Antibodies as diagnostic tools Flashcards

1
Q

Describe the immunology department

A

88 tests listed

57 of these detect specific antibodies

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2
Q

Describe the structure of antibodies

A

Fc: constant part of antigens don’t change so can attach other groups without affecting ability to bind to antigen
Fab: is variable and produces specificity to antigen

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3
Q

What can be added to the Fc region of the antibody

A

antibodies can be raised against almost ANY antigen.
 The Fc-region is constant – this is where you attach molecules (reporters) and you don’t affect the specificity of the antibody.
 Reporters or drugs:
o Enzymes – e.g. peroxidase, alkaline phosphatase.
 Antigens washed over antibodies with enzyme, colourless substrate is then added which turns colour.
o Fluorescent probes – e.g. dyes and beads of various size.
o Magnetic beads – e.g. purification of cell types.
 Magnet-antibody attaches to receptor and then run sample over a magnet and only linked-cells bind.
o Drugs – e.g. Kadcyla, anti-HER2 linked to emtansine.

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4
Q

What colour does peroxidase stain

A

Brown

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5
Q

What is the purpose of using fluorescent probes of different sizes

A

Fluorecent probes- muitiplexing- different sizes

screen for different antibodies

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6
Q

Summarise the use of antibodies in diagnostics

A

The unique specificity of antibodies for their target antigens is the basis of many diagnostic tests

Antibodies can be raised against almost any antigen (often but not always proteins)
Including immunoglobulins from other species
=anti-antibodies

Antibodies can be made against DNA or phospholipid

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7
Q

Describe indirect labelling using an anti anti-body

A

 Use of an anti-antibody to detect existing antibodies in the body.
 Antibodies:
o Produced by patient – for autoimmune disease OR defence against infection.
o Produced artificially – antisera from immunised animals (polyclonal – have many specificities), monoclonal antibodies and genetically engineered antibodies.

Secondary Ab with reporter molecule attached
secondary Ab bound to primary Ab- which is bound to antigen

Single secondary Ab tod etect many bound primary antibodies

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8
Q

Where do the antibodies come from

A

Produced by the patient
in autoimmune disease
for defence against infection
and in Billy’s case, used to diagnose his infection

Manufactured antibodies
antisera from immunised animals (polyclonal)
monoclonal antibodies
“genetically engineered” antibodies

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9
Q

Describe the use of genetic engineering

A

G.E- DNA sequence to make libraries of antibodies

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10
Q

Describe antisera

A

Natural- polyclonal – anti-serum with a mix of different antibodies – tetanus to immunize horses- anti-sera to treat patients with tetanus- but only a limited supply of antibody- can’t be used for vast majorirty of diagnostic tests- use mAbs- can make a large amount and of single specificity

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11
Q

Describe the process of generating monoclonal antibodies

A

Challenge mouse with antigen you want to make antibody against
Harvest B cells from mice which produce Ab
Fuse with immortal myeloma cells
This forms a hybridoma
Culture in HAT medium (ultra-medium which only allows hybridomas to grow)
Select for positive cell

Clone by limiting dilution
Limiting dilution- one cell in each well –let expand- screen supernatants for antibodies

Harvest monoclonal antibodies
Grow antibody infedinitley

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12
Q

Describe the production of antibodies using recombinant DNA technology

A

Population of genes encoding Ab variable regions isolated
Variable region gene fused with bacteriophage coat protein gene
Random population of variable region bacteriophages are cloned - a phage display library
Phages that bind to specific antigen are selected

Phage display library- expressed on surface

Wash overs other- multiply cycles ot enrich phage
Can be expanded massively by growing in bacteria

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13
Q

Describe the therapeutic use of manufactured antibodies

A

Therapeutic

Prophylactic protection against microbial infection -e.g. IVIG, synagis (anti-RSV)- IVIG- polyclonal- purified from many different patients
RSV- babies at risk

