20. Depleting and Modifying Immune Cell Function Flashcards
What are integrins?
Cell adhesion molecules
Composed of a/B heterodimers
What cells are integrins found in?
Platelets and lymphocytes
Name a monoclonal antibody that binds to integrins
Natalizumab
What is Natalizumab used for?
Prevents lymphocytes infiltrating into the brain
Used in MS and Crohn’s disease
What adverse effect is associated with natalizumab?
PML
What is PML?
Progressive Multifocal Leukoencephalopathy
Reactivation of JC virus or HHV 6 in the brain
Name a S1P receptor antagonist
Fingolimod
What is the ligand for the S1P receptor?
Sphingosine-1-phosphate
What is the usual function of sphingosine-1-phosphate?
Release of lymphocytes from lymphoid tissue
How does fingolimod work?
Causes S1P receptor to be internalised
Reduces lymphocyte levels in blood and reduces hyperactivity of astrocytes
What disease is fingolimod used to treat?
MS
What are the adverse effects of fingolimod?
Affects HR and conduction in the heart
Macular oedema
Name 2 other a4/B7 antagonists
Vedozilumab
Etrolizumab
Name another S1P1 antagonist
Siponimod
Also used for MS and more selective than fingolimod
What is rituximab a monoclonal antibody to?
CD20 (specific to B cells)
How does rituximab work?
Triggers complement formation and lysis of B cells
What diseases is rituximab used to treat?
B cell lymphoma
RA resistant to TNF
What adverse effects are associated with rituximab?
SIRS
PML
Which drug is a monoclonal antibody to CD52?
Alemtuzumab
What cells is CD52 found on?
Mature lymphocytes
What diseases is alemtuzumab used for?
MS
T cell leukaemia
What is the use of glatiramer in MS?
Induces a Th2 immune response
Production of anti-inflammatory cytokines and neurotrophic factors
Helps remyelinate
What is the use of dimethyl fumarate in MS?
Causes apoptosis of lymphocytes
Shifts response from Th1 to Th2
Inhibits pro-inflammatory CKs
Name an immune stimulator
Imiquimod
What is imiquimod used to treat?
Genital warts
Basal cell carcinoma
How does imiquimod work?
Increase CKs, infiltration and apoptosis
What is IV IgG used for?
Treat patients with low IgG: can be enriched with certain antibodies against infection
Anti-inflammatory activity
Which diseases is IV IgG used to treat?
Immune thrombocytopenia
Kawasaki syndrome
What is the target of IV IgG?
FCyRIIa
What is the main principle in treatment of RA?
Start with symptomatic treatment, use DMARDs early, starting with monotherapy
Start with cheap drugs first
If mono therapy doesn’t work, move to double and triple
What drug is used in mono therapy of RA?
Methotrexate
What are the options for double therapy of RA?
Methotrexate and sulfasalazine
Methotrexate and hydroxychlorine
Sulfasalazine and plaquenil
Which drugs are used in triple therapy of RA?
Methotrexate, sulfasalazine, hydroxychlorine
What treatment should be given in RA if mono, double and triple therapy fail?
Biologic therapy
