Applied Immunity Flashcards

1
Q

Immunity in the Oral Cavity

The oral cavity is the port of entry for many pathogens, food, and drugs which can trigger an immune response.

___t components: __ ___, ___, ___

____ components: ___ pathogens that colonize the oral cavity

A

Immunity in the Oral Cavity

The oral cavity is the port of entry for many pathogens, food, and drugs which can trigger an immune response.

Transient components: Dead pathogens, allergens, food

Persistent components: Live pathogens that colonize the oral cavity

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2
Q

Oral Cavity

Distinct locations:

Tooth surface, tongue, oral mucosa gingival crevices have selective immune responses

Distinct inductive sites: ___ ___

Two distinct effector sites:

  • ___ ___
  • ___ ___ ___

Pathogens have developed mechanisms to subvert or inactivate the host immune system

Unchecked growth of pathogens can lead to deterioration or loss of oral function

A

Oral Cavity

Distinct locations:

Tooth surface, tongue, oral mucosa gingival crevices have selective immune responses

Distinct inductive sites: Waldeyer’s ring

Two distinct effector sites:

Salivary glands

Gingival lamina propria

Pathogens have developed mechanisms to subvert or inactivate the host immune system

Unchecked growth of pathogens can lead to deterioration or loss of oral function

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3
Q

NALT: Inductive and Effector Sites

Inductor Sites represented by various tonsils. You have M cells to transport Ag to be processed by dendritic cells or macrophages. When those are activated, they migrate to the lymph nodes where they activate and cause differentiation of B and T cells.

They move to effector sites.

A

NALT: Inductive and Effector Sites

Inductor Sites represented by various tonsils. You have M cells to transport Ag to be processed by dendritic cells or macrophages. When those are activated, they migrate to the lymph nodes where they activate and cause differentiation of B and T cells.

They move to effector sites.

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4
Q

NALT Tissue: Waldeyer’s Ring

Named after the nineteenth century Heinrich Wilhelm Gottfried von Waldeyer-Hartz (German anatomist)

Consists of the lymphoid tissue on the __ of the tongue (___ tonsil), ___ (____) tonsils, the ____(____ tonsil), and the ___ tonsils (located bilaterally, where each Eustachian tube opens into the nasopharynx)

___ __in the lymphatic system that ___ and ___ to airborne and alimentary antigens

Tonsillectomies and/or adenoidectomies are indicated for children with impaired breathing through the ___ (i.e. sleep apnea), chronic upper __ __ infections, or recurrent ____

Ring of lymphoid tissue that surrounds ___ and ___ ___

A

NALT Tissue: Waldeyer’s Ring

Named after the nineteenth century Heinrich Wilhelm Gottfried von Waldeyer-Hartz (German anatomist)

Consists of the lymphoid tissue on the base of the tongue (lingual tonsil), two (palatine) tonsils, the adenoids (nasopharyngeal tonsil), and the tubal tonsils (located bilaterally, where each Eustachian tube opens into the nasopharynx)

First organs in the lymphatic system that analyze and react to airborne and alimentary antigens

Tonsillectomies and/or adenoidectomies are indicated for children with impaired breathing through the nose (i.e. sleep apnea), chronic upper respiratory tract infections, or recurrent earaches

Ring of lymphoid tissue that surrounds respiratory and alimentary tracts

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5
Q

Unique Defense Mechanisms in the Oral Cavity

In addition to normal tissue responses to infections, the oral cavity has two important biologic fluids which help prevent microorganisms from entering through the oral cavity:

  • ___
    • ___ ____ (Ab)
    • ___ Immunity
  • ___ __ __
    • ___ ___(Ab)
    • ___ Immunity
      *
A

Unique Defense Mechanisms in the Oral Cavity

In addition to normal tissue responses to infections, the oral cavity has two important biologic fluids which help prevent microorganisms from entering through the oral cavity:Saliva

Mucosal sIgA

Mucosal Immunity

Gingival Crevicular Fluid (GCF)