Anti-cancer therapy- anti-HER2

Removal of T-cells from bone marrow grafts - ANTI-cd3

Block cytokine activity - anti-TNFa- used in rheumatoid arthritis

Anti-calcitonin gene-related peptide (CGRP) for migraine

recently against myeloid protein

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14
Q

What is the issue with the therapeutic use of mAbs

A

Very expensive- volatile and need rigorous quality control

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15
Q

Name the therapeutic monoclonal antibodies

A

 Therapeutic:
o Prophylactic against microbial infection – e.g. Synagis (anti-RSV).
 Suffix “-umab” – human – e.g. Synagis (anti-RSV).
o Anti-cancer therapy – e.g. anti-HER2.
o Removal of T-cells (bone marrow transplant) – e.g. anti-CD3.
 Suffix “-omab” – mouse monoclonal – e.g. anti-CD3.
o Block cytokine activity – e.g. anti-TNF-alpha.
 Suffix “imab” – chimeric/partly humanised – e.g. anti-TNF-alpha

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16
Q

Describe the diagnostic use of monoclonal antibodies

A
Diagnostic
Blood group serology
Quantitative immunoassays 
hormones
antibodies
antigens
Immunodiagnosis
Infectious diseases
Autoimmunity
Allergy (IgE)
Malignancy (myeloma)
17
Q

Describe the process of ELISA in HIV

A

Partially purified, inactivated HIV antigens pre-coated onto an ELISA plate
Patient serum which contains antibodies. If the patient is HIV+, then this serum will contain antibodies to HIV, and those antibodies will bind to the HIV antigens on the plate.
Anti-human immunoglobulin coupled to an enzyme. This is the second antibody, and it binds to human antibodies.
Chromogen or substrate which changes color when cleaved by the enzyme attached to the second antibody.

18
Q

Describe the general process of ELISA

A

ELISA: Enzyme Linked ImmunoSorbant Assay
Capture antibody fixed to plate
Test sample containing target antigen added
Target antigen binds to capture antibody and excess washed away
Detection antibody with enzyme on Fc added to dish
Detection antibody binds to target antigen and excess washed
Clear solution added and enzyme on Fc converts to coloured

Binds to different place to first antibody
Signal proportional to amount of antigen in sample-quantitative

Inflamamtory markers in patients

19
Q

Describe some potential errors in ELISA

A

It is entirely possible that an individual not infected with HIV has antibodies which may give a positive result in the HIV ELISA. This is called a false positive. One reason for this is that people (especially women who have had multiple pregnancies) may possess antibodies directed against human leukocyte antigens (HLA) which are present on the host cells used to propagate HIV. As HIV buds from the surface of the host cell, it incorporates some of the host cell HLA into its envelope. False negatives can occur during the window between infection and an antibody response to the virus (seroconversion).

20
Q

Describe rapid testing

A

Test sample added to sample pad, and runs over antibodies conjugated to gold nanoparticles
Ag-Ab complexes run along pad, binding to test line if positive and control line in all cases to ensure validity

21
Q

How can an individual have anti-HIV antibodies without being infected with HIV

A

Mother hIV psotivie- IgG antibodies will cross placenta to fetus
 To diagnose HIV, you can have an HIV-antibody test. You may have anti-HIV antibodies but NOT HIV if:
o Maternal antibodies.
o Volunteers in clinical trials.

22
Q

Describe Billy’s symptoms

A

Signs & Symptoms
Vague aches and pains

Loss of appetite
Weight loss

“Glands” up in his neck

Fever, rash, small red patches, some lumpy

23
Q

Describe the immunological concerns we have for Billy

A

Immune complexes

Effect of poor nutrition on bone marrow cells

Immune activation

Acute phase, activation, immune complexes

24
Q

What is causing Billy’s symptoms

A
Signs and symptoms – Immunological concerns
Immune complexes
Inflammation / complement activation
Serum sickness (immune complexes in circulation)
Immune complex glomerulonephritis
Immune complex deposition at other sites
Skin 
Joints
Lungs
25
Q

