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Rory's Year 5 pathology > Immunology: Immune modulating therapies (1+2) > Flashcards

Immunology: Immune modulating therapies (1+2) Flashcards

(51 cards)

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1
Q

Two types of immune modulation

A

-Boosting immune response -Suppression of immune response

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2
Q

List the 4 ways in which the immune system can be boosted

A

-Vaccination -Replacement of missing components -Blocking immune checkpoints -Cytokine therapy

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3
Q

Outline the immunological mechanisms involved in vaccines

A

-Vaccines utilise the adaptive immune response (Overall keypoint) -Clonal expansion following exposure to antigen within vaccine -T cells with appropriate specificity will proliferate and differentiate into effector cells (cytokine secreting, cytotoxic) -B cells with appropriate specificity will proliferate and differentiate to T cell independent (IgM) (memory) and plasma cells undergo germinal centre reaction and differentiate to T cell dependent IgG/A/E(M) memory and plasma cells -Immunological memory -Following infection, residual pool of specific cells with enhanced capacity to respond if re-infection occurs

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4
Q

What is an APC?

A

APCs (Antigen presenting cells) are cells that can present peptides to T lymphocytes to initiate an acquired immune response

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5
Q

3 examples of antigen presenting cells (APCs)?

A

-Dendritic cell -Macrophage -B lymphocyte

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6
Q

What Virus is associated with excess stimulation of clonal CD8+ T cells?

A

Epstein Barr Virus

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7
Q

Immunological memory is mediated by:

A

-B and T lymphocytes

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8
Q

What do we want from a vaccine?

A

-MEMORY - Generate protective, long-lasting immune response -No adverse reactions -Practical considerations – one shot, easy storage, inexpensive…

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9
Q

How is the effectiveness of the flu vaccine measured?

A

-Haemaglutinin inhibition assay

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10
Q

What is a mantoux test?

A

-A test to measure the immune response against TB, ie the effectiveness of the BCG vaccine. -Tuberculin is injected intradermally, the degree of swelling determines immune response

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11
Q

What are the types of vaccines? (Give examples)

A

-Live attenuated vaccines (eg MMR, yellow fever) -Inactivated/Component vaccines (eg trivalent flu vaccines, cholera)/(Hepatitis B) -Conjugates+ Adjuvants to increase immunogenicity (eg haemophilus infleunzae) -DNA vaccines (Experimental) -Dendritic cell vaccines (Experimental)

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12
Q

Advantages of Live vaccines?

A

-Establishes infection – ideally mild symptoms -Raises broad immune response to multiple antigens – more likely to protect against different strains -Activates all phases of immune system. T cells, B cells – with local IgA, humoral IgG -Often confer lifelong immunity after one dose

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13
Q

Problems with live vaccines

A

-Reversion to virulence -Spread to contacts

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14
Q

Advantages of Inactivated/ component vaccines?

A

-No mutation or reversion -Can be used with immunodeficient patients -Storage easier -Lower cost

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15
Q

Problems with Inactivated/ component vaccines?

A

-Often do not follow normal route of infection -Some components have poor immunogenicity -May need multiple injections -May require conjugate protein carrier or adjuvants to enhance immunogenicity

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16
Q

Risks or complication of vaccines?

A

-Live attenuated vaccines can cause reversion to virulence

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17
Q

Describe how conjugate vaccines are formed

A

-Polysaccharide plus protein carrier -Polysaccharide alone induces a T cell independent B cell response – transient -Addition of protein carrier promotes T cell immunity which enhances the B cell/antibody response

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18
Q

How are adjuvants used in vaccines?

A

-Adjuvant increases the immune response without altering its specificity (eg aluminium salts, lipids)

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19
Q

DNA vaccines: Advantages and disadvantages?

A

-Advantages -Mimics a virally infected cell -Potential for developing cancer vaccines against tumour associated antigens or mutational antigens -Disadvantages -Possible plasmid integration into host DNA -Possible response to DNA could lead to autoimmune diseases such as SLE

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20
Q

Which type of vaccine should NOT be given to an immunosuppressed individual?

A

Live attenuated vaccines (eg BCG)

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21
Q

Methods of replacing missing components of the immune system?

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A

-Haematopoietic stem cell transplantation (Radical) -Antibody replacement -Adoptive Cell transfer (T cells)

22
Q

Indications for Haematopoietic stem cell transplantation?

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A

-Life-threatening immunodeficiencies -Haematological malignancies

23
Q

Indications for antibody replacement therapy?

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A

-Primary antibody deficiency (eg X linked agammaglobulinaemia) -Secondary antibody deficiency: -Haematological malignancies -After bone marrow transplantation

24
Q

Describe CAR T cell therapy

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A

-Inducing the patient’s own T cells to target CD19+ B cells -Used to treat ALL, NHL (+ other Haem malignancies)

