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Gastrointestinal Week 2 2016/17 > 3: Immunology - role of mucosal immunity in disease > Flashcards

3: Immunology - role of mucosal immunity in disease Flashcards

1
Q

Which cells initiate presentation of antigen to T cells in lymph nodes to start the adaptive immune response?

A

Dendritic cells

Macrophages

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2
Q

Which signal molecules trigger activation of immune cells following a cellular insult?

A

Cytokines

Chemokines

Defensins

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3
Q

The appropriate immune response to a pathogen tends to have a ___ effect for the host.

The inappropriate immune response to a pathogen ___ the host’s cells.

A

protective

damages

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4
Q

Which pathogen is notable for causing mucosal immune dysregulation?

A

HIV

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5
Q

Upon HIV infection of the mucosa, which immune cell takes it up for presentation and inadvertently spreads it throughout the gut and lymphoid tissue?

A

Dendritic cells

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6
Q

Which T cells are infected and killed by HIV?

A

CD4+ T cells (helper / memory)

someone says this in Trainspotting

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7
Q

In which types of tissue is HIV infection common?

A

Mucosal tissue

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8
Q

What is primary immunodeficiency?

A

Part of the immune system is missing from birth

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9
Q

HIV infection is a (primary / acquired) immunodeficiency.

A

acquired

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10
Q

What immunoglobulin is the most common in the mucosal immune response?

A

IgA

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11
Q

Which primary immunodeficiency is responsible for Coeliac disease?

A

IgA deficiency

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12
Q

What is CVID?

A

Collection of immunodeficiencies which causes sinopulmonary and GI infections

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13
Q

If someone presents with recurrent infections, what should you check?

A

Immunoglobulin levels

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14
Q

What is XLA?

A

X-linked agammaglobulinaemia

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15
Q

What immunodeficiency is seen in people with XLA?

A

No B cells

No IgG

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16
Q

What will you see in someone with XLA?

A

Recurrent infection

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17
Q

XLA is only present in (males / females).

A

males

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18
Q

What is used to treat XLA patients?

A

Immunoglobulin infections

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19
Q

What is the phagocyte respiratory burst?

A

Phagocytes produce reactive oxygen species (superoxide) to kill pathogens

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20
Q

What is CGD?

What is the primary immunodeficiency?

A

Chronic granulomatous disease

Failure of phagocytes to produce superoxides for respiratory burst

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21
Q

What does SCID stand for?

What is the immunodeficiency?

What will the patient present with?

A

Severe combined immunodeficiency

No B cells; No T cells

Constant infection (pulmonary and GI), opportunistic

22
Q

What immunoglobulin is associated with allergy?

Which immune cell is activated and degranulates due to the action of this antibody?

What symptoms present after?

A

IgE

Mast cells

Allergy symptoms - bronchoconstriction, increased permeability of blood vessels, runny nose, anaphylaxis

23
Q

Mast cell activation by IgE is self-perpetuating because:

Activated ___ ___ produce ___ which stimulates B cells to produce more IgE.

(mast cells, IL-4)

A

mast cells , IL-4 , TH2

24
Q

What immune cells are activated by allergens?

What happens systemically if this isn’t treated?

A

Mast cells, Basophils, Eosinophils

Anaphylaxis

25
Q

Which diseases causes small intestine damage leading to malabsorption ⇒ malnutrition?

A

Coeliac disease

IBD (Crohn’s, UC)

26
Q

Which foods does gluten come from?

A

Wheat

Barley

Rye

27
Q

Is coeliac disease an allergy?

A

No

Genetically linked autoimmune disorder which can develop at any time

28
Q

Which foodstuff triggers the symptoms of coeliac disease?

A

Gluten

29
Q

Which genes trigger the development of Coeliac disease?

A

HLA-DQ2

HLA-DQ8

30
Q

Is Coeliac disease antibody-mediated or T cell mediated?

A

T cell mediated

31
Q

Gluten specific T cells produce IFgamma which triggers other T cells.

Which T cells are triggered?

What happens?

A

Intraepithelial lymphocytes (CD8+ T cells)

Killing of epithelial cells

32
Q

What will patients with undiagnosed Coeliac disease present with?

A

Abdominal pain

Bloating

Diarrhoea - steatorrhoea

Weight loss

33
Q

What components of epithelial cells atrophy in Coeliac disease?

A

Villi

34
Q

The immune response associated with Coeliac disease ___ the intestinal epithelium.

A

damages

35
Q

Patients with Coeliac disease will have a ___ epithelium on endoscopy.

A

flattened

36
Q

Why do damaged villi and a flattened epithelium, associated with Coeliac disease, cause malnutrition?

A

Loss of villi - less absorption

Smaller surface area - less absorption

37
Q

What structures, usually found between villi on intestinal epithelium, are the only things visible on someone with damaged epithelium due to Coeliac disease?

A

Crypts

38
Q

Coeliac disease is caused by an adaptive T-cell mediated reaction to gluten.

Which genes are responsible for the protein which activates the T cells?

A

HLA-DQ2 / HLA-DQ8

39
Q

How do you treat Coeliac disease?

A

Stop eating gluten

the gut then returns to normal

40
Q

How is Coeliac disease diagnosed?

A

Positive tTG-IgA antibody test with the patient still eating gluten

Then positive biopsy (flattened epithelium)

41
Q

What is the usual method of diagnosing Coeliac disease?

Who’s excluded from this?

A

Biopsy to confirm damage to small intestine

Children

42
Q

What are the symptoms of Coeliac disease?

A

Weight loss

Anaemia

Diarrhoea - steatorrhoea

Abdominal pain

Bloating

i.e all of them, impossible to do serology on ALL of these people

43
Q

Which test is done to confirm Coeliac disease instead of biopsying or doing serology on every patient who has GI symptoms?

A

tTG-IgA test

tissue transglutaminase test

44
Q

Under what circumstances will the IgA autoantibody test give a false negative?

A

If the patient is complying with “no gluten” before they’re officially diagnosed

catch 22 because you can only be formally diagnosed if you eat gluten, which causes your symptoms

45
Q

What is the gold standard method of diagnosing Coeliac disease?

A

Duodenal biopsy

AFTER positive tTG-IgA test

46
Q

Why may a person with diagnosed Coeliac disease experience symptoms again?

A

Non-compliance with gluten-free diet

47
Q

Which enzyme modulates gluten when it enters the gut to form a complex with it?

A

Tissue transglutaminase

48
Q

Are B cells specific for the gluten itself or tTG enzyme which has formed a complex with it?

A

tTG

49
Q

The more gluten you eat, the more ___ that will be presented to B cells and the more epithelial damage which will be done.

A

tTG

50
Q

Which inflammatory bowel disease can appear anywhere from the rectum to the mouth?

A

Crohn’s disease

51
Q

What inflammatory bowel disease tends to move progressively from the rectum up the GI tract?

A

Ulcerative colitis

Gastrointestinal Week 2 2016/17 (7 decks)

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