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Immunopathology 2 Flashcards

1
Q

HYPERSENSITIVITY REACTIONS

Here the organism responds to _____ with an antigen that it ______ and to which it is _____.

A

renewed contact

already knows

hypersensitive

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2
Q

Adverse reactions caused by immune mechanisms in which there is damage to the tissues/organs in the body.
Gell & Coombs classification

1) _______
2)_________
3)____________
4)__________ H.R

A

Anaphylactic

Cytotoxic/Cytolytic

Immune complex/Toxic complex rxn

Cell mediated

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3
Q

The first 3 in types of HR reactions requires ______. They are also (delayed or immediate?) H.R, ____hrs after exposure

The last is ____ mediated( ______ and ____)-(delayed or immediate?) H.R., _____hrs after exposure

A

antibodies(plasma cells); immediate; 2-6

cell ; Tcells & Macrophages; delayed ; 24-36

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4
Q

Hypersensitivity

Excessive pathogenic reaction of a ________ body to _______ contact with the ________

A

sensitized

renewed; sensitizing antigen.

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5
Q

H.R.- TYPE I

Common allergens in immediate- hypersensitivity reactions causing _____ symptoms include:

____,_____, and _____

Cat antigen and other ______ antigens

____ mite fecal pellet antigens
Mold spores

A

respiratory

Tree, grass, and weed pollens

animal dander

Dust

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6
Q

HR TYPE 1

Many allergens are environmental substances that are harmless for most individuals. Some individuals apparently inherit genes that make them susceptible to allergies. This susceptibility is manifested by the propensity of these individuals to make strong ____ responses and, subsequently, ____ antibody against the allergens.

A

TH2

IgE

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7
Q

HR TYPE 1

On first exposure,
____ gets implanted on ____ of ___ cells & ______

This causes ______ of the those cells

2nd exposure causes _________ Fc on surface of the mast cells
Mast cells becomes stimulated to __________

The process is called ______

A

IgE; FcR

mast; basophils

priming; cross linking of IgE

release all its products.
mast cell degranulation

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8
Q

In HR TYPE 1

Complement is involved

T/F

A

F

not

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9
Q

HR TYPE 1 PATHOGENESIS
Allergens may be introduced by inhalation, injection or ingestion

*____ cells are often recruited to the site of allergic reactions in response to chemokines that are produced locally; among these chemokines is _____, which also recruits ______ to the same site.

A

TH2

eotaxin

eosinophils

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10
Q

TYPE 1 PATHOGENESIS

IL-__ stimulates B cells specific for the allergen to undergo ______ to IgE and to secrete this isotype.
IL-___ activates _____ that are recruited to the reaction, and
IL- ___ acts on ____ cells and stimulates ______

A

4; heavy-chain class switching

5 ; eosinophils

13; epithelial; mucus secretion

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11
Q

Mast cells express a high-affinity receptor for the ___ portion of the __ (light or heavy?) chain of IgE, called _____.

A

Fc

ε

Heavy

FcεRI

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12
Q

______ are the circulating counterparts of mast cells.

A

Basophils

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13
Q

role of basophils in most immediate hypersensitivity reactions is not established

T/F

With reason

A

T

since these reactions occur in tissues and not in the circulation

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14
Q

Mention 3 cells that express the Fc3RI

A

Mast cell
Basophils
Eosinophils

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15
Q

The third cell type that expresses FcεRI are eosinophils, which are often present in these reactions and also have a role in IgE-mediated host defense against _______ infections

A

helminth

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16
Q

H.R.-TYPE I

Primary mediators (such as _____,______,____,____,_____,_____ )
cause vaso____, broncho______, etc.
and release of secondary mediators (such as _______,______,_____, and ______)
which lead to inflammatory cell infiltrates.