Blood plasma IgG

Systemic Immunity

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6
Q

Anti-microbial Components in Saliva

Antibodies: ____ Defense

Bind Bacteria

Calprotectin: Innate Defense

Chelates Zn and Ca to inhibit growth

Cystatins: Innate Defense

Inhibit ___ ___

Defensins: Innate Defense

___ mediated disruption of membrane

Histatins: Innate Defense

____

Lactoferrin: Innate Defense

Binds __ to inhibit growth

Lysozyme: Innate Defense

___

Mucins: Innate Defense

___ and aggregate microbe

PRP: Innate Defense

__ Bacteria

Statherin: Innate Defense

___ Bacteria

A

Anti-microbial Components in Saliva

Antibodies: Acquired Defense

Bind Bacteria

Calprotectin: Innate Defense

Chelates Zn and Ca to inhibit growth

Cystatins: Innate Defense

Inhibit Cysteine proteases

Defensins: Innate Defense

Charge mediated disruption of membrane

Histatins: Innate Defense

Antifungal

Lactoferrin: Innate Defense

Binds Fe to inhibit growth

Lysozyme: Innate Defense

Lyses

Mucins: Innate Defense

Entrap and aggregate microbe

PRP: Innate Defense

Bind Bacteria

Statherin: Innate Defense

Bind Bacteria

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7
Q

Calprotectin

  • ___ ___
  • Bacterial ___ ____ depend on ___ for ___
    • àSensitivity to___
  • Abundant in ____
  • Sucks up Mn in environment so the SODs are inactive and bacteria more sensitive to ROS
  • Marker of____ in IBD
  • Increase Calprotectin à_____inflammation à Increased disease activity
    *
A

Calprotectin

Metal chelator

Bacterial superoxide dismutases (SODs) depend on Mn2+ for activityàSensitivity to ROS

Abundant in neutrophils

Sucks up Mn in environment so the SODs are inactive and bacteria more sensitive to ROS

Marker of inflammation in IBD

Increase Calprotectin à Increased inflammation à Increased disease activity

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8
Q

Specific Immune Components in Saliva

Secretory IgA (mucosal immune system)

  • Found as a dimer connected by a “J” chain
  • Contains a secretory component (“Sc” protein)
  • Secreted by __ ___ in ___ ____
  • Acts as a specific agglutinin of bacteria or fungus
  • Prevents bacterial ____ to host cells or salivary ____
  • Does not bind ___ and does not ___ bacteria well
    *
A

Specific Immune Components in Saliva

Secretory IgA (mucosal immune system)

Found as a dimer connected by a “J” chain

Contains a secretory component (“Sc” protein)

Secreted by Plasma cells in Salivary Glands

Acts as a specific agglutinin of bacteria or fungus

Prevents bacterial adhesion to host cells or salivary pellicle

Does not bind complement and does not opsonize bacteria well

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9
Q

Gingival Crevicular Fluid (GCF)

Is a __ ___or___ ___ derived from periodontal tissues that is found in the ___ ___

GCF contains molecules found in ___, the ___ ___, and in the ___

Contains:

___ Epithelial Cells

Leukocytes (predominately ____)

Host ____ (Collagenase, Elastase)

____ Components

_____ (IL-1, IL-8, TNF)

Immunoglobulins (IgG, IgA)

____ Acid metabolites

Prostaglandins

Leukotrienes

Other host proteins

A

Gingival Crevicular Fluid (GCF)

Is a serum transudate or inflammatory exudate derived from periodontal tissues that is found in the gingival sulcus

GCF contains molecules found in serum, the periodontal tissues, and in the sulcus

Contains:

Shed Epithelial Cells

Leukocytes (predominately Neutrophils)

Host Enzymes (Collagenase, Elastase)

Complement Components

Cytokines (IL-1, IL-8, TNF)

Immunoglobulins (IgG, IgA)

Arachidonic Acid metabolites

Prostaglandins

Leukotrienes

Other host proteins

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10
Q

The Gut is Bombarded by Foreign Antigens

A

The Gut is Bombarded by Foreign Antigens

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11
Q

Host needs to have a Balance between Respond and Don’t Respond

Respond: Fight and Eradicate Pathogens

Ignore: Self, Food

A

Host needs to have a Balance between Respond and Don’t Respond

Respond: Fight and Eradicate Pathogens

Ignore: Self, Food

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12
Q

Antigenic Challenge and Immune Responses in Mucosal Immunity

The context in which peptide antigen is presented to T lymphocytes in the mucosal immune system is important.

