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.Pathology 2 > Immunopathology II > Flashcards

Immunopathology II Flashcards

1
Q

describe the direct pathway of transplant rejection

A

in the direct pathway, donor class I and class II MHC antigens on antigen-presenting cells in the graft are recognized by host CD8+ cytotoxic T cells and CD4+ helper T cells.

  • CD4+ cells proliferate and produce cytokines (IFN-gamma) which induce tissue damage by a local inflammatory reaction
  • CD8+ T cells responding to graft antigens differentiate into CTLs that kill graft cells
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2
Q

describe the indirect pathway of transplant rejection

A

in the indirect pathway, graft antigens are picked up, processed, and displayed by host APCs and activate CD4+ T cells which damage the graft by an inflammatory reaction and stimulate B lymphocytes to produce antibodies

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3
Q

describe the time of onset, the mechanism and morphology of hyperacute rejection

A
  • time of onset: minutes to few hours
  • mechanism: preformed antibodies bind to graft endothelium
  • morphology: vascular thrombosis +/- necrosis
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4
Q

describe the time of onset, the mechanism and morphology of acute cellular rejection

A

acute cellular rejection

  • time of onset: days to weeks, months to years
  • mechanism: T cells injure graft by direct cytotoxicity and type IV HS
  • morphology: interstitial infiltrate of lymphocytes with tubulitis +/- arteritis
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5
Q

describe the time of onset, the mechanism and morphology of acute humoral rejection

A

acute humoral

  • time of onset: days to weeks, months to years
  • mechanism: antidonor antibodies against graft antigens
  • morphology: microcirculatory inflammation +/- arteritis/thrombosis
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6
Q

describe the time of onset, the mechanism and morphology of chronic rejection

A

chronic rejection

  • time of onset: months to years (irreversible)
  • mechanism: T cell cytokines stimulate vascular smooth muscle proliferation
  • morphology: arteriosclerosis; ischemic injury; interstitial fibrosis
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7
Q

describe what is seen in the image

A
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8
Q

describe what is seen in the image

A
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9
Q

describe what is seen in the image

A
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10
Q

describe what is seen in the image

A
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11
Q

describe graft versus host disease

A
  • donor tissue is immunocompetent
  • donor T cells react to “foreign” antigens of host tissues
  • recipient is immuno-depleted (whole body irradiation or chemotherapy)
  • most commonly occurs following allogeneic bone marrow transplantation
  • activation of donor CD4 and CD8 T cells
    • type IV HS rxn
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12
Q

describe the acute vs. chronic form of graft versus host disease

A
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13
Q

describe central tolerance

A
  • apoptosis of self-reactive lymphocyte clones during maturation
    • T cells in thymus
    • B cells in bone marrow
  • some survive to become regulatory T cells
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14
Q

describe peripheral tolerance

A
  • back-up mechanisms to neutralize self-reactive T cells that escape central neutralization
    • anergy
    • suppression by regulatory T cells
    • activation-induced cell death
    • antigen segregation
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15
Q

in SLE, there are antibodies against ___ components and ____

A

in SLE, there are antibodies against nuclear components and phospholipids

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16
Q

the basic mechanism of SLE is the loss of _____

A

the basic mechanism of SLE is the loss of self-tolerance

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17
Q

describe how SLE affects the skin

A
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18
Q

describe what is seen in the image

A
19
Q

describe what is seen in the image

A
20
Q

describe how SLE affects the kidney

A
21
Q

describe what is seen in the image

A

SLE

focal proliferative glomerulonephritis with 2 focal necrotizing lesions at the 11 o clock and 2 o clock positions

22
Q

describe what is seen in the image

A

SLE

diffuse proliferative glomerulonephritis; note the marked increase in cellularity throughout the glomerulus

23
Q

describe the image

A

SLE

lupus nephritis showing a glomerulus with several “wire loop” lesions representing extensive subendothelial deposits of immune complexes (PAS stain)

