Autoimmune Disease

Question 1

What is immunologically acted on in Graves’ disease?

Answer 1

TSH receptors in thyroid

Question 2

What is immunologically acted on in type 1 diabetes?

Answer 2

Beta islet cells of the pancreas

Question 3

What are some examples of autoimmune diseases of HLA B27-associated apondyloarthropathies?

Answer 3

Reactive arthritis
Psoriatic arthritis
Urethritis
Iritis

Question 4

What is systemic lupus erythematosus characterised by?

Answer 4

Autoantibodies binding to nuclear antigens

Question 5

What is autoimmunity?

Answer 5

Failure of regulatory controls to attacking host components

Question 6

What is immune tolerance?

Answer 6

Knowing what to attack/what not to attack

Question 7

What is central tolerance?

Answer 7

Destruction of self-reacting T or B cells before they enter circulation

Question 8

What happens in central tolerance ?

Answer 8

Immature B cells in bone marrow encounters antigen in a form which can cross-link their IgM, triggering apoptosis

Question 9

What is peripheral tolerance?

Answer 9

Destruction or control of any self-reactive T or B cell which do not enter circulation

Question 10

What are the types of peripheral tolerance?

Answer 10

Ignorance
Anergy
Regulation

Question 11

When does ignorant peripheral tolerance happen?

Answer 11

Antigen present in too low a concentration to reach the threshold for T cell receptor trigger

Immunologically privileged sites means there are T cells but they cant get to the sites

Question 12

What causes anergic peripheral tolerance?

Answer 12

Naive T cell seeing its MHC without appropriate costimulatory protein

Question 13

What is Anergy?

Answer 13

Naive T cells need costimulation to become activated

If they dont, they’re less likely to be stimulated in future even if costimulation is present

Question 14

Which cells inhibit T cells?

Answer 14

Treg cells

Question 15

Which disease has defective treg cells been observed in?

Answer 15

Multiple sclerosis

Question 16

How does treg regulation happen?

Answer 16

Expresses transcription factor FOXP3

Question 17

What conditions does a mutation in FOXP3 lead to?

Answer 17

Fatal autoimmune disorder
Immune disregulation
Polyendocrinopathy
Eneropathy X-linked syndrome

Question 18

What does autoimmune regulator (AIRE) do?

Answer 18

A specialised transcription factor that allows thymic expression of genes that are expressed in peripheral tissues

Question 19

How does AIRE promote self-tolerance?

Answer 19

Allowing the thymic expression of genes from other tissues

Question 20

Which autoimmune conditions are more likely in females?

Answer 20

Lupus

MS

Question 21

Which autoimmune conditions are more common in males?

Answer 21

Ankylosis spondylitis

Question 22

Which autoimmune condition is equally common in women and men?

Answer 22

Diabetes

Question 23

What is the hygiene hypothesis of autoimmune disease?

Answer 23

Exposure to different pathogens may lead to expression/non-expression of a disease

Question 24

What might trigger a breakdown of self tolerance?

Answer 24

Loss of/problem with regulatory cells
Release of sequestered antigen
Modification of self
Molecular mimicry

Question 25

How does modification of self take place?

Answer 25

Citrullination

Question 26

What is citrulline?

Answer 26

An amino acid not coded by DNA

Question 27

What may citrullination be increased by?

Answer 27

Inflammation

Question 28

What is an example of molecular mimicry?

Answer 28

Rheumatic fever

Question 29

What is rheumatic fever triggered by?

Answer 29

Infection with streptococcus pyrogen

Question 30

How does Graves’ disease happen?

Answer 30

Autoantibodies bind TSH receptor and stimulate it, causing hyperthyroidism

Question 31

How can Graves’ disease be transferred?

Answer 31

IgG antibodies

Question 32

What causes myasthenia gravis?

Answer 32

Autoantibodies binding to ACh receptors that block the binding ability of ACh

Question 33

How are immune complexes in SLE and vasculitis formed and what do they cause?

Answer 33

Autoantibodies to soluble antigens form immune complexes Deposited in tissue Can lead to activation of complement and phagocytic cells

Question 34

Which autoimmune diseases can be transferred across the placenta?

Answer 34

IgG mediated ones

Question 35

What is the autoimmune pathology of T cells?

Answer 35

Direct killing by CD8+ CTL Self-destruction induced by cytokines such as TNFalpha Recruitment and activation of macrophages leading to bystander tissue destruction CD4 cells providing help for Ab and cytotoxicity

Question 36

What do TH17 cells produce?

Answer 36

Cytokine IL-17

Question 37

What do TH17 produce?

Answer 37

Cytokines involved in the recruitment, migration and activation of immune cells

Question 38

What anti-inflammatories are used in autoimmune treatment?

Answer 38

NSAIDs and corticosteroids

Question 39

What theraputic strategies are used to treat T and B cell depletion?

Answer 39

Anti-CD4 | Anti-CD20

Question 40

What are examples of theraputic antibodies?

Answer 40

Anti-TNF | Anti-VLA-4