A

histamine, serotonin,NCF,ECF,proteases

dilation; constriction

leukotrienes, prostaglandin, PAF, cytokines

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17
Q

HR TYPE 1

CHEMOTAXIS- ____,_____,____

VASOACTIVITY- ______________

SMOOTH MUSCLE SPASMS- ______________

A

LTB4,ECF,NCF

histamine, PAF, LTC4, D4, E4, neutral protease,PGD2

LTC4,D4,E4,histamine,PG,PAF

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18
Q

HR TYPE 1

Consequences of the mediators

___ease vascular permeability
_____ of lining epithelium
___ease glandular secretion
Smooth muscle (relaxation or contraction?)
Inflammatory cell attraction( _______ and _______)

A

Incr

Edema

Incr

contraction

eosinophils & neutrophils

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19
Q

HR TYPE 1 Important medical conditions fall into this category

Systemic anaphylaxis: Classic examples are _________ and ______
In some individuals, a severe reaction occurs within minutes, leading to symptomatology such as acute _____, _____ edema, diarrhea, ______, and _____.

A

penicillin allergy and bee sting allergy.

asthma

laryngeal

urticaria

Shock

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20
Q

HR TYPE 1

Local anaphylaxis (_____)

Classic examples are food allergies and hay fever to ragweed pollen

A

atopy

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21
Q

About ____% of people have “atopy” and are easily sensitized to allergens that cause a _____ reaction when inhaled or ingested.
This can produce _____,_____,_____ , etc..

A

10

localized

hay fever, hives, asthma

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22
Q

H.R.-TYPE II

Type II hypersensitivity –cytotoxic

Definition

Ig_ or Ig__ against specific target in the body (cell or receptor)

Pathogenesis: once ____ is attached, the cell would be injured by either _______ or ______

A

M; G

Antibody; complement or cell mediated cytotoxicity

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23
Q

HR TYPE 2

•Complement-dependent cytotoxicity

-__________ anemia : Body is producing _____ against ______ & attaching to it

•Antibody-dependent cell-mediated cytotoxicity
_______ anemia

•Anti-receptor antibodies
Activate receptors- ______ disease Ab against a specific receptor

A

Autoimmune hemolytic; auto-ab

its own rbc

Pernicious

Grave’s

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24
Q

Complement dependent reactions:

Antibody is directed against antigen on cells (such as circulating ______) or extracellular materials (________).
The resulting Ag-Ab complexes activate _____ (via the ____ pathway), leading to _____ or extracellular tissue damage.

A

red blood cells; basement membrane

complement; classic

cell lysis

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25
Q

HR TYPE __

a red blood cell has _____ fixed on its surface to which _____ attaches.

The attached stuff sets off the ______, which ends with the formation of the “__________” of C_-__ which causes lysis of the cell. Other complement components may be generated, such as the opsonin ____.

A

2

antigen; antibody

complement cascade; membrane attack complex

C5-9 ; C3b

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26
Q

HR TYPE 2
Diseases in this complement dependent category include:

_______ reactions

__________ anemia.

____________: ______ crosses the placenta and attaches to fetal RBC’s.

___________

A

Transfusion

Autoimmune hemolytic

Erythroblastosis fetalis; maternal IgG

Good pasture syndrome

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27
Q

Goodpasture’s syndrome: _____ basement membrane antibody is present. Same type ___ ——- is also present in the ____

A

glomerular

IV collagen

lungs

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28
Q

Antibody-dependent cell-mediated cytotoxicity (ADCC):
(Low or High?) concentrations of IgG or IgE (in the case of parasites) coat target cells.

Inflammatory cells such as NK (natural killer) cells, monocytes, and granulocytes then bind to the _________ receptors and lyse, but __________, the target cells.

A

Low

immunoglobulin Fc

do not phagocytize

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29
Q

HR Type 2

A macrophage with Fc receptors on its surface is able to recognize a target cell coated with ____ via the ______ portion of the attached antibody.

The macrophage can then demolish the targeted cell by elaboration of _____.

