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Year 5 😊✌🏼 > Immunomodulation 1&2 > Flashcards

Immunomodulation 1&2 Flashcards

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1
Q

Cells involved in immune memory

A

pool of specific B and T cells

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2
Q

How do follicular T helper cells provide help to B cells for expansion and isotope swiching?

A

CD40L and cytokines

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3
Q

antibody order in immune response

A

IgM initial response
IgG than takes over

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4
Q

what criteria are important for generating a vaccine?

A
  1. Memory
  2. no adverse effects
  3. safe, easy to administer, one dose only if possible
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5
Q

Haemagglutiniation inhibition assay

A

wells with RBC only - dot where RBCs sink

wells with RBC plus virus - haemagglutination

wells with RBC and effective antibody - dot where RBCs sink because antibodies bind and neutralises to the HA -> no haaemaagglutiinataion

for influenza vaccination

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6
Q

Manatoux test - immune reaction

A

Type IV

(delayed response, have to read the results around 72h post injection)

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7
Q

Cytokine therapy -

A

used to be used

goal waas to induce interleukin 2 (two stimulate T cell response)

some of the TT-cells

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8
Q

Cytokine therapy - interlukin 2, where useful?

A

renal cell cancer

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9
Q

IFN-gamma cytokine therapy

A

add from lecture

can be used in chronic granulomatous disease

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10
Q

INF-alpha cytokine therapy

A
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11
Q

Replacing missing components of the immune system as immune modulating therapy

A

HSCT

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12
Q

Antibody replacement

A

noramal

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13
Q

How is human normal IgG made?

A

prepared form pools or >1000 people

….

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14
Q

human IgG when uussed.

A

primary and secondary antibody deficiencies

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15
Q

Specific Ig - when used?

A

PEP (Hep B)

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16
Q

Specific Ig - How made?

A

derived from plasma donors with high titres of IgG Abs to specific pathogens.

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17
Q

When do you use VZVIgG rather tthan

A

<20w pregnant

or

immunocompromised?

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18
Q

ACT - what is it?

A
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19
Q

ACT - when is it used?

A
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20
Q

TIL T-cell therapy

A
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21
Q

what does IL-2 do?

A

proliferation of T-cells

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22
Q

TCR and CAR-T cell therapy

A
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23
Q

Issue with checkpoint inhibitors

A

often develop autoimmune diseases (because of the T-cell activation)

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24
Q

Examples of what checkpoint inhibitors bind to?