25
Car T cell therapy indications?
ALL, NHL (Haem malignancies)
26
An immunosuppressed individual, who has not had chicken pox, is exposed to the infection. Which is the most appropriate treatment?
Human varicella-zoster specific immunoglobulin (Post exposure prophylaxis)
27
Blocking immune checkpoints: Examples?
-Ipilimumab: Antibody specific for CTLA4 -Pembrolizumab and Nivolumab: antibodies specific for PD-1
28
Indications for immune checkpoint blockers?
Melanoma (Especially advanced)
29
Outline the mechanisms of checkpoint inhibitors
-Example: Ipilimumab: Antibody specific for CTLA4 -Antibody binds to CTLA4 (T cell receptor) CTLA4 regulated T cell activation -Blocks immune checkpoint -Allows T cell activation -Complication: autoimmunity
30
Cytokine Therapy examples?
-//recombinant cytokines -Interferon alpha -Interferon beta -Interferon gamma -Interleukin 2
31
Clinical uses of recombinant cytokines?
-Aim: to modify (boost) the immune system Interferon alpha: Hairy cell leukaemia, chronic myeloid leukaemia, multiple myeloma -Interferon beta: Behcet’s -Interferon gamma: Chronic granulomatous disease -Interleukin 2: Renal cell cancer
32
-A 23 year old has metastatic melanoma. Which of the following may reduce disease progression? BCG vaccination Bone marrow transplantation CAR-T cells with specificity for CD19 Nivolumab, an antibody specific for PD-1 Normal human immunoglobulin
Nivolumab, an antibody specific for PD-1 //Checkpoint Inhibitor
33
6 Methods of suppressing the immune response?
-Steroids -Anti-proliferative agents -Plasmapheresis -Inhibitors of cell signalling -Agents directed at cell surface antigens -Agents directed at cytokines
34
What corticosteroids are used in immune suppression?
-Prednisolone (Glucocorticoid agonist) -Cortisone (Glucocorticoid agonist)
35
What are the indications of corticosteroids for immunosuppression?
-Allergic disorders -Auto-immune disease -Auto-inflammatory diseases -Transplantation -Malignant disease
36
How do corticosteroids lead to reduced inflammation/ immune activity?
-Work on many aspects of immune system -Corticosteroids inhibit phospholipase A2 -Blocks arachidonic acid and prostaglandin formation and so reduces inflammation -Phospholipase A2: Breaks down phospholipids to form arachidonic acid which is converted to eicosanoids (eg prostaglandin)s, leukotrienes) by cyclo-oxygenases -Leads to production of prostaglandins -Act broadly on phagocytes: -Causing decreased traffic of phagocytes to inflamed tissue -Decreased phagocytosis -Decreased release of proteolytic enzymes -Corticosteroids also act on lymphocytes -Sequester lymphocytes, so they stay in the lymphoid tissue (Causes lymphopenia in blood) -Furthermore, they block cytokine gene expression -Cause decreased antibody production -Promotes apoptosis (Basically quite a broad effect)
37
Side effects of corticosteroids
-(Metabolic) -Diabetes, central obesity -Moon face -Lipid abnormalities -Osteoporosis -Hirsuitism -Adrenal suppression -(Other) -Cataracts -Glaucoma -Peptic ulceration -Pancreatitis, -Avascular necrosis
38
Examples of antiproliferative immunosuppressants
-Cyclophosphamide -Mycophenolate -Azathioprine
39
Mechanism of action of antiproliferative agents?(immunosuppressants)
Inhibit DNA synthesis Cells with rapid turnover most sensitive
40
Side effects of antiproliferative agents?(immunosuppressants)
-Bone marrow suppression -Infection -Malignancy -Teratogenic
41
Give an indication for cyclophosphamide
-SLE -(Multisystem connective tissue disease or vasculitis with severe end-organ involvement or cancer)
42
What infection is cyclophosphamide associated with?
-Pneumocystis jiroveci
43
Indications for azathioprine?
-Transplantation -Auto-immune disease -Auto-inflammatory diseases, eg Crohn’s, ulcerative colitis
44
What is Mycophenolate?
-Anti-proliferative immunosuppressant
45
What is plasmapheresis
-Removal of pathogenic antibody -Patient’s blood passed through cell separator
46
Indications for plasmapheresis?
-Severe antibody-mediated disease -Goodpasture syndrome -(Anti-glomerular basement membrane antibodies) -Severe acute myasthenia gravis -(Anti-acetyl choline receptor antibodies) -Severe vascular rejection -(Antibodies directed at donor HLA molecules) -Mainly type II hypersensitivity reactions
47
What are the mechanisms of action of Ciclosporin and Tacrolimus?
-Calcineurin inhibitors -Block the process of T cell activation -Block cytokine transcription by T cells, therefore prevent lymphocyte proliferation and effector functions.
48
Side effects of Ciclosporin and Tacrolimus?
-Ciclosporin -(Dysmorphic features, nephro-neuro-toxicity, HTN) -Tacrolimus -(Diabetes, nephro-neuro-toxicity, HTN)
49
What is Tofacitinib?
-Immunosuppressant by inhibiting cell signalling -Inhibitor or JAK1 and JAK3 (non-receptor tyrosine kinases) ie a 'Jakinib' -Inhibits production of inflammatory molecules -Effective in Rheumatoid arthritis, psoriatic arthritis
50
What is Apremilast?
-Immunosuppressant by inhibiting cell signalling -Inhibitor of PDE4 (Inflammatory mediator) -Inhibition of PDE4 leads to increase in cAMP -Inhibits production of cytokines -Effective in psoriasis and psoriatic arthritis
51
//Agents directed at cell surface antigens
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Rory's Year 5 pathology (39 decks)

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