Immunomodulation and Immunosuppression Flashcards Preview

Clinical Pathology > Immunomodulation and Immunosuppression > Flashcards

Flashcards in Immunomodulation and Immunosuppression Deck (28):
1

Immunomodulation

Manipulating the immune system using immunomodulatory drugs to achieve a desired immune response.

2

Biologics- Immunomodulators

Products using molecular biologic techniques including recombinant DNA technology e.g. monoclonal antibodies, fusion proteins etc.

3

An example of a biologic immunomodulator

anti-TNF (pro-inflammatory cytokine) e.g. infliximab, etanercept

4

Passive immunisation is used for what infectious agents?

Hep B, botulism, VZV, antivenom

5

Give 2 examples of immunostimulation

Pooled human immunoglobulin for antibody deficiencies
G-CSF/GM-CSF (colony stimulating factor) act on bone marrow to increase production of mature neutrophils e.g. neutropenic patients post chemo

6

Give 6 effects of corticosteroid actions

Decrease neutrophil margination
Decrease production of pro-inflammatory cytokines
Inhibits phospholipase A2 (decreases production of arachidonic acid)
Lymphopenia
Decreased T cell proliferation-less likely to respond
Decreases immunoglobulin production

7

Side effects of corticosteroids

Carbohydrate and lipid metabolism (diabetes, dyperlipidaemia)
Decreased protein synthesis-poor wound healing
Osteoporosis
Glaucoma and cateracts
Psychiatric complications

8

Name 4 antimetabolites (T cell targeted immunosuppression)

Azathioprine
Mcophenolate Mofetil
Methotrexate
Cyclophosphamide

9

Name 4 types of T cell targeted immunosuppression

Antimetabolites
Calcineurin Inhibitors
M-Tor Inhibitors
Biological DMARDs

10

Mechanism of action of antimetabolites

Inhibit nucleotide purine synthesis-prevents early stages of activated cells proliferation-will target any rapidly dividing cell.
Azathioprine is a guanine anti-metabolite
Mycophenolate Mofetil prevents the production of guanosine triphosphate

11

Side effects of azathioprine and mycophenolate mofetil

Hepatotoxicity/hepatitis
Anaemia
Bone marrow suppression

12

Describe the mechanism of action of methotrexate and common side effect

Folate antagonist- pneumonitis

13

Describe the mechanism of action of cyclophosphamide and common side effect

X link DNA- cystitis

14

Mechanism of action of calcineurin inhibitors

Interfere with the initial T cell activation- prevent activation of NFAT-factors which stimulate cytokines i.e IL-2 and INF-y gene transcription. REVERSIBLE inhibition of T cell activation, proliferation and clonal expansion.

15

What are 2 calcineurin inhibitors

Ciclosporin A
Tacrolimus

16

Mechanism of action of ciclosporin A

Binds to intracellular protien cylophilin.

17

Mechanisms of action of tacrolimus

Bind to intracellular protein FKBP-12

18

Give an example of an M-Tor inhibitor

Sirolimus (rapmycin)
Macrolide antibiotic-also binds to FKBP12 but different effects-inhibits response to IL-2, causes cell-cycle arrest at G1-S phase in T cell.

19

Calcineurim/M-TOR side effects

Hypertension
Nephrotoxicity
Hepatotoxicity
Hirsutism-excessive hair growth

20

Name the 2 main groups of biological DMARDs

Anticytokines
Anti B cells

21

Anticytokines- Anti TNF

TNF activates macrophages, Used in treatment of RA, Crohn's, psoriasis, ankylosing spondylitis. Increases risk of TB

22

Anti IL-6

Type of biological DMARD e.g. tocilizimab
Used in therapy of RA and AOSD (adult onset still's disease)

23

Anti IL-1

Used in treatment of AOSD and other autoimmune conditions

24

Anti B cells

Rifuximab (rufus shakespeare -BNOC)
mAb against CD20 on B cell surface. Used for treatment of lymphomas, leukaemias, transplant rejection and autoimmune disorders. Only targets B cells in the blood, not in the bone marrow or lympphoid tissue.

25

2 examples of adoptive immunotherapy

Bone marrow transplant
Stem cell transplant

26

Describe 4 immunomodulators used for the treatment of allergies

Immune suppressants e.g. steroids
Allergen-specific immunotherapy
Anti-IgE monoclonal therapy
Anti-IL5 monoclonal treatment

27

Mechanism of allergen specific immunotherap

Give a small amount of the allergen to switch off the immune response from Th2 (allergic) to Th1(non allergic) development of Treg cells and tolerance.

28

mAB against IgE, used in the treatment of asthma, chronic urticaria and angioedema

Omalizumab