A

PD1
PD2
CTLA4

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25
Examples of checkpoint inhibitors
26
Which vaccines are live?
BCG Polio (oral) MMR
27
What do steroids block?
Phospholipase A2
28
Why are neutrophil counts high in poeple on high dose steroids?
interfere with trafficking and function in the innate immune system ....
29
effects of corticosteroids on lymphocyte function
lymphopenia (sequestration of lymphocytes ion lymphoid tissue)
30
Side effects of ssteroids
diabetes central obesity moon face lipid abnormalities osteoporosis hirsutism adrenal suppression infection cataracts glaucoma peptic ulcer pancreatitis
31
Anti-proliferative immunosuppressaants - examples
cyclophosphamide (most toxic) mycophenolate azathioprine (caban be used in pregnancy)
32
Anti-proliferative immunosuppressaants - MoA
inhibitt DNA synthesis
33
Aside effects of cyclophosphamide
bone marrow depression hair loss sterility (men >>> women -> sperm storage) haaemorrhagic cysts malignancy (bladder cancer, haematological malignancies, non-melaonma skin cancer) Infection (pneumocystsitis jiroveci)
34
Azathioprine SE
bone marrow suppression (1 in 300 individuals are extremely susceptible to this because of TPMT polymorphisms) hepatotoxicity Infection (less common)
35
Azathioprine SE
bone marrow suppression (1 in 300 individuals are extremely susceptible to this because of TPMT polymorphisms) hepatotoxicity Infection (less common)
36
What do you do before staarting azathioprine?
check TPMT for polymorphisms if homozygous: don't use if heterozygous: use 50% dose
37
SE of mycophenolate mofetil
bone marrow suppression herpes virus reactoncation progressive multifocaal leukoencepaahlopathy (JC virus)
38
How does plasma exchange work?
remove patients blood, filter out antibodies and return blood without the anttibodies temporary effects until the useful in severe antibody mediated disease or antibody mediated transplant rejection T2 hypersensitivity reaction
39
What immune reaction type does plasma exchange work for>
type 2 (AB mediated)
40
What diseases can plasma exchange help wth ?
Myasthenia gravis Goodpaasture syndrome
41
Tacrolimus
calcineurin inhibitor
42
where is tacrolmus used?
transplant AI-diseasse e.g.SLE, psoriatic arthritis
43
examples of calcineurin inhibitors
tacrolimus
44
Rapamycin
mTOR inhibitor
45
mTOR inhibitor examples
Sirolimus Rapamycin
46
Jakinibs
JAK inhibitors effective in RA, psoriatic arthritis, axial spondyloarthritis. more SE than some of the monocolonals oraal agent so some people prefer it to monoclonals
47
Why do some people prefer Jakinibs to monoclonal despite more SE?
because they are an oral agent
48
Why do some people prefer Jakinibs to monoclonal despite more SE?
because they are an oral agent
49
anti-thymocyte globulin - how is it made?
inject human thymocyte into rabbit ??? more
50
toxic effects of anti-thymocyte immunoglobulin
51
CD25 antibody
IL-2R alpha chain blocks the effect of IL-2 given before and after transplant surgery for prophylaxis of rejection
52
Toxicity associated with IL-2Ralpha chain monoclonla
53
CTLA4-Ig fusion protein mAb - indications
RA (IV 4 weekly, sc weekly)
54
How does CTLA4-Ig work?
reduces co-stimulation of CD28 + T cells
55
Rituximab - what is lit against?
CD20 = B-cells depletes mature B cells but keeps plasma cells
56
Indications for rituximab
lymphoma RA SLE 2 doses IV every 6-12 months (RA)
57
toxicities of rituximab
Infusion reactions infection (PML) exacerbation CV disease NOT mlaignancy
58
Vedolizumab - alpha4beta7 integrin - indication and frequency
IBD IV every 8w
59
How does Vedolkizumab work?
inhibits leukocyte migration?
60
Toxic effects of Vedolizumaab
61
TNF-alpha blocker examples
Infliximab Adalimumab Certoliizumab Golimumab
62
Conditions where you can use TNF-alpha inhibitors
RA psoriasis psoriatic arthritis IBD FMF ankylosing spondylitis sc or IV
63
Toxicity of TNF-alpha inhibitors
infusion or injection site reactions infection (TB, HBV, HCV) - screen for latent TB infection before you start lupus like conditions demyelination malaignancy
64
Etanercept
TNF - alpha inhibitor works differently?
65
IL-1 blocl
66
IL-6 / IL-6 R block
in RA, GCA, LV vasculitis affects T-cells, B-cells, synoviocytes
67
IL-23 and IL-17 pathway
important in spondyloarthriitides and related conditions
68
Important pathway in spondyloarthtitides
IL-23 -> TH17 differentiation -> IL-17 anad IL-22 can block this pathway with Secukinumab (anti IL17) and guuselkumab (anti IL 23)
69
IL 4, 5 13 axis
asthma eczema
70
Where was Rank Rank ligand useful?
osteoporosis
71
Immunosuppression - advice to give aaptients
2x risk of infection wash hands / avoid contact vaccination /avoid live vaccines... ,,,,
72
what vaccines are we particularly worried about in immunosuppressed patients?
chronic infections, particularly TB -> CXR and elispot/quantiferon usually done before starting treatment
73
latent TB in someone you want to start immunosuppressive treatment in
generally, treat latent TB before starting immunosuppressive treatment if the disease is very severe you may not want to wait
74
JCV
John Cunningham virus common polyomaviru s....
75
what malignancies are we worried about in immunosuppressed individuals.
lymphoma (EBV) - 3-4x risk non-melanoma skin cancer (HPV) ?melanoma
76
AI side effects of iimmunosuppression
SLE and lupus like syndromes APS vasculitis interstitial lung disease sarcoidosis autoimmune hepatitis ...
77
when do you see lupus like syndromes?
in TNF alpha therapy
78
Psoriasis and psoriatic aarthritis - what type of autoimmunity
T-cell mediated autoimmunity

Year 5 😊✌🏼 (53 decks)

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