In the absence of inflammation and co-stimulation, presentation of peptide to T cells by MHC molecules on antigen presenting cells induces ____

In the presence of inflammation and pathogenic microorganisms in the tissues, the maturation and expression of co-stimulatory molecules on antigen presenting cells is stimulated. Antigen presentation to T cells under these conditions favors development of a _____ ____ ____

A

Antigenic Challenge and Immune Responses in Mucosal Immunity

The context in which peptide antigen is presented to T lymphocytes in the mucosal immune system is important.

In the absence of inflammation and co-stimulation, presentation of peptide to T cells by MHC molecules on antigen presenting cells induces tolerance.

In the presence of inflammation and pathogenic microorganisms in the tissues, the maturation and expression of co-stimulatory molecules on antigen presenting cells is stimulated. Antigen presentation to T cells under these conditions favors development of a protective TH1 response.

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13
Q

Oral Tolerance

Oral tolerance is

A general _____ state in the oral mucosa to prevent reaction to ____ Ags such as commensals or foods

The generation of systemic immune unresponsiveness by feeding of ____

Necessary to prevent excessive response to normal flora and food antigens

A

Oral Tolerance

Oral tolerance is

A general immunosuppressive state in the oral mucosa to prevent reaction to harmless Ags such as commensals or foods

The generation of systemic immune unresponsiveness by feeding of antigen

Necessary to prevent excessive response to normal flora and food antigens

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14
Q

Biological variables that influence the immunophenotype

Many factors determine whether you have ___ ___ or __ __

A

Biological variables that influence the immunophenotype

Many factors determine whether you have immune response or oral tolerance

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15
Q

Protective Immunity Versus Tolerance

  • Protective Immunity ,Oral Tolerance
  • Ag:
    • Invasive Pathogens
    • Food, commensals
  • Ig Production
    • ___ ___, ___ Ab present in serum
    • ____ local IgA, ___ or ___ Ab serum
  • T Cell Response
    • Local and systemic ___ and___ T cells
    • ___ local effector T cell response
  • Response to Ag Reexposure
    • Enhanced (____) Response
    • __or __ response
      *
A

Protective Immunity Versus Tolerance

Protective Immunity

Oral Tolerance

Ag

Invasive Pathogens

Food, commensals

Ig Production

Intestinal IgA

Specific Ab present in serum

Some local IgA

Low or no Ab serum

T Cell Response

Local and systemic effector and memory T cells

No local effector T cell response

Response to Ag Reexposure

Enhanced (memory) Response

Low or no response

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16
Q

Experimental Demonstration of Oral Tolerance

Humoral Response

Mice fed Ag A. They were then challenged with that Ag via an injection 7 days later. Then mice were sacrified. Response to Ag was assessed via Ab production.

Fed nothing and challenged with Aà __ ___ response to A

Fed B and then challenged with Aà __ response

Fed A and then challenged with Aà ____ Ab response

Control: fed A and challenged with Bà ___ Ab response to A

A

Experimental Demonstration of Oral Tolerance

Humoral Response

Mice fed Ag A. They were then challenged with that Ag via an injection 7 days later. Then mice were sacrified. Response to Ag when assessed via Ab production.

Fed nothing and challenged with Aà Distinct Ab response to A

Fed B and then challenged with Aà Ab response

Fed A and then challenged with Aà reduced Ab response

Control: fed A and challenged with Bà no Ab response to A

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17
Q

Experimental Demonstration of Oral Tolerance

Did same experiment but wanted to look at CD4 T cell

Fed Ovalbumin. Challenge with Ovalbumin

Mice that were fed Ovalbumin and then challenged with Ovalbumin had ____ response.

If not fed Ovalbumin, you had ___ response (CD4 T cells ___to Ovalbumin)

A

Experimental Demonstration of Oral Tolerance

Did same experiment but wanted to look at CD4 T cell

Fed Ovalbumin. Challenge with Ovalbumin

Mice that were fed Ovalbumin and then challenged with Ovalbumin had a low response.

If not fed Ovalbumin, you had High response (CD4 T cells specific to Ovalbumin)

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18
Q

Oral Tolerance can be _____

Cell Mediated Portion of Response

Fed mouse with Ag A.