Describe the formation of immune complexes

A

Antigen in excess- small immune complexes- not efficient at activting complement
But once membrane-bound- activate complement- get inflammation in vessels

Big problem in the kidney

Can use immunofluorescence to stain for IgG immune complexes and complement C3

26
Q

What are our immunological concerns

A

Serum Immunoglobulin levels
IgG, IgM, IgA and IgG1, IgG2, IgG3, IgG4
(Serum electrophoresis / ELISA / Nephelometry)
Specific Antibodies (ELISA)

Protein antigens – Tetanus & Haemophilus
Polysaccharides antigens – Pneumococcus- see if vaccines have worked

Lymphocyte subsets	(Flow Cytometry)
CD3 / CD4 / CD8 / CD19 / NK cells - anti-bodies against cell markers
27
Q

Summarise immune complexes

A

 Large immune complexes – recognised more easily by the immune system and cleared quickly.
o Activate platelets and neutrophils that release mediators.
 Small immune complexes – get trapped in sub-endothelial layer.
o Can activate complement when stuck to the surface and so attract neutrophils that can damage kidney function.

28
Q

Describe serum electrophoresis

A

 In a healthy person, smear at top is gamma globulin region.
 It is diffuse due to a varying range of antibodies.
 In someone with an active immune response, this region becomes darker due to more gamma globulins.
 If you see a single sharp band, this indicates a monoclonal expansion of b-cells – e.g. myeloma

Smear- different specificitiy of antibodies

Single band- monoclonal expansion- myeloma- bone marrow aspirate- will see immature cells

29
Q

Describe the markers for the different lymphocyte populations

A
Lymphocyte subpopulations
CD3+   T cells – pan T cell marker
CD4+   T cells – T helper/cells
CD8+   T cells – cytotoxic T cells
CD19+   B cells
CD56+    Natural Killer (NK) Cells
30
Q

Describe flow cytometry

A

 To measure cell populations, you attach different monoclonal antibodies with fluorescent dyes attached to them to each cell type.
 The cells are then passed into a stream through a laser and the dyes are detected and each cell is categorised based on its fluorescence.
 The results are then shown on a flow cytometry graph.

photomultiplier tubes feed to CPU

31
Q

Summarise the HIV infection history

A

 Blue = CD4 T-cell count.
 Red = viral load.
 When CD4 gets very low, the patient will be prone to opportunistic disease and viral load will shoot up.
 Antibody HIV test  Low CD4, high viral load  commence ART (1st line)  monitor CD4/viral load  CD4 down or viral load up  ART (2nd line) increase.
o This increases life expectancy.

32
Q

Describe what happens in HIV

A

Primary infection
CD4 count decreases, viral load increases
rapid increase is acute HIV syndrome- wide dissemination of virus, seeding of lymphoid organs

viral load reaches peak

viral load decreases, cd4 recovers slightly to a peak

clinical latency- virus increases, cd4 decreases, once cd4 decreased enough, rapid increase in viral load – constitutional symptoms, opportunistic disease and death

ART effective at preventing depletion of CD4

33
Q

Describe the importance of CD4

A

CD4 T cell count defines extent of immune damage and predicts short term outlook in ART naïve HIV-1 patients
 This graph shows reducing CD4 and the infections they get at each stage.
 At LOW CD4, you get MAC infections (mycobacterium avium complex) – normal people don’t get this.

34
Q

Describe pneumocystis

A

Pink- exudate in alveolar space- pneumocystic pneumonia

35
Q

Summarise the post-mortem

A

Progressive wasting and weight loss
Presents in A&E with confusion
He dies and has a post mortem
Necrotic haemorrhage

Hospital- can take tissue
Coroner- need permission to take tissu

36
Q

Describe high grade B cell lymphoma

A

Large, irregular nuclei

Associate with HIV and EBV

37
Q

Summarise antibody usage

A

Antibody usage: antibodies are uniquely specific to their target antigen, and can be raised against almost any antigen including Ig from other species