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Clinical Pathology > 12 - Immunomodulation & suppression > Flashcards

12 - Immunomodulation & suppression Flashcards

(51 cards)

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1
Q

Immunomodulation definition

A

The act of manipulating the immune system using immunomodulatory drugs to achieve
a desired immune response

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2
Q

Immunomodulation definition

A

Medicinal products produced using molecular biology techniques including recombinant DNA technology
e.g. monoclonal antibodies + fusion bodies

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3
Q

Definition of passive immunisation

A

transfer of specific, high-titre antibody from donor to recipient. Provides immediate but transient protection

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4
Q

Passive immunisation problems

A

Risk of transmission of viruses

Serum sickness

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5
Q

Passive immunisation types

A

Pooled specific human Ig

Animal sera

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6
Q

Passive immunisation uses

A

Hep B prophylaxis and treatment

Botulism, VZV (pregnancy), diphtheria, snake bites

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7
Q

Active immunisation definition

A

To stimulate the development of a protective immune response and immunological memory

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8
Q

Active immunisation immunogenic material

A

Weakened form of pathogen
Killed inactivated pathogens
Purified materials (proteins, DNA)
Adjuvants

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9
Q

Active immunisation problems

A

Allergy to any vaccine component
Limited usefulness in immunocompromised
Delay in achieving protection

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10
Q

What stimulates immunosuppression?

A 
Corticosteroids
Cytotoxic agents
Anti-proliferative agents
DMARD's
Biological DMARD's
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11
Q

Action of corticosteroids

A

Decreased neutrophil margination
Reduced production of inflammatory cytokines
Inhibition of phospholipase A2 (less arachidonic acid metabolite production)
Lymphopenia
Decreased T cells proliferation
Reduced immunoglobulins production

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12
Q

Corticosteroids - side effects

A

CHO and lipid metabolism - diabetes and hyperlipidaemia
Reduced protein synthesis - poor wound healing
Osteoporosis
Glaucoma and cataracts
Psychiatric complications

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13
Q

Corticosteroid - uses

A

Autoimmune disease
Inflammatory disease
Malignancies (lymphoma)
Allograft rejection

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14
Q

Drug targeting lymphocytes

A

Antimetabolites
Calcineurin inhibitors
M-TOR inhibitors
IL-2 receptor mABs

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15
Q

Antimetabolites e.g.

A

Azathioprine (used to treat Crohn’s)

Mycophenolate mofetil

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16
Q

Calcineurin inhibitors

A

Ciclosporin A

Tacrolimus

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17
Q

M-TOR inhibitors

A

Sirolimus

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18
Q

IL-2 receptor for mABs

A

Basiliximab

Daclizumab

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19
Q

Calcineurin inhibitors - how do they work

A

Bind to intracellular protein cyclophilin

Prevents activation of NFAT

Stops factors that stimulation cytokines

Reversible inhibition of T-cell activation, proliferation and clonal expansion

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20
Q

Sirolimus (aka rapamycin) what is it, how work

A

Macrolide antibiotic
Binds to FKBP12 but different effects
Inhibits mammalian target of rapamycin (mTOR)

Inhibits response to IL-2

Cell cycle arrest of T cells at G1-S phase

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21
Q

Calcineurin/mTOR - side effects

Study These Flashcards
A 
Hypertension
Hirsutism
Nephrotoxicity
Hepatotoxicity
Lymphomas
Opportunistic infections
Neurotoxicity
Multiple drug interactions (induce P450)
22
Q

Calcineurin - clinical use

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A

Transplantation - allograft rejection

Autoimmune diseases

23
Q

Antimetabolites - what do

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A

Inhibit nucleotide (purine) synthesis

24
Q

Antimetabolites - AZA

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A

guanine anti-metabolite

25
Antimetabolites - MMF
Non-competitive inhibitor of IMPDH
26
Antimetabolites - T and B cell effects
Impaired DNA production Prevents early stages of activated cell proliferation
27
Antimetabolites - MTX
Methotrexate | Folate antagonists
28
Antimetabolites - cyclophosphamide
Cross-link DNA target
29
Cytotoxic - side effects
Bone marrow suppression Gastric upset Hepatitis Susceptibility to infections Cyclophosphamide - cystatis MTX - pneumonitis
30
Cytotoxics - clinical use for AZA/MMF
AZA/MMF - autoimmune diseases (SLE, vasculitis, IBD), allograft rejection
31
Cytotoxics - clinical use for MTX
MTX - RA, PsA, polymyositis, vasculitis, GvHD in BMT
32
Cytotoxics - clinical use for cyclophosamide
Vasculitis (Wagner's, CSS) | SLE
33
Biological DMART's
``` Anticytokines Anti-B cell therapies Anti-T cell activation Anti-adhesion molecules Complement inhibitors ```
34
Anticytokines - types
Anti-TNF Anti-IL-6 Anti-IL-1
35
Anticytokines - anti-TNF
first therapy for RA Also used in Crohn's, psoriasis, ankylosing spondylitis Caution: increased risk of TB
36
Anticytokines - anti-IL-6
Tocilizumab Blocks IL-6 receptor Used in therapy of RA and AOSD May cause problems with control of serum lipids
37
Anticytokines - anti-IL-1
Used in AOSD and autoinflammatory syndromes
38
AOSD stands for?
Adult's onset still's disease
39
Rituximab what is it
Chimeric mAb against CD20-B cell surface
40
Rituximab uses
Lymphomas, leukaemias Transplant rejection Autoimmune disorders
41
Adoptive immunotherapy
BMT | SCT
42
BMT stands for
bone marrow transplant
43
SCT stands for
stem cell transplant
44
Adoptive immunotherapy uses
Immunodeficiencies (SCID) Lymphomas & leukaemias Inherited metabolic disorders (osteopetrosis) Autoimmune disease
45
Immunomodulators - allergy
Immune suppressants Allergen specific immunotherapy Anti-IgE monoclonal therapy Anti-IL-5 monoclonal treatment
46
Allergen specific immunotherapy - indications
Allergic rhino-conjunctivitis not controlled on max medical therapy Anaphylaxis to insect venoms
47
Allergen specific immunotherapy - mechanisms
Switching of immune response from Th2 (allergic) to Th1 (non-allergic) Development of T reg cells and tolerance
48
Allergen specific immunotherapy - routes
SC or sublingual for aero-allergens
49
Allergen specific immunotherapy - side-affects
Localised and systemic allergic reactions
50
Omalizumab
mAb against IgE Used in Rx of asthma Also useful in Rx of chronic urticaria and angioedema may cause severe systemic anaphylaxis
51
Mepolizumab
mAb against IL-5 prevents eosinophil recruitment and activation limited effect on asthma no clinical efficacy in hypereosinophilic syndrome

Clinical Pathology (65 decks)

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