_________ is not involved

A

antibody

Fc receptor

proteases

Complement

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30
Q

Examples of ADCC include:

_______
Immune reactions against _______
Immune reactions against ______

A

Transplant rejection

neoplasms

parasites

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31
Q

HR TYPE 2

Antireceptor antibodies: ____ antibody is directed against ____ in target cells, resulting in _____- mediated ______ of the receptors.

A

IgG; receptors

complement; destruction

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32
Q

HR TYPE 2

Antibodies can bind to cell surface receptors or essential molecules, and cause functional derangements (either _______ or _________) without cell injury.

The variant is sometimes classified as _____

A

inhibition or unregulated activation

TYPE V

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33
Q

HR TYPE 2

Antibody is directed against _____ receptors at the motor end plate of a muscle, ____ the receptors and diminishing the muscular response. This is the mechanism for muscle weakness in ____________

A

acetylcholine

blocking

myasthenia gravis

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34
Q

HR TYPE 2

Diseases caused by Antireceptor antibodies mechanism include:

____________: acetylcholine receptor antibody.
______ disease (thyrotoxicosis): _____ receptor antibody/TSI
______ anemia:_______ antibody.

A

Myasthenia gravis

Grave’s; anti-TSH

Pernicious; anti-parietal cell

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35
Q

H.R.-TYPE III

Type III hypersensitivity–immune complexes
Definition-

This reaction is mediated by _______ which promote tissue damage primarily through _______

A

immune (Ag-Ab) complexes

complement activation

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36
Q

HR TYPE 3

-_______ formation deposition in tissue inflammation + disease

____ as an opsonin attracts _____, which then release lysosomal enzymes.
____ as a chemoattractant brings in ____.

A

Immune complex

C3b; neutrophils

C5a; neutrophils

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37
Q

HR TYPE 3

Serum complement is ???

With reason

A

reduced

as it is used up in this process.

38
Q

HR TYPE 3

Caused by (low or high?) levels of circulating, (soluble or insoluble ?) immune complexes containing _____ or ______ .

Circulating immune complexes overwhelm the ability of the _________ to __________ (eg. skin, glomeruli, blood vessels, synovium, lungs) and end up ______

A

High; soluble ; IgG or IgM antibody

mononuclear phagocyte system to remove them and deposit in various tissues

activate complement.

39
Q

HR TYPE 3

_______ complexes are circulating and becoming trapped ______ of a small blood vessel, setting off the ______ and generating components that attract _____ to generate an ongoing inflammatory response.

A

antigen-antibody

beneath the basement membrane; complement cascade

PMN’s

40
Q

HR TYPE 3

In contrast to type II, the ______ is not ___________

A

the Ag is not an intrinsic component of the target cells

41
Q

In H.R.-TYPE III
Immune complexes can only be deposited locally

T/F

A

F

Both systemic and/or locally

42
Q

H.R.-TYPE III

Complement is chemotactic for neutrophils with release of ____,____,_____

F.XII is activated causing _____ of nearby vessels
activation of the kinin system causes _____ and ——-
Platelet aggregation causes _____ formation and release of ______ from its ____ core granules

A

PG,kinin & free radicals

thrombosis; vasodilation & edema

microthrombi; vasoactive amines

dense

43
Q

HR TYPE 3

Systemic immune complex disease:

Ag-Ab complexes form in the circulatory system and are deposited in tissues, typically near basement membranes in places such as __,_____,______ ,_____ .

A

blood vessels, glomeruli, skin, joints, pleura, and pericardium

44
Q

HR TYPE 3

Larger immune complexes are _______ by ______ and _____, but small to intermediate complexes formed with antigen excess may escape removal leading to:

_________
____________
________

A

quickly phagocytized

macrophages and removed

Glomerulonephritis
Serum sickness
Vasculitis

45
Q

HR TYPE 3

Local immune complex disease: Also called an “ ______ “ reaction,

it occurs with ______ of the antigen and leads to ________.

A

Arthus

local injection

focal vasculitis

46
Q

HR TYPE 3

Local immune complex disease

This kind of immune reaction also plays a role in the development of hypersensitivity _____ (so-called “_________”).