24
Q

describe how SLE affects the joints

A
  • non-erosive synovitis
  • no deformities
  • neutrophils and fibrin in synovial fluid
25
Q

describe how SLE affects the heart and blood vessels

A
  • pericarditis, myocarditis
  • Libman Sacks endocarditis
  • necrotizing vasculitis of small arteries & arterioles
26
Q

a sensitive but not specific test for SLE (or any autoimmune disorder) is for ____

A

a sensitive but not specific test for SLE (or any autoimmune disorder) is for antinuclear antibodies (ANA)

27
Q

name the 2 main specific antibodies used for diagnosis of SLE

name 3 other one

A
  • specific antibodies
    • anti-double stranded DNA (ds-DNA)
    • anti-Smith (Sm)
  • other antibodies
    • antiphospholipid
    • antiplatelets
    • antiRBCs
28
Q

___ levels are decreased in active SLE disease

A

complement levels are decreased in active SLE disease

29
Q

name the antibodies specific for SLE

A

anti-dsDNA

anti-Sm

30
Q

name the antibodies specific for drug-induced SLE

A

antihistone

31
Q

name the antibodies specific for systemic sclerosis (scleroderma)

A

Scl-70

32
Q

name the antibodies specific for CREST

A

anticentromere

33
Q

name the antibodies specific for Sjogren syndrome

A

SS-A

SS-B

34
Q

name the antibodies specific for myopathies

A

Jo-1

35
Q

describe the significance of antiphospholipid antibodies in SLE and name 2 major complications

A
  • against proteins complexed to phospholipids
  • can bind to Cardiolipin Ag of Treponema (syphillis) and cause a false positive
  • causes procoagulant complications:
    • recurrent thromboemboli
    • recurrent abortions, focal cerebral ischemia
  • anti-phospholipid antibody syndrome = when without SLE
36
Q

describe drug-induced SLE (4 drugs)

which antibody is present in this condition?

A
  • drugs
    • procainamide = most common
    • hydralazine
    • isoniazid
    • D-penicillamine
  • renal and CNS involvement uncommon
  • remits with withdrawal of drug
  • high frequency of anti-histone antibodies
37
Q

in systemic sclerosis, there is excessive ___ throughout the body and ___ is almost always involved

name the 2 basic forms of the systemic type

A

in systemic sclerosis, there is excessive fibrosis throughout the body and the skin is almost always involved

  • 2 basic forms of systemic type:
    • diffuse
    • limited (CREST syndrome)
38
Q

describe symptoms associated with systemic sclerosis (scleroderma)

A
  • skin abnormalities distinctive
  • Raynaud phenomenon
  • difficulty swallowing
39
Q

describe how systemic sclerosis (scleroderma) affects the GI tract

A
  • GI tract
    • muscular and mucosal atrophy and fibrosis
    • loss of normal motility and absorption
40
Q

____ aka ____ is highly specific for systemic sclerosis (scleroderma)

while

____ is highly specific for CREST

A

anti-topoisomerase I aka anti-SCL 70 aka antiis highly specific for systemic sclerosis (scleroderma)

while

anticentromere is highly specific for CREST

41
Q

describe CREST syndrome and symptoms

A
  • limited form of systemic sclerosis
  • relatively mild, indolent course
  • acronym:
    • Calcinosis
    • Raynaud phenomenon
    • Esophageal dysmotility
    • Sclerodactyly
    • Telangiectasia
42
Q

in Graves disease, immunoglobulins mimic ___ which results in ____

A

in Graves disease, immunoglobulins mimic TSH which results in hyperthyroidism

43
Q

in autoimmune gastritis, there are autoantibodies against ____ which leads to a decrease in ___ and ____

A

in autoimmune gastritis, there are autoantibodies against gastric parietal cells which leads to a decrease in acid secretion and intrinsic factor secretion (necessary for B12 absorption → leads to pernicious anemia)

.Pathology 2 (28 decks)

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