blood flow through arteries ——> Arterioles ——> capillaries contain pores
  • However RBC cant pass through pores but ALBUMIN and fluid can.
  • Lymphatics collect excessive fluid and return it to the blood to keep interstitial fluid and blood volume constant.
203
Q

what is endothelial cells 1- way minivalues FUNCTION in lymphatic capillary

A

these are very permeable walls open and close by collagen and its controlled by osmatic pressure of fluid between the capillary and interstitial fluid

204
Q

what is spleen

A

is lymph but it receives blood unlike other lymph’s
SEPRATE INTO
White pulp and Red pulp

205
Q

Name the parts of the GI tract associated with lymphoid tissue
A

A

Adenoid
Tonsil
Small intestine
Appendix
Large intestine

206
Q

what is the site of immunological defect with development of small intestine?

A

A

peyers patches- fewer and less cellular

lamina propria- thinner and less cellular

germinal centres- fewer plasma cells

isolated lymphoid follicles- smaller and less cellular

207
Q

what is the location of an immunological defect of CD8 T-cells?

A

A

intestinal epithelial lymphocytes- fewer cells with reduced cytotoxicity

208
Q

what is the immunological response following invasion?

A

A
  • MALT (mucosa associated lymphoid tissue)
    • GALT (gut associated lymphoid tissue)
209
Q

where is MALT located?

A

A

found in submucosa below the epithelium, as lymphoid mass containing lymphoid follicles

210
Q

what are MALT follicles surrounded by?

A

A

HEV postcapillary venules, allowing easy passages of lymphocytes

211
Q

what is GALT responsible for?

A

A
  • adaptive & innate immune responses
    • Consists of B & T lymphocytes, macrophages, APC (dendritic cells), and specific epithelial & intra-epithelial lymphocytes
212
Q

what are the types of lymphoid tissue?

A

A

non- organised

organised

213
Q

what are the types of non-organised GALT?

A
  • Intra-epithelial lymphocytes
    • Make up 1/5th of intestinal epithelium, e.g. T-cells, NK cells
      • Lamina propria lymphocytes
214
Q

what are the types of organised lymphoid tissue?

A
  • Peyer’s patches (small intestine)
  • Caecal patches (large intestine)
  • Isolated lymphoid follicles
    • Mesenteric lymph nodes (encapsulated)
215
Q

what are non-organised GALT?

A

A

Non-organized GALT is made up of individual immune cells, such as lymphocytes and macrophages, that are interspersed among other cells in the lining of the gut. These scattered immune cells can detect and respond to foreign invaders, initiating an immune response to help eliminate them.

216
Q

What is MALT ?

A

Mucosal associated lymphoid tissue (MALT) is the main site of antigen recognition, and comprises more than 50% of the human bodyís lymphoid tissue.

217
Q

How can antigen presenting cells take up pathogens?

A

Antigen presenting cells can take up pathogens by phagocytosis or endocytosis. Macrophages and dendritic cells are able to carry out phagocytosis, whereas endocytosis is the major mechanism for B cells.

218
Q

What type of antibodies do B naive B cells express?

A

Most B cells are naive; they are yet to encounter specific antigen, and have the ability to express both monomeric IgM and IgD.

219
Q

Which interleukins are anti-inflammatory?

A

Anti-inflammatory interleukins:
IL-10,
IL-3,
IL-13,
IFN-alpha,
TGF-beta

220
Q

How does IgM exist in the body?

How does IgG exist in the body?

A

Exists in both monomeric and pentameric forms.

IgG: Exists as a monomer (this is the principal antibody in the body)

221
Q

What are Peyers Patches?

A

are isolated, organised aggregations of lymphoid tissue located mainly in the ileum.

222
Q

What is the underlying cause of hypotension in anaphylaxis?

A

Inflammatory mediators released by mast cell degranulation cause systemic vasodilation.

223
Q

What is an example of a subunit vaccine?

