(13) MHC and transplantation Flashcards

1
Q

Where has blood group substance been revealed by immunofluorescent staining?

A

In the cell membranes of all vascular endothelial cells, and certain epithelial cells

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2
Q

Normal individuals have naturally occuring isoagglutinins of which type?

A

Normal individuals have naturally occurring anti-A or anti-B isoagglutinins

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3
Q

How is blood group related to transplant?

A

Poor outcome of transplants performed between blood group incompatible individuals

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4
Q

Who discovered the MHC?

A

Peter Alfred Gorer

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5
Q

Describe the discovery of the MHC?

A
  • tumour transplantation between mouse strains
  • sarcoma tissue from strong’s albino A strain grew in F2 cross and backcross generations between the A strain and the resistant C57 black strain
  • all susceptible animals possessed an antigen derived form their albino acceptors “antigen II”
  • anti-antigen II antibody produced in C57 black mic by transfer of sarcoma tissue from the A strain
  • maximal titres of anti-antigen II antibody corresponded with time of complete tumour regression
  • “…genes govern the transplantability of the tumour and determine isoantigenic differences’
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6
Q

What was the experiment done by Peter Medawar concerning MHC?

A
  • skin allograft rejection in burns victims
  • rabbit skin graft model

gave different donor strains to incompatible recipient, measured time taken for graft to become necrotic

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7
Q

What were the results from Medawar’s experiment?

A
  1. recipient strain = X, donor strain = Y, graft loss = 10-14 days (1st set response)
  2. recipient strain = X’, donor strain = Y, graft loss = 5-7 days (2nd set response)
  3. recipient strain = X’, donor strain = Z, graft loss = 10-14 days (1st set response)

MHC responsible for these observations

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8
Q

The MHC is a set of genes found in who?

A

All vertebrate species

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9
Q

What is the role of the MHC?

A
  • immune function
  • diseases susceptibility
  • reproductive success
  • role in histocompatibility, major influence on graft survival
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10
Q

Where are the proteins encoded by the MHC expressed and what do they present?

A

They are expressed at the cell surface and function to present ‘self’ and ‘non-self’ antigens for inspection by T cell antigen receptors

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11
Q

How many MHC molecules are on the average mammalian cell?

A

50,000-100,000

It is the most prolific cell surface protein/antigen

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12
Q

Are MHC proteins polymorphic?

A

Highly polymorphic

Most polymorphic system in the human genome

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13
Q

Where is the human MHC genes found?

A

6p21.3

the short arm of chromosome 6

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14
Q

How big is the human MHC?

A

3.6Mbp

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15
Q

The MHC is divided into 3 regions. Which proteins/antigens do each of these 3 different regions encode?

A

class I region = HLA-A, B, C (‘classical’) antigens

class II region = HLA-DR, DQ, DP antigens

class III region = HSP70, TNF, C4A, C4B, C2, BF, CYP21

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16
Q

HLA-DR is encoded by what region of the MHC?

A

Class II region

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17
Q

What are the antigens encoded by MHC called?

A

HLA

Human leucocyte antigens

18
Q

Where are class I antigens found?

A

On all nucleated cells

19
Q

Class I HLA antigens mainly serve to present which antigens?

A

Endogenous antigens (result of changes in the cell eg. virus)

20
Q

Where are class II antigens found?

A

Primarily expressed on B lymphocytes but expression can be induced on T lymphocytes and other cells

21
Q

Class II HLA antigens mainly serve to present which antigens?

A

Exogenous antigens

22
Q

What type of proteins are HLA antigens?

A

Membrane-bound glycoproteins

23
Q

What are class I HLA-A, B, C molecules composed of?

A

MHC encoded 45kd heavy chain non-covalently associated with non-polymorphic B2 microglobulin

24
Q

What are class II HLA-DR, DP, DQ molecules composed of?

A

MHC encoded 31-34kd associated A chain non-covalently associated with 26-29kd B chain

25
Q

Which part of the HLA molecule presents the antigen to the T cells?

A

The peptide-binding groove

26
Q

How are MHC inherited?

A

Mendelian inheritance - 1 in 4 chance of mismatch with sibling, 1 in 2 chance of partial match, 1 in 4 chance of match

En-bloc from each parental chromosome. Each individual inherits two antigens at a given locus

Codominant expression. All of the inherited antigens are displayed on the cell surface (HLA phenotype)

27
Q

Describe HLA polymorphism

A
  • MHC is highly polymorphic
  • large number of allelic variants at each locus
  • allelic variation maintained at population level due to survival advantage
  • significant in terms of capacity of individual to mount an immune response in response to an antigenic challenge
28
Q

In HLA nomenclature, what are the 3 levels of specificity?

A
  • broad eg. HLA-A19
  • split eg. HLA-A29(A19)
  • allele eg. HLA-A*29:01

serology (broad)
serology (split)
molecular (low)
molecular (high)

29
Q

In HLA nomenclature, what does an * mean?

A
  • = molecular

no * = serology

30
Q

What are the 3 categories of response when the immune system experiences foreign HLA in transplant tissue?

A
  • direct recognition
  • indirect recognition
  • semi-direct recognition
31
Q

What happens in direct recognition in response to transplant tissue (foreign HLA)?

A
  • graft + damaged endothelium due to surgical stress
  • T cell binding direct to graft
  • donor DCs presenting to recipient T cells
  • T cell proliferation
32
Q

What happens in indirect recognition in response to transplant tissue (foreign HLA)?

A
  • graft peptides
  • movement of recipient APC
  • processing of donor peptides (lymph node)
  • T cells migrate to the graft (immune response)
33
Q

What happens in semi-direct recognition in response to transplant tissue (foreign HLA)?

A
  • movement of recipient APC
  • donor APC
  • recipient and donor APC interaction
  • migration of ‘new’ APC to lymph node to present to T cells
34
Q

Which type of recognition (direct, indirect, semi-direct) occurs straight away in transplantation?

A

Direct

Unique to transplantation

35
Q

What is sensitisation and give examples of events

A

Any event which elicits an HLA directed immune response

  • pregnancy
  • blood transfusion
  • transplantation
36
Q

How can you determine HLA profile?

A
  • serum screening

- cross matching (directly test recipient serum against donor cells)

37
Q

cRF% is a measure of what?

A

Sensitisation

38
Q

If you have a 0% cRF, what does this mean?

A

Any donor can be used

39
Q

What does 50% cRF mean?

A

50% sensitised

lost 50% chance of finding donor

but better than 100% cRF (100% not actually possible, but have to find donor exactly matching)

40
Q

What happens in hyperacute rejection?

A
  • activate clotting cascade
  • activate complement
  • lost integrity of vascular endothelium
  • organ engorges with blood and becomes necrotic
  • DIC