Took ___ ___ from the cells and transferred it to another mouse

Wanted to see if immune response/tolerance could be transferred by immune cell

Challenged second mouse with A

Conclusion: if you transferred T cells from mouse that were previously fed the Ag, the T cell oral tolerance could be transferred along with the cells.

A

Oral Tolerance can be Transferred

Cell Mediated Portion of Response

Fed mouse with Ag A.

Took bone marrow from the cells and transferred it to another mouse

Wanted to see if immune response/tolerance could be transferred by immune cell

Challenged second mouse with A

Conclusion: if you transferred T cells from mouse that were previously fed the Ag, the T cell oral tolerance could be transferred along with the cells.

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19
Q

Oral Tolerance can be ___ / ____

Depends on microenvironment around it

Feed mouse Ag with IFN Gamma (____ ____), it would ____tolerance.

Feed mouse Ag with IL10 or TGFB (____ ___), it would ____ your tolerance

A

Oral Tolerance can be Enhanced/ Reduced

Depends on microenvironment around it

Feed mouse Ag with IFN Gamma (pro-inflammatory cytokine), it would reduce tolerance.

Feed mouse Ag with IL10 or TGFB (anti-inflammatory cytokine), it would increase your tolerance

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20
Q

Oral Tolerance Mechanism

____

Induction of ___ ___

Induction of ____ ___

Induction of ___ ___ ___ which produce_____ cytokines

A

Oral Tolerance Mechanism

Ignorance

Induction of clonal anergy

Induction of clonal deletion

Induction of T regulatory cells which produce suppressor cytokines

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21
Q

Ignorance

  • There are T cells and B cells specific for _____ present in circulation.
  • These cells are quite ___ of making a response but are ____ of the presence of their auto-antigen.
  • Why?
  • 1.Antigen____ is too ___-lymphocytes have a threshold for receptor occupancy which is required to trigger a response
  • 2.Antigens are ____ from the immune system in locations which are not freely____ to surveillance- immunologically ____ sites Barriers
  • a)Potential____ ramifications if barriers disrupted
    *
A

Ignorance

There are T cells and B cells specific for auto-antigens present in circulation.

These cells are quite capable of making a response but are unaware of the presence of their auto-antigen.

Why?

  1. Antigen concentration is too low-lymphocytes have a threshold for receptor occupancy which is required to trigger a response
  2. Antigens are sequestered from the immune system in locations which are not freely exposed to surveillance- immunologically privileged sites Barriers
    a) Potential autoimmune ramifications if barriers disrupted
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22
Q

High vs. Low Dose Tolerance

That will influence how mechanism of tolerance works

High Dose: Induce ___ or ____ of T cell that recognizes that ___

Low Dose: Favor product of __ _____ (______)

A

High vs. Low Dose Tolerance

That will influence how mechanism of tolerance works

High Dose: Induce Anergy or deletion of T cell that recognizes that Ag

Low Dose: Favor product of T regulatory cells (immunosuppressive)

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23
Q

Oral Tolerance Summary

Oral tolerance is a specific mechanism

Clonal deletion and regulatory T cells are the primary mechanisms

Breakdown of tolerance can lead to _____ disorders.

A

Oral Tolerance Summary

Oral tolerance is a specific mechanism

Clonal deletion and regulatory T cells are the primary mechanisms

Breakdown of tolerance can lead to autoimmune disorders.

24
Q

Mucosal Immunity: Commensals

  • Microbiota communities affected by
    • Age
    • Location
    • Environmental cues (i.e. antibiotics, diet)
      • Therapy
    • Genetics predisposition
    • Disease vs. health
    • Dynamic communityà Changes thruout life
  • ___ ___ ___ play role in regulating response to commensals
    • IECs deficient in _____ (____ regulator of ____s) show ____cytokines, ____ susceptibility to intestinal inflammation
  • Immune status of host also influences makeup of commensal flora, thereby affecting immune system function
  • IgA-deficient mice have different microbial spp
  • Tbet KO/scid mice have increased “_____” bacteria and ___ symptoms
    *
A

Mucosal Immunity: Commensals

Microbiota communities affected by

Age

Location

Environmental cues (i.e. antibiotics, diet)

Therapy

Genetics predisposition

Disease vs. health

Dynamic communityà Changes thruout life

Intestinal epithelial cells play role in regulating response to commensals

IECs deficient in SIGGIR (negative regulator of TLRs) show increased cytokines, increased susceptibility to intestinal inflammation

