Autoimmunity Flashcards

1
Q

your _____ immune system has 2 receptors ____ and _____, responsible for recognizing _______ of antigens

A

adaptive, immunoglobulin, TCR, 10^9 or more

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2
Q

there are ___ antigen receptor genes, ___ responsible for immunoglobulins _____, and ____ responsible for t cell receptor

A

7, 3, heavy, kappa lamda, 4 TCR: alpha, beta, gamma, delta

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3
Q

when apc presents to a naive tcell, it secretes ____ to turn it into a Th17 ____ to turn it into a Th1, and ____ to turn it into a Th2

A

TGFB, IL-6, IFN-gamma, IL-12, IL-4

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4
Q

Th17 cells turn on ____, Th1 cells turn on ____, Th2 cells turn on____

A

neutrophils, macrophages+mast cells, eosinophils

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5
Q

hypersensitivity is defined as:

A

injurious immune reactions (tissue injury as a direct result of your immune system)

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6
Q

definition of Type I hypersensitivity:

A

immediate, rapid immunologic reaction that occurs from previous sensitization, triggered by binding of antigen to IgE on mast cells

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7
Q

Type I Hypersensitivity pathogenesis:

A

initiated by introduction of allergen, stimulate Th2 responses and IgE production in genetically susceptible individuals (IgE class switching in B cells), re-exposure to allergen cross-links IgE and activates mast cells to secrete mediators

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8
Q

Cells associated with Type 1 Hypersensitivity

A

Mast cells (look like basophils deep blueish color) A in ACID mnemonic

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9
Q

in a slide of a type I hypersensitivity response, you see:

A

initially mast cells, later you see eosinophils

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10
Q

In a Type II hypersensitivity reaction:

A

antibodies react with antigens on cell surface or in the extracellular matrix causing disease by destroying cell, triggering inflammation, or interfering with normal functions (C in ACID, cy-TWO-toxic T cells)

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11
Q

pathogenesis of type II hs:

A

3 types: opsonization (direct coating of cell with antibodies and complement components, ingestion by phagocyte), inflammation (induced antibody deposition in fixed tissues i.e. basement membrane and extracellular matrix and by complement breakdown products i.e. glomerularnephritis, Cellular dysfunction from antireceptor antibodies that disturb the normal function of receptors i.e. myasthenia gravis, anti-TSH receptor activating TSH receptor in Graves causing hyperthyroidism

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12
Q

define Type III HS:

A

immune complex-mediated, antigen-antibody complex produces tissue damage by eliciting inflammation at the sites of deposition (I in ACID mnemonic “think 3 parts, antigen, antibody and complement protein”).

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13
Q

immune complexes are____ and _____ causing_____

A

insoluble, deposit in tissues, tissue damage via inflammation at the sites of deposition (usually at a site with lots of blood vessels), i.e. lupus- causing glomerular nephritis, complex gets lodged in the kidney

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14
Q

pathogenesis of Type 3 HS:

A

formation of immune complex (protein antigen triggers immune response, formation of antibodies) deposition of immune complex (deposited in blood vessels or tissues, organs where blood is filtered at high pressure, i.e. kidney), inflammation and tissue injury (activates complement system with release of breakdown products or engaging Tc receptors of leukocytes) this all results in vasculitis glomerulonephritis, and arthritis

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15
Q
A

Type 3, immune complex-mediated hypersensitivity, acute vasculitis, associated with necrosis of the vessel wall and intense neutrophilic infiltration

fibrinoid necrosis: necrotic tissue and deposits of immune complexes (the pink rink around vessel), inflamation. complement, and plasma protein area of tisue destruction, an apearance termed

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16
Q

Type 4 hypersensitivity is:

A

T-cell mediated

ACID: delayed (t-cell mediated)

inflammation resulting from cytokines produeced by CD4+T cells and cell killing CD8+T cells

RA, MS, Type 1 Diabetes, IBD,

type 1: immune system has turned on cytotoxic T cells to kill Beta islet cells in pancreas

17
Q

Pathogenesis of Type 4 HS:

A

depends on type of cell turned on: 1 cytokine mediated: CD4+ t cells activated by exposure to antigen and differentiate into Th1 and Th17 effector cells

subsequent exposure results in cytokine secretion e.i. IFN-gamma activates macrophages to produce substances that cause tissue damage

2: cytotoxic reaciton: CD8+ cytotoxic T lymphocytes CTLs directly kill tissue cell (type 1 DM)

18
Q

TB is a _____ hypersensitivity related to _____ cells

A

delayed-type, CD4 (Tuberculin PPD reaction)

19
Q

ON TEST!