A

pneumonitis

farmer’s lung

47
Q

HR TYPE 3

Arthus reaction

-Local reaction which occurs when ________________ , In the presence of an excess of preformed Ab

-As the antigen diffuses into the vascular wall, it binds the ______, and (small or large?) immune complexes are formed locally.

These complexes precipitate in the vessel walls and cause _______, and super imposed ______ worsens the ischemic injury.

A

Ag is introduced- by injection/organ transplant

preformed antibody

Large ; fibrinoid necrosis

thrombosis

48
Q

HR TYPE 3

Clinical examples:
Serum ______
_____
______ reaction
________
Immunecomplex mediated ______ dx
Rheumatoid arthritis

A

sickness

SLE; arthus

Polyarteritis nodosa

glomerular

49
Q

In SLE(___vs our own dna)

In Rheumatoid arthritis(___ vs our own igg)

A

antibody

igm

50
Q

HR TYPE 3

Serum sickness;
A systemic deposition of ag-ab complexes in multiple sites
Esply the _____,_____,____

A

kidneys,heart,joints

51
Q

Before antibody containing foreign(horse) serum was used for ________ againts micro-orgs.and toxic products

Stopped because of __________

A

passive immunisation

the danger of S.S.

52
Q

HR TYPE 3

The pathogenesis of systemic immune complex disease can be divided into three phases:
(1) formation of _________ in the circulation;
(2) ______ of the immune complexes in various tissues, thus initiating
(3)__________ at the sites of immune complex deposition

A

antigen-antibody complexes

deposition

an inflammatory reaction

53
Q

SLE

Also an e.g.of multisystemic illness

Characterized by the _____ immune complex deposition

A

malar rash-

54
Q

HR TYPE 3

PAN;
_________ complex dx

Especially involving the ___ sized arteries

A

Generalised immune

small & medium

55
Q

HR TYPE 3

Immune-complex mediated glomerular diseases

Includes ________ glomerulonephritis , __________ glomerulonephritis & _______

A

post-streptococcal

membranous

lupus nephropathy

56
Q

HR TYPE IV

Type IV hypersensitivity– _____/_____ type

Definition-no ____ is required

A

cell –mediated

delayed; antibody

57
Q

HR TYPE IV

A disease mediated by sensitized _________

The cell-mediated type of hypersensitivity is initiated by antigen-activated (sensitized) __ lymphocytes, including ____________ T cells

Found in;______ formation Virus
Tumor

A

Th1 lymphocytes

T

CD4+ and CD8+

Granuloma

58
Q

HR TYPE IV

Reactions of CD4+ T Cells: _____-Type Hypersensitivity and _______

Reactions of CD8+ T Cells: _____- mediated _______

A

Delayed; Immune Inflammation

Cell-Mediated Cytotoxicity

59
Q

HR TYPE IV

Delayed-Type Hypersensitivity and Immune Inflammation

Both TH1 and TH17 cells contribute to organ- specific diseases in which inflammation is a prominent aspect of the pathology.
The inflammatory reaction associated with TH1 cells is dominated by _____, and that triggered by TH17 cells has a greater ______ component.

A

activated macrophages

neutrophil

60
Q

The cellular events in T cell–mediated hypersensitivity consist of a series of reactions in which ______ play important roles.

A

cytokines

61
Q

The reactions can be divided into the following stages:

_____________ of CD4+ T Cells.

_______________ T Cells.

A

Proliferation and Differentiation

Responses of Differentiated Effector

62
Q

HR TYPE IV: delayed type hypersensitivity

Proliferation and Differentiation of CD4+ T Cells.

___ CD4+ T cells recognize peptides displayed by dendritic cells and secrete IL-__ , which functions as an autocrine growth factor to stimulate proliferation of the antigen-responsive T cells.

The subsequent differentiation of antigen-stimulated T cells to ____ or ____ cells is driven by the cytokines produced by _____ at the time of T-cell activation

In some situations the ___ produce IL- ____, which induces differentiation of CD4+ T cells to the ____ subset.