Immune status of host also influences makeup of commensal flora, thereby affecting immune system function

IgA-deficient mice have different microbial spp

Tbet KO/scid mice have increased “colitogenic” bacteria and UC symptoms

25
Microbiota changes with life stage Normal weight, Obese, Gastric Bypass Pregnancy Fecal transplant to mice from pregnant women 1st trimester: mouse\_\_\_ weight 3rd trimester: mouse ____ and developed ___ \_\_\_
Microbiota changes with life stage Normal weight, Obese, Gastric Bypass Pregnancy Fecal transplant to mice from pregnant women 1st trimester: mouse normal weight 3rd trimester: mouse fatter and developed insulin desensitization
26
Specific commensals determine ___ vs. \_\_\_\_ Differentiation of lamina propria T cells into ____ vs \_\_\_\_cells is determined by flora Bacterial DNA signals through TLR9 to suppress Treg conversion, acts as a “natural adjuvant” (Hall, Immunity 2008) Specific types of flora promote Th17 vs Treg development in the intestine (Ivanov, Cell Host & Microbe, 2008)
Specific commensals determine inflammation vs. suppression Differentiation of lamina propria T cells into Treg vs Th17 cells is determined by flora Bacterial DNA signals through TLR9 to suppress Treg conversion, acts as a “natural adjuvant” (Hall, Immunity 2008) Specific types of flora promote Th17 vs Treg development in the intestine (Ivanov, Cell Host & Microbe, 2008)
27
Breakdown of oral tolerance Immune responses to food leads to\_\_ \_\_\_ e.g. celiac disease Immune responses to\_\_\_ \_\_\_eads to ___ \_\_\_ \_\_\_ Crohn’s disease Ulcerative colitis
Breakdown of oral tolerance Immune responses to food leads to food intolerance e.g. celiac disease Immune responses to commensal bacterialeads to inflammatory bowel disease (IBD) Crohn’s disease Ulcerative colitis
28
Diseases of the Intestinal Immune System Caused by: Failure to ____ oral tolerance or Food Allergies Failure to ____ oral tolerance
Diseases of the Intestinal Immune System Caused by: Failure to establish oral tolerance or Food Allergies Failure to maintain oral tolerance
29
Food Allergies Failure to establish tolerance Production of __ to an antigen (allergen) which is then encountered again 2-4% of children and fewer adults suffer Sensitive patients are usually atopic Treatment is simple; avoidance and replacement
Food Allergies Failure to establish tolerance Production of IgE to an antigen (allergen) which is then encountered again 2-4% of children and fewer adults suffer Sensitive patients are usually atopic Treatment is simple; avoidance and replacement
30
Classification of adverse reactions to foods Non immune mediated (\_\_\_ \_\_\_) and immune mediated (\_\_\_ \_\_\_)
Classification of adverse reactions to foods Non immune mediated (food intolerance) and immune mediated (food allergy)
31
Common Food Allergies Allergen Source Antigen M Codfish Tropomysin Shrimp \_\_\_\_\_ Peanuts Trypsin inhibitor Soybean
Common Food Allergies Allergen Source Antigen M Codfish Tropomysin Shrimp Peanut I Peanuts Trypsin inhibitor Soybean
32
Allergic Responses \_\_\_\_\_ of IgE on cells by food \_\_\_ Activation of ___ \_\_\_ \_\_\_ Release of\_\_\_\_ mediators which cause * Transepithelial __ \_\_\_\_ * ____ muscle \_\_\_\_ * ___ and \_\_\_ * \_\_\_\_
Allergic Responses Crosslinking of IgE on cells by food Ag Activation of mucosal mast cells Release of inflammatory mediators which cause Transepithelial fluid loss Smooth muscle contraction Vomiting and diarrhea Anaphylaxis
33
Celiac Disease (Gluten-Sensitive Enteropathy) Hypersensitivity to ___ \_\_\_, especially gliadin of wheat gluten 1 to 35 people affected per 10,000 Geographical differences Genetic predisposition (\_\_\_\_\_ allele in ~90% of patients; HLA DQ8 allele in ~8%) Villous atrophy in ___ \_\_\_ Mal\_\_\_\_\_ Treatment is modified diet and avoidance