A

Hepatitis B, tetanus, diphtheria

Subunit vaccines are a type of vaccine that contains only specific antigenic components of a pathogen, rather than the entire pathogen.

224
Q

What are the M cells?

A

M cells detect antigen presence in the gut, and will transfer antigen to antigen presenting cells to stimulate an immune response from lymphocytes.

225
Q

What is the primary antibody involved in the immune response at mucosal surfaces, and what role does it play in preventing pathogen attachment and invasion?

A

IgA is the primary antibody involved in the immune response at mucosal surfaces. It plays a critical role in preventing the attachment and invasion of pathogens at these surfaces by binding to the surface of pathogens and neutralizing their toxins.

226
Q

What is an example of a live attenuated vaccine?

A

BCG vaccine against TB

227
Q

Which type of antigen will be presented by MHC Class 1 molecules to T cells?

A

Viruses are hydrolysed into smaller chains of amino acids in the proteasome and processed by the endoplasmic reticulum, before binding to MHC Class I molecules and being transported to the surface of the cell.

228
Q

What is the primary humoral response at the mucosal surface?

What type of antigen do MHC II glycoproteins present?

A
  • At the mucosal surface, IgA forms the primary humoral immune response.
  • MHC II proteins present exogenous antigens that originate extracellularly from foreign bodies such as bacteria in this presenting happen in the payer’s patches
229
Q

How is IgA protected against proteolytic eznymes at the mucosal surfaces?

A

At mucosal surfaces, IgA exists in a dimeric form, which protects it against proteolytic digestion at the mucosal surface. This enables it to act as the principal antibody in the primary humoral response at the mucosal surface.

230
Q

Which white blood cell gives rise to plasma cells?

A

B lymphocyte

231
Q

How does the membrane attack complex kill bacteria?

A

The membrane attack complex forms a channel in the bacterial cell membrane, causing the cell to swell and burst, leading to bacterial cell lysis and death.

232
Q

Which diseases are covered in the 4-in-1 vaccine?

A

Tetanus, Diphtheria, Pertussis and Polio

233
Q

Plasmacytoid dendritic cells produce high levels of which cytokine in response to infection?

A

Type 1 interferons

234
Q

.

A

.

235
Q

What are the categories of Gell and Coombs hypersensitivity reactions (5 categories)?

A
  • Type I = IgE mediated mast cell degranulation
  • Type II = Antibody to cell surface antigens
  • Type III = Immune complex mediated
  • Type IV = T-cell mediated hypersensitivity (delayed type)
    • Type V = Stimulatory receptor type hypersensitivity
236
Q

Which 3 interleukins are most likely to be involved in B-cell proliferation and modulation?

A

Il-2, Il-4 and Il-7

237
Q

How does IgA exist in the body?

A

IgA exists in both a monomeric form (found in the circulation and made by plasma cells in the bone marrow) and a dimeric form (also known as secretory IgA).

238
Q

What is the role of adjuvants in the context of human vaccinations?

A

Adjuvants prolong the presence of the introduced antigen in the hosts circulation and help it to be recognized and absorbed by professional antigen-presenting cells. Adjuvants also directly activate the immune system by activating lymphocytes and helping cytokine production.

239
Q

How do tissue-resident innate immune cells stimulate acute inflammatory responses?

A

How do tissue-resident innate immune cells stimulate acute inflammatory responses?

240
Q

Phagocytosis is a specific form of endocytosis True / False

A

True
Phagocytosis is a specific form of endocytosis

241
Q

which innate immune cells are invloved agenist parariste

A

Both **mast cells **and **neutrophils **can be involved in the immune response against parasites.

Mast cells release granules that help to recruit other immune cells and can phagocytose parasites.

Neutrophils release toxic granules that can kill parasites and can also phagocytose parasites.

242
Q

which innate immune cells are invloved agenist parariste

A

Both **mast cells **and **neutrophils **can be involved in the immune response against parasites.

Mast cells release granules that help to recruit other immune cells and can phagocytose parasites.