____ produced by these effector cells promotes _______ , thus amplifying the reaction.

A

Naive; 2

TH1 or TH17

APCs; APCs ; 12; TH1

IFN-γ; further TH1 development

63
Q

HR TYPE IV: delayed hyper sensitivity

Proliferation and differentiation phase:

If the APCs produce inflammatory cytokines such as __,___ and a close relative of IL-12 called IL-___,
these work in collaboration with transforming growth factor-β (TGF-β) (made by many cell types) to stimulate differentiation of T cells to the ____ subset.
Some of the differentiated effector cells ________ and may remain in the ________ of T cells for long periods, sometimes years.

A

IL-1, IL-6, 23

TH17

Enter the circulation; memory pool

64
Q

HR TYPE IV: Delayed-Type Hypersensitivity:Responses of Differentiated Effector T Cells.

Upon repeat exposure to an antigen, previously activated T cells recognize the antigen displayed by APCs and respond.
TH1 cells secrete cytokines, mainly ____, which are responsible for many of the manifestations of _______

A

IFN-γ; delayed- type hypersensitivity.

65
Q

IFN-γ–activated macrophages are altered in several ways: their ability to _____ and ______ is markedly augmented; they express more class ___ MHC molecules on the surface, thus facilitating further antigen presentation; they secrete ___,____ and chemokines, which promote inflammation

A

phagocytose and kill microorganisms

II

TNF, IL-1,

66
Q

HR TYPE IV: Delayed-Type Hypersensitivity: response of effector cells

TH17 cells are activated by some _______ and by ______ in autoimmune diseases.

Activated TH17 cells secrete IL- ___, IL-___, chemokines, and several other cytokines.

Collectively, these cytokines recruit _____ and —— to the reaction, thus promoting inflammation.

TH17 cells also produce IL- ____ , which amplifies the TH17 response.

A

microbial antigens ; self-antigens

17; 22; neutrophils and monocytes

21

67
Q

Delayed-Type Hypersensitivity and Immune Inflammation

MORPHOLOGY

The classic example of DTH is the _____ reaction, which is produced by the intracutaneous injection of __________ (also called tuberculin), a protein-containing antigen of the tubercle bacillus.

In a previously sensitized individual, ______ of the site appear in 8 to 12 hours, reach a peak in 24 to 72 hours, and thereafter slowly subside

In fully developed lesions, the venules show marked _____, reflecting cytokine-mediated _______

With certain persistent or nondegradable antigens, such as tubercle bacilli colonizing the lungs or other tissues, the perivascular infiltrate is dominated by ______ over a period of 2 or 3 weeks.

A

tuberculin

purified protein derivative (PPD,

reddening and induration

endothelial hypertrophy; endothelial activation

macrophages

68
Q

________ is a common example of tissue injury resulting from DTH reactions.

It may be evoked by contact with ______, the antigenic component of _____ or ______ , and presents as a ________

A

Contact dermatitis

urushiol; poison ivy or poison oak

vesicular dermatitis.

69
Q

H.R.- TYPE IV
Reactions of CD8+ T Cells: Cell-Mediated Cytotoxicity

In this type of T cell–mediated reaction, __________ kill antigen- bearing target cells.

Tissue destruction by ____ may be an important component of many T cell–mediated diseases, such as ______,______
in reactions against viruses.

A

CD8+ CTLs

CTLs

type 1 diabetes, graft rejection

70
Q

H.R.- TYPE IV
Reactions of CD8+ T Cells: Cell-Mediated Cytotoxicity

In a virus-infected cell, viral peptides are displayed by class I MHC molecules and the complex is recognized by the _____ of _________.

The killing of infected cells leads to the elimination of the infection, and is responsible for _______ (e.g., in viral hepatitis).