Celiac Disease (Gluten-Sensitive Enteropathy) Hypersensitivity to cereal grain, especially gliadin of wheat gluten 1 to 35 people affected per 10,000 Geographical differences Genetic predisposition (HLA DQ2 allele in ~90% of patients; HLA DQ8 allele in ~8%) Villous atrophy in small intestine Malabsorption Treatment is modified diet and avoidance
34
Inflammatory Bowel Disease * _____ of oral tolerance * Chronic ____ and remitting inflammatory disorders of ____ etiology * ___ \_\_\_ (UC) affects colon * To treat, remove the colon * ___ \_\_\_ (CD) affects entire GI * Incidence of 1 in 600 and \_\_\_\_ * \>8,000 new cases of IBD /year * \>130,000 affected people in UK. * Age range 15-35 * Symptoms include pain, ___ diarrhea, \_\_\_\_ * Some ___ manifestations * Egzma or Alzheimer * No\_\_\_ for CD *
Inflammatory Bowel Disease Breakdown of oral tolerance Chronic relapsing and remitting inflammatory disorders of unknown etiology Ulcerative colitis (UC) affects colon To treat, remove the colon Crohn’s disease (CD) affects entire GI Incidence of 1 in 600 and increasing \>8,000 new cases of IBD /year \>130,000 affected people in UK. Age range 15-35 Symptoms include pain, bloody diarrhea, ulcers Some extraintestinal manifestations Egzma or Alzheimer No cure for CD
35
IBD is a complex disease Has influences from \_\_\_\_, ___ of the host, ___ and defective immune \_\_\_\_
IBD is a complex disease Has influences from microbiome, genetics of the host, environment and defective immune regulation.
36
Immunopathogenesis of IBD \_\_\_\_ disorder,\_\_\_\_\_ inflammatory response Mechanisms of epithelial cell injury unknown \_\_\_\_T cell-mediated \_\_\_ __ \_\_\_are an initiating stimulus
Immunopathogenesis of IBD Autoimmune disorder, uncontrolled inflammatory response Mechanisms of epithelial cell injury unknown CD4+T cell-mediated Commensal gut flora are an initiating stimulus
37
Autophagy in Crohn’s Disease 2 genes implicated in chrons are ATG16L1 and NOD 2. These are important for ___ \_\_\_ in the host. In CD, they don’t recognize bacteria as well
Autophagy in Crohn’s Disease 2 genes implicated in chrons are ATG16L1 and NOD 2. These are important for sensing bacteria in the host. In CD, they don’t recognize bacteria as well
38
Oral Manifestations of UC and CD \_\_\_ of \_\_\_ \_\_\_\_ \_\_\_ \_\_\_
Oral Manifestations of UC and CD Swelling of Lips, Ulcers and Mucosal Tags
39
Antibiotic induced Gastrointestinal Disease Be careful taking Ab: Ab resistance and affecting host system Can kill off commensals
Antibiotic induced Gastrointestinal Disease Be careful taking Ab: Ab resistance and affecting host system Can kill off commensals
40
ANTIBIOTICS PREDISPOSE GI DISEASAE FREQUENTLY \_\_\_\_ \_\_\_ RARELY \_\_\_ \_\_\_
ANTIBIOTICS PREDISPOSE GI DISEASAE FREQUENTLY Ampicillin “cillins” Cephalosporin RARELY Aminoglycosides METRONIDAZOLE
41
Important Diseases involving the Oral Cavity Infections Bacterial (\>\_\_\_% of oral disease) Periodontal Disease Dental Caries Viral Herpes Herpes labalis Herpetic gingivostomatiis Kaposi’s Sarcoma Epstein-Barr * “Oral ___ \_\_\_\_” in immunodeficient patients HIV FungalOral Candidiasis Common in immunocompromised patients
Important Diseases involving the Oral Cavity Infections Bacterial (\>95% of oral disease) Periodontal Disease Dental Caries ViralHerpes Herpes labalis Herpetic gingivostomatiis Kaposi’s Sarcoma Epstein-Barr “Oral Hairy leukoplakia” in immunodeficient patients HIV FungalOral Candidiasis Common in immunocompromised patients
42
Periodontal Disease: Immune Component \_\_\_\_ in host or establishment of ____ pathogen in the gum lining cause an inflammatory response that’s started by ___ and ____ that are recruited to the site and then release chemokines IL8, L1, TNF alpha