TB skin test is an example of:

A

Type 4, delayed-type hypersensitivity

positive PPD reaction,

during the Tuberculin PPD test, as the innoculation grows larger there are CD4 helper T cells that cause the inflammatory response

20
Q

type I HS

A

ACID, A for allergy, anaphalaxis, bronchial Asthma

Immediate response,

production of IgE

21
Q

autoimmune diseases def:, clinical features:

A

immune mediated damage of self tissues, clinical features: progressive with relapse and remission

22
Q

Type 2 HS

A

ACID-C is for complement

antibody-mediated response

IgG, IgM, phagocytosis or lysis of target cell by activated comlement receptor,

autoimmune hemolytic anemia, myasthenia gravis, graves

23
Q

Type 3 HS

A

ACID: I is for inflammation, Immune complex mediated

deposition of antigen-antibody comples into tissue, necrotizing vasculitis

SLE, Glomerulonephritis, serum sickness and arthus reaction

24
Q

Type 4 HS:

A

ACID: D is for Delayed, activated T lymphocytes,

CD4 Tcell is making too much IFN-gamma recruites neutrophils or IL17 recruits macrophages

TB test, granuloma formulation, perivascular infiltrates,

MS, Type 1 diabetes, TB, Hashimoto’s thyroiditis

25
Q

Difference between type 2 and 3 hs

A

type 2, the antibody is causing the response,

type 3, the antibody is combining with something else that is being deposited in the tissues that is causing the damage

type 3 is usually systemic, where as type 2 is localized

26
Q

Increased metabolic state, protusion of eyes,

thyroid test shows:

elevated total and free T4

elevated T3

decreased TSH

suggests?

A

Thyrotoxicosis, hyperthyroidism

pituitary gland is trying to shut it off

27
Q
A

hyperplasia, graves disease, hypertrophic thyroid, hyperthyroidism

28
Q

what is the etiology of granves?

pathogenesis?

(Probably TEST)

A

patients have autobodies to TSH receptors that cause mitogenesis of thyroid epithelial cells

path: 1. IgG autoantibodies to the TSH receptor
2. Bind to thyroid follicular cells
3. Thyroid hypertrophy/hyperplasia
4. increased secretion of T3 and T4

what kind of hypersensitivity is this?

2, Classic, type 2, antibody mediated hypersensitivity, autoimmune disease

Increased total and free T4, decreased TSH

29
Q

lab results for hypothyroid?

A

decreased total and free T4

elevated TSH

30
Q

pathogenesis of autoimmunity includes:

A
  1. susceptibility genes (HLA genes, i.e. HLA-B27)
  2. Environmental triggers (antigens)
  3. Lymphocytes enter tissues
  4. Activation of self-reactive lymphocytes-tissue damage (too many turned on and can’t get turned off)
31
Q

why is the thyroid enlarged?

what kind of hypersensitivity?

A

hypothyroidism from direct damage from the inflammation

enlarged thyroid

lymphocytes are destroying the thyroid follicles

type 4, t-cell mediated HS, not systemic (like type 3) localized, and includes both T and B cells

continued inflammation leads to scarring and ceased function

Hashimoto’s thyroiditis is the most common cause of hypothyroidism

decreased T4, increased TSH

32
Q
A

lymphocytes are directly damaging the thyroid follicles

Hashimoto’s Thyroiditis

leads to fibrosis and scarring

most common cause of hypothyroidism

elevated T4 and decreased TSH

33
Q

what labs do you look for in SLE?

A

ANA positive (not specific) for the diagnosis of SLE

anti-dsDNA and anti-Smith antigen (specific for lupus)

note:ANA and anti-dsDNA antigens are in the nucleus and are released to provoke an immune response

34
Q
A

when cells of the epidermis die, they release toxins that get deposited into the basement membrane of the skin (immune complex in the skin, kidneys, joints, etc)

classic for Type 3, complex deposits in skin, joints, kidneys

35
Q
A

SLE: kidney, lupus nephritis, deposition of immune complexes on basement membrane

type 3: Immune complex

Antinuclear Antibodies

anti-dsDNA

Antigen-antibody complex generated at higher level and deposited in multiple tissues/organs

36
Q

autoimmune disease associated with salivary glands:

A

Sjogren syndrome

type 4 HSR

Destruction of lacrimal/salivary glands

antibodies: anti-SSA anti-SSB RF

37
Q

Autoimmune disease?

A

RA

Rheumatoid Factor: affects joints extraarticular tissues

cellular and humoral immune response against self-antigens

synovitis

38
Q

autoimmune disease?

A

systemic sclerosis (scleroderma)

activation of fibroblasts by cytokines produced by cd4 T cells

immense collagen build up

classic autoimmune disease