A

TCR of CD8+ T lymphocytes

cell damage that accompanies the infection

71
Q

H.R.- TYPE IV
Reactions of CD8+ T Cells: Cell-Mediated Cytotoxicity

____-associated antigens are also presented on the cell surface

A

Tumor

72
Q

CTLs are involved in tumor rejection

T/F

A

T

73
Q

H.R.- TYPE IV
Reactions of CD8+ T Cells: Cell-Mediated Cytotoxicity

The principal mechanism of T cell–mediated killing of targets involves ______ and ______ , preformed mediators contained in the _______ granules of ____

CTLs that recognize the target cells secrete a complex consisting of _______, and a protein called _____, which enters target cells by _____.

In the target cell cytoplasm, perforin facilitates the release of the granzymes from the complex.
Granzymes are proteases that cleave and activate ______, which induce apoptosis of the target cells ..

A

perforins and granzymes,

lysosome-like ; CTLs.

perforin, granzymes; serglycin

endocytosis; caspases

74
Q

Reactions of CD8+ T Cells: Cell-Mediated Cytotoxicity

Activated CTLs also express Fas ligand, a molecule with homology to ____, which can bind to Fas expressed on target cells and trigger apoptosis

CD8+ T cells also produce cytokines, notably IFN-γ, and are involved in inflammatory reactions resembling ____, especially following ____ infections and exposure to some contact sensitizing agents.

A

TNF

DTH; virus

75
Q

Role of antibody in DTH

A

Antibody and complement play no role in DTH.

76
Q

Role of complement in DTH

A

Antibody and complement play no role in DTH.

77
Q

TYPE I – IMMEDIATE, _____, ANAPHYLACTIC

A

ATOPIC

78
Q

Atopy is the term for the genetic trait to ___________________

Atopic individuals have higher levels of ______________

A

have a predisposition for localized anaphylaxis.

IgE and eosinophils.

79
Q

Treatment of type 1 HR

DRUGS
________
______
______
Theophylline OR epinephrine -inhibits ______

A

Non-steroidal anti-inflammatories

Antihistamines

Steroids

degranulation

80
Q

Treatment of type 1 HR

Immunotherapy

___sensitization (___sensitization) also known as ________
Repeated injections of allergen to ___________ and ________

A

De; hypo; allergy shots

reduce the IgE on Mast cells and produce IgG

81
Q

Immediate (Type I) hypersensitivity ;

May be prevented by administration of disodium chromoglycate

T/F

A

T

82
Q

Examples of type 2 hyper reactions

List 10!

A

Autoimmune hemolytic ananemia
Transfusion reactions
Immune thrombocytopenia
Erythroblastosis fetalis

Goodpasture syndrome
Hyperacute transplant rejection
Rheumatic fever

Grave’s disease
Myasthenia gravis
Pemphicus vulgaris

83
Q

Goodpasture disease aka ________

A

Anti-GBM glomerulonephritis

84
Q

Type 3 HR

Large amount of antigen and antibodies form complexes in blood.
If not eliminated can deposit in ______ or _____ and trigger inflammation.

A

capillaries or joints

85
Q

IL__ activates eosinophils

IL__ does class switching to IgE

A

5

4

86
Q

Type I hypersensitivity

The reaction may involve skin (____,_____), eyes (______), nasopharynx (____,_____), bronchopulmonary tissues (____) and gastrointestinal tract ( _______ ).

A

urticaria and eczema

conjunctivitis

rhinorrhea, rhinitis

asthma

gastroenteritis

87
Q

Type 3 HR consists of 3 things
List them

A

antigen
Antibody
Complement

88
Q

Examples of type 3 HR

LIST 4

A

SLE
Rheumatoid arthritis
Reactive arthritis
Polyarteritis nodosa
Post streptococcal glomerulonephritis

89
Q

4Ts of HR type 4

A

Touching (contact dermatitis)
T cells
Transplant rejection
TB skin tests

90
Q

Farmer’s lung disease

Type ___ HR

A

3

91
Q

Poison ivy

Type ___ HR

A

4

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