Periodontal Disease: Immune Component Predisposition in host or establishment of ketone pathogen in the gum lining cause an inflammatory response that’s started by neutrophils and macrophages that are recruited to the site and then release chemokines IL8, L1, TNF alpha
43
Periodontal Disease: RANKL vs. OPG Initiation of RANKL-RANK pathway promotes \_\_\_\_ Osteoprotegerin (OPG) is a ___ \_\_\_ of RANK( Receptor for Rank Ligand) When RANK ligand binds RANK it causes preosteoclasts to differentiate into activeosteoclasts which promote\_\_\_ \_\_\_ \_\_\_ cells release \_\_\_. This increases amt of RANKL which will promote tissue destruction and ___ \_\_\_ Balance bw RANKL and OBG controls bone resorption in perio disease
Periodontal Disease: RANKL vs. OPG Initiation of RANKL-RANK pathway promotes osteoclastogenesis Osteoprotegerin (OPG) is a competitive inhibitor of RANK( Receptor for Rank Ligand) When RANK ligand binds RANK it causes preosteoclasts to differentiate into activeosteoclasts which promote bone breakdown Th17 cells release RANKL. This increases amt of RANKL which will promote tissue destruction and bone loss Balance bw RANKL and OBG controls bone resorption in perio disease
44
Cytokines and Periodontal Disease \_\_\_ and ___ promote expression of RANKL \_\_\_ and ___ secrete IL4 and IL10 that block this effect.
Cytokines and Periodontal Disease Th1 and Th17 promote expression of RANKL Th2 and Treg secrete IL4 and IL10 that block this effect.
45
Clodronate liposome ___ macrophages (Mj) by inducing \_\_\_ Experimental techniques to study macrophages Clodronate is toxic chemical. When macrophages phagocytose the clodronate, they die.
Clodronate liposome deplete macrophages (Mj) by inducing apoptosis Experimental techniques to study macrophages Clodronate is toxic chemical. When macrophages phagocytose the clodronate, they die.
46
Inject mice with P. gingivalis and looked at response of macrophages in oral tissue Experiment 1 Give mice Pg in oral cavity. Get ___ in macrophages in oral cavity Intraoral infection with P. gingivalis attracts \_\_\_\_ Experiment 2 Clodronate ___ Mj response to P. gingivalis infection What happens if you clodronate to remove macrophages. Treat with clodronate liposomes and Pg, you don’t get ___ in macrophages (Same for IV or S.C treatment)
Inject mice with P. gingivalis and looked at response of macrophages in oral tissue Experiment 1 Give mice Pg in oral cavity. Get increase in macrophages in oral cavity Intraoral infection with P. gingivalis attracts Mj Experiment 2 Clodronate subverts Mj response to P. gingivalis infection What happens if you clodronate to remove macrophages. Treat with clodronate liposomes and Pg, you don’t get increase in macrophages (Same for IV or S.C treatment)
47
Bone resorption ___ with Mj (Macrophage) depletion When macrophages die/deplete there is less bone resorption NO PGING --\> ___ bone resporbtion PGINGIVITIS --\> bone resorbtion If you eliminate the macrophages with clodronate, you ___ get the bone resorption MACROPHAGES NORMALLY ____ \_\_\_ \_\_\_\_
Bone resorption decreased with Mj (Macrophage) depletion When macrophages die/deplete there is less bone resorption NO PGING à no bone resporbtion PGINGIVITIS à bone resorbtion If you eliminate the macrophages with clodronate, you don’t get the bone resorption MACROPHAGES NORMALLY STIMULATE BONE RESORBTION
48
Bone resorption correlates with ___ \_\_\_ Greater Bacterial load you have, the ___ BR you have
Bone resorption correlates with bacterial load Greater Bacterial load you have, the greater BR you have
49
P. gingivalis infection promotes ___ Mj accumulation Remember you have multiple subtypes of macrophages M1:\_\_\_\_\_\_
P. gingivalis infection promotes M1 Mj accumulation Remember you have multiple subtypes of macrophages M1: Pro-inflammatory
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While the Arachidonic Pathway drives Inflammation,\_\_\_ \_\_\_\_, and \_\_\_\_mediate ____ of Inflammation R, L and P discourage\_\_\_ \_\_\_n but encourage ___ \_\_\_\_ Knock out any of these and you can get failed ____ and continued \_\_\_\_