Neutrophils release toxic granules that can kill parasites and can also phagocytose parasites.

243
Q

The process of transendothelial migrations can be divided up into a number of broad steps

A
  1. Margination of Neutrophils to the endothelium near sites of tissues damage/infection.
  2. Binding of Neutrophils to adhesion molecules (selectins, ICAM-1) on the endothelial cells.
  3. Migration of Neutrophils across the endothelium, via the process of diapedesis.
  4. Movement of Neutrophils within the tissue via chemotaxis.
  5. Activation of Neutrophil by PAMPs and TNFα
244
Q

How is neutrophils differ from macrophages

A
  1. size and shape : Neutrophils are smaller
  2. life span neutrophils have a shorter lifespan
  3. neutrophils phagocytosing and killing microbes
    However macrophages They play a broader role in the immune response and are involved in phagocytosing and presenting antigens to other immune cells, as well as producing cytokines and other immune modulators.
245
Q

what are the three meachnims of killing by neutrophils

A
  1. Release of antimicrobial molecules(Degranulation)
  2. Formation of Neutrophil Extracellular Traps (NETs)
  3. Phagocytosis
246
Q

What are the Acute phase protiens

A
  • Proteins produced by the liver whose plasma concentrations increase or decrease in response to inflammation
  • **C3 **- involved in complement
  • CRP - activates complement via classical pathway
    • Very rapidly increased during inflammation
    • Very short half-life - decreases rapidly once well
  • **MBL **- activates complement via MBL pathway
247
Q

What is the function of complement system

A

Opsonization of pathogens
Direct pathogen killing (Membrane attack complex (MAC)
Acute inflammation
Leukocyte recruitment

which is a structure that can form a pore in the cell membrane of path

248
Q

what is the difference between BCR and TCR

A
  • T cells can only recognise peptide antigens which bound to MHCI or II
  • BCR bind to membrane associated or soluble antigens (ciculating around in the blood stream)
249
Q

Agglutination

A

is the clumping together of particles (e.g. microbes) caused by antibody molecules binding to antigens on the surface of two adjacent particles/cells/pathogens/antigens.

  • Agglutination increases the efficacy of pathogen elimination by enhancingphagocytosis
  • Agglutination prevents viruses them from binding to and infecting host cells
    *** Mediated by specific antigen binding to IgM and IgG antibodies
    *
250
Q

How can B cells activate complement system

A

by Fc region of IgM and IgG antibodies when they are bound to specific antigens

251
Q

what is neutralization and how is it mediated

A

it is a process by which the biological activity of a molecule, such as a virus or toxin, is inhibited or abolished by binding to a neutralizing antibody or other molecule.
* Mediated by specific antigen binding to **high affinity IgG **and **secretory IgA (sIgA) antibodies (in the GI track) **

252
Q

IgG antibodies are excellent opsonins
true / false

A

True

253
Q

Identify the immune cells aginst each of the fallowing pathogenes
1. Bacteria (3)
2. Viruses (2)
3.Fungi (3)
4. Protozoa (2)
5. worms .(2)

A
  1. Phagocytes , Antib and B cells and Complement
  2. T cells , Anti and B cells
  3. Pagocytes, T cells and Eosinophils
  4. Tcells and Eosinophils
  5. Mast cells and Eosinophils.
254
Q

Best antibodies to activate NK (Antibody-Dependent Cell-Mediated Cytotoxicity, ADCC)

A

Antigen-bound IgG is another very good activator of Natural Killer cells

255
Q

In membrane-bound monomeric form, IgD serves as a B cell antigen receptor
true / false

A

True

256
Q

major antibody class which activate B cells

A

IgM
It is the first antibody produced in response to an infection, and its production is triggered by the presence of the antigen.

257
Q

MAdCAM

A

Homing molecule which is found in the vasculature of other mucosal sites - means that lymphocytes primed in the gut can migrate to other mucosal sites

FOUNDATION MEDICINE (23 decks)

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