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PPOM1 Block 4 > Lecture 158 > Flashcards

Lecture 158 Flashcards

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1
Q

Opportunistic microbes only cause disease when what part of the immune response is compromised?

A

T-cell mediated immunity

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2
Q

T-cell derived CTLA-4 binds to what two CDs with higher affinity than CD28?

A

CD80 or CD86

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3
Q

What type of signals does CTLA-4 send upon binding?

A

Inhibitory signals to the T cell

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4
Q

PD-1, AKA

A

Programmed cell death-1

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5
Q

Ligation of PD-1 leads to inhibition of ____

A

Cytokine secretion

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6
Q

What type of T-cells suppress autoimmunity and downregulate responses?

A

Tregs

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7
Q

An immune response mounted by the recipient against the graft due to antigen incompatibility:

A

Allograft rejection

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8
Q

What is the gold standard for the diagnosis of graft rejection?

A

Biopsy

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9
Q

GVHD

A

Graft-versus-host disease

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10
Q

When functional immune cells transplanted from a donor recognize the recipient cell as “foreign” and mount an immune attack:

A

GVHD

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11
Q

What is the standard of care for the treatment of GVHD?

A

Glucocorticoids

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12
Q

What type of rejection results in irreversible damage within minutes to hours after organ reperfusion?

A

Hyperacute (early) rejection

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13
Q

What triggers hyperacute rejection?

A

Preformed antibodies against the donor organ

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14
Q

What type of rejection occurs within days to months and involves mainly cellular immunity?

A

Acute rejection

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15
Q

What type of rejection involves both cellular and humoral immunity?

A

Chronic rejection

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16
Q

What type of rejection results in thickening and fibrosis of the vasculature of the transplanted organ?

A

Chronic rejection

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17
Q

Immunosuppressant therapy agents that cause T-cell lysis or clearance, resulting in depletion of circulating lymphocytes

A

Depleting agents

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18
Q

What class of immunomodulators does rATG belong to?

A

Immunosuppressant depleting agents

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19
Q

rATG

A

Rabbit antithymocyte globulin

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20
Q

What class of immunomodulators does alemtuzumab belong to?

A

Immunosuppressant depleting agents

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21
Q

Alemtuzumab is anti-____

A

Anti-CD52 antibody

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22
Q

Immunosuppressant therapy agents that block IL-2 mediated T-cell activation

A

Nondepleting agents

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23
Q

What class of immunomodulators does basiliximab belong to?

A

Immunosuppressant nondepleting agents

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24
Q

Basiliximab is anti-____

A

Anti-IL-2R(alpha) receptor antibody

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25
A typical oral 3-drug combination for maintenance immunosuppressive therapy typically includes:
Calcineurin inhibitor, antimetabolite, and glucocorticoid
26
How is treatment of cell-mediated acute rejection guided?
By histopathologic severity of rejection
27
How are glucocorticoids administered to treat T-cell mediated acute rejection?
High-dose pulse therapy
28
What two classes of immunomodulators are used to treat acute rejection?
Glucocorticoids and depleting agents
29
Long-term duration and intensity of immunosuppression increases the risk of ____
Malignancy
30
PTLD
Post-transplant lymphoproliferative disorders
31
Lymphoid or plasmacytic proliferations in solid organ or allogenic HSCT that result from immunosuppression
PTLDs
32
When should transplant recipients receive inactivated vaccines?
3-6 months following transplantation
33
When should transplant recipients receive live vaccines?
Never
34
How long may lymphopenia persist after rATG therapy?
>1 year
35
Polyclonal antibodies act on surface antigens of circulating lymphocytes and induce direct cytotoxicity leading to profound lymphocyte depletion
rATG
36
What is the effect of rATG?
Impaired delayed hypersensitivity and cellular immunity
37
What are the clinical uses of rATG?
Solid organ transplant, GVHD, acute rejection
38
What potentially fatal infusion reaction is associated with rATG?
Cytokine release syndrome (CRS)
39
What type of hypersensitivity reaction is serum sickness?
Type III immune-complex reaction
40
What do clinical symptoms of serum sickness typically present?
3-4 days after exposure
41
Monoclonal antibody targeting CD52 cell surface glycoproteins found on T and B cells, NK cells, monocytes, and macrophages
Alemtuzumab
42
What is the typical dosing of alemtuzumab in transplantation?
1 or 2 doses perioperatively
43
What is the MOA of alemtuzumab?
Binds CD52 proteins on the surface if lymphocytes leading to direct antibody-dependent lysis
44
What protein does alemtuzumab bind to?
CD52
45
What are the clinical uses of alemtuzumab?
Alternative in solid organ transplant induction, steroid-refractory acute GVHD
46
What neoplasm is associated with the use of alemtuzumab?
B cell chronic lymphocytic leukemia
47
Chimeric monoclonal IgG antibodies targeting the alpha-chain of the IL-2 receptor
Basiliximab
48
How long is the receptor blockade in basiliximab?
25-35 days
49
What is the result of basiliximab blocking of the alpha chain on IL-2R?
Prevents IL-2 induced T cell proliferation and induces downregulation of IL-2R
50
IL-2R(alpha) is found exclusively on ____
Activated T cells
51
What are the therapeutic uses for basiliximab?
Induction therapy in renal transplant patients at low risk for acute rejection
52
What are the adverse effects of basiliximab?
Low incidence, hypersensitivity, HAMA reaction
53
Glucocorticoids bind reversibly to ____
Albumin
54
What immunomodulator alters gene transcription of anti-inflammatory proteins?
Glucocorticoids
55
What does the dimerized GC-GR complex bind to?
Glucocorticoid response elements (GREs)
56
What anti-inflammatory protein do glucocorticoids induce?
Lipocortin
57
What protein inhibits phospholipase A2?
Lipocortin
58
Inhibition of phospholipase A2 inhibits synthesis of what two products?
Prostaglandins and lipoxygenase
59
Glucocorticoids have relatively little effect on ____
Humoral immunity
60
Glucocorticoids downregulate what two proinflammatory interleukins?
IL-1 and IL-6
61
What are the therapeutic uses of glucocorticoids?
Acute transplant rejection, GVHD, cytokine release syndrome

PPOM1 Block 4 (44 decks)

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