While the Arachidonic Pathway drives Inflammation, Resolvins, Lipoxins, and Protectins mediate Resolution of Inflammation R, L and P discourage neutrophil infiltration but encourage monocyte recruitment Knock out any of these and you can get failed resolution and continued inflammation
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Resolvins can ____ Periodontitis Skin ligatures tied around teeth of rabbit. Then inoculate with Pg in vehile or Pg in resolvin. Vehicle: ___ \_\_\_ and ___ \_\_\_ Resolvin: ___ \_\_\_\_ Step further Started with periodontal disease in the rabbits and then treated them to see if it had a therapeutic effect in addition to the preventative effect Resolvin: ___ periodontal health
Resolvins can Prevent Periodontitis Skin ligatures tied around teeth of rabbit. Then inoculate with Pg in vehile or Pg in resolvin. Vehicle: bone loss and gum disease Resolvin: No periodontitis Step further Started with periodontal disease in the rabbits and then treated them to see if it had a therapeutic effect in addition to the preventative effect Resolvin: improved periodontal health
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Chronic Inflammation increases Risk of \_\_\_
Chronic Inflammation increases Risk of Cancer
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Important Diseases with Oral Cavity Manifestations * Autoimmune * IBD * Aphthous Ulcers and other oral lesions * Desquamative gingivitis * Benign Mucous Membrane Pemphigoid * Lichen planis * Pemphigus * Sjogren’s Syndrome * Oral Mucositis * Wound Healing * Implants and Grafts *
Important Diseases with Oral Cavity Manifestations Autoimmune IBD Aphthous Ulcers and other oral lesions Desquamative gingivitis Benign Mucous Membrane Pemphigoid Lichen planis Pemphigus Sjogren’s Syndrome Oral Mucositis Wound Healing Implants and Grafts
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Mucositis Can occur anywhere along the mucosal surface Stomatitis * Any ____ of oral tissue Oral mucositis * Oral tissue inflammation due to ___ \_\_\_\_ therapies (chemotherapy or radiotherapy) Oral Mucositis Grading \_\_\_with _ being more severe
Mucositis Can occur anywhere along the mucosal surface Stomatitis Any inflammation of oral tissue Oral mucositis Oral tissue inflammation due to cytotoxic anticancer therapies (chemotherapy or radiotherapy) Oral Mucositis Grading 0-4 with 4 being more severe
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Hypersensitivity Reactions * Antibody-mediated * Type I (immediate or ____ hypersensitivity) * \_\_\_anaphylaxis * Mediated by ___ and \_\_ * ___ Ag * Ex) Allergicenitis or anaphylaxis * Type II (\_\_\_\_ hypersensitivity) * Drug induced Thrombocytopenia or Graves’ disease * Mediated by ___ and\_\_\_ and \_\_\_\_ * ___ or ___ \_\_\_ Ag * Type III (\_\_\_ \_\_\_hypersensitivity) * ___ diseases * SLE * Mediated by ___ and \_\_\_\_ * ___ Ag * Cell-mediated * Type IV (cell mediated or ___ type hypersensitivity) * Contact Dermitis * Latex Allergy * Nickel Allergy (metal crowns) * Mediated by \_\_\_\_\_ * Takes the\_\_\_ * ________ Ag *
Hypersensitivity Reactions Antibody-mediated Type I (immediate or anaphylactic hypersensitivity) Systemic anaphylaxis Mediated by IgE and IgG Soluble Ag Ex) Allergicenitis or anaphylaxis Type II (cytotoxic hypersensitivity) Drug induced Thrombocytopenia or Graves’ disease Mediated by IgG and IgM and Complement Cell or mucosal Associated Type III (immune complex hypersensitivity)Autoimmune diseases SLE Mediated by IgG and Complement Soluble Ag Cell-mediated Type IV (cell mediated or delayed type hypersensitivity)Contact Dermitis Latex Allergy Nickel Allergy (metal crowns) Mediated by cytotoxic T cells Takes the longest Solube or Cell Associated Ag