balancing immune response Flashcards

1
Q

Immune responses from lymphocytes are a balance between – & – signals (via – & – receptors)

A

+ve n -ve
inhibitory n activator

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2
Q

activatory receptors:
Signal 1: —
CD3 – role in –
CD4 or CD8 co-receptor
Signal 2: – receptor on T cell
binds to – (CD80/86) on APC
- instructive – secretion + – molecules leads to —
inhibitory receptors:
CTLA-4 and PD-1 on T cells are – receptors structurally related to –
CTLA-4 on T cell binds – (CD80/86) on APC
or – on T cell binds PD-L1 on APC
this leads to –

A

TCR-peptide MHC
signalling
CD28
B7
cytokines
adhesion
T cell activation
co inhibitory ]b7
PD-1
no T cell activation

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3
Q

1-the outcomes of T cell stimulation:
2- instructive cytokines by apc: t helper subset : response:
IL-12 — > — —> fights —
IL-10 —> —- —-> fights — and — via —
IL-23 –> —- —> fights — and —
TGF-B —> — —> —

A
  • suppression by treg cells
  • anergy
  • apoptosis
  • proliferation
    ( check slide 9,10)
    TH1 fights intracellular pathogens
    TH2 fights helminth infection and allergy via mast cells
    TH17 fights extracellular bacterial and yeast infection
    Treg immunosuppressive
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4
Q

Downregulation of T cell immune responses- via regulatory T cells (Treg):
How do Treg cells act to suppress the immune response?
Known mechanisms include:
* Secretion of – (eg. TGFb, IL-10)
* Engagement of – pathway rather than B7/CD28
* – “consumption”…less CK available for – of activated T cells

A

inhibitory cks
CTLA-4
IL-2
proliferation
( check slide 12)

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5
Q
  • What happens when the immune response can’t / won’t switch off?
    Inappropriate / excessive immune responses – > –
  • — disorders:
    Group of diseases linked with uncontrolled
    production of lymphocytes;
    often in immunocompromised patients
A

immunopathology
Lymphoproliferative

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6
Q

Autoimmune lymphoproliferative syndrome (ALPS):
1-Defect of —
2-Immune cells fail to undergo — when they should
3-Cause: mutation(s) in the – pathway of apoptosis (Fas, Fas ligand, Caspase-10)
4-Extent of the defect determines disease –
- – may die in infancy
- disease in – can wax and wane

A

lymphocyte haemostasis
programmed cell death
FAS
severity
homozygots
heterozytes

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7
Q

diagnosis of ALPS:
-Suspect ALPS if:
* – (swollen lymph nodes, spleen, liver etc).
* — (eg. various lymphopenias, some hepatitis or nephritis)
* – (especially EBV-linked)
* Skin –
* Family history of – disorders
-Definitive diagnosis:
Must have both - – (>6 months) – lymphadenopathy or splenomegaly
- – a/b double-negative T cell count
and one of - lab findings of defective – (2 assays)
- – in FAS, FAS ligand or Caspase-10

A

chronic lymphoproliferation
autoimmune disease
lymphoma
skin rashes
lymphoproliferative
chronic
non malignant
elevated
defective lymphocyte
gene mutation

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8
Q

management of ALPS:
Only cure = — or — (severe cases only)
- Usually treat the manifestations of the condition (autoimmune cytopenias, lymphomas etc)
- Often adults are — symptomatic than children
- Regular surveillance is important
- Genetic counselling for family members

A

haematopoetic stem cell transplant or bone marrow transplant
less

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9
Q

What happens when the immune response won’t switch on when required —> —- which can increase the risk of — and —

A

inadequate immune protection
infection and cancer incidence/ progression

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10
Q

immune response to tumours:
-Tumours arise from “ – ” cells that have gone wrong….
-Immune system recognises and responds to them as it would other “altered self” situations (eg. virally-infected cells)

A

self ( check slide 18)

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11
Q

innate immune response to tumours and the role of nk cells:
NK cells activated to generate an — response
* Tumour cells may lose – expression –> – receptor on NK cells not engaged
* Activating receptors are engaged by ligands expressed by —
* Activated NK cells can also secrete— that activate – and – cells

A

anti tumour
lose MHC class 1
inhibitory
tumour cells
pro inflammatory cks
macrophages n dendritic cells

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12
Q

Innate/adaptive IS cooperation in anti-tumour immunity -role of antibodies in ADCC:
tumour cells coated w — will can — onto nk cells bearing – receptors which can lead to –

A

anti tumour antibodies
dock
Fc
Antibody-dependent cellular cytotoxicity (ADCC)

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13
Q

— are principle of anti tumour response
process:
The process:
* Tumour – are processed; some peptides displayed on cell surface on —
* Recognised by – CTL with receptor specific for
that antigen
* — etc
* Activated CTL binds and releases – and – to destroy tumour cell

A

CTLS ( cytotoxic cell )
tumour antigen
MHC class 1
CD8+
co stimualtion
perforin n granzym

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14
Q

how tumours evade the immune response:
Strategy 1: “ – ”
- Tumour cells – surface antigens
- Tumour cells – or – the –
which is harder for T cells to recognise tumours
Strategy 2: “Attack is the best – ”
- Tumour cells produce – CKs
- Tumour cells express – surface proteins
( both of these will lead to inhibition of T cell activation )
- Enlist the help of other cells in the tumour – which will lead to – (etc) can inhibit CTL function and differentiation
of Th cells into – subtype

A

deregulate
mutuate or down regulate mhc-1
immunosuppressive cks
inhibitory surface proteins
microenvironment
tumour-associated macrophages
TH1
( check slide 26 so important )

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15
Q

cancer immunotherapy:
– and – affect normal proliferating cells –> significant mortality and morbidity
- – often unsuccessful in achieving durable benefits
-Can we “train” the immune system to better recognise or target tumours?

A

chemo n radio
cytotoxic drugs

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16
Q

approaches towards cancer immunotherapy:
* Use – antibodies to target cancer cells
* Use — to “take the brakes off” the immune response (eg. checkpoint inhibitors)
*— stimuli to boost the immune response
* “ – ” our own (autologous) T cells to recognise cancer antigens
* Cancer –

A

synthetic anti tumour anitbodies
synthetic antibodies
pro inflammatory
train
vaccines

17
Q

using antibodies to target tumour cells:
deally…synthetic antibodies should be designed against targets which are — for tumour cells, or at least — on tumour cells or— expressed at particular differentiation stages.
Targets should also be important for — or— signalling…or may get dumped!

A

specific
overexpressed
only expressed
cell survival and tumprogenic signalling
( check slide 30 so important )

18
Q

checkpoints inhibitors in cancer immunotherapy:
- Use – as drugs to “inhibit the inhibitors” – > stimulate —- immune responses — > tumour –
- * — : Ipilimumab approved for advanced melanoma,
mesothelioma, colorectal, some lung cancers…
Works by inhibiting CTLA-4 and by depleting Treg cells
* — , — : Nivolumab and Pembrolizumab approved
for melanoma, lung, renal, bladder, colorectal, gastric cancer…;
Atezolizumab approved for melanoma, urothelial, breast, some
lung cancers…
- More – and less – than anti-CTLA-4
- Can be used combined: but more side effects

A

MAbs
t cell
cell death
anti-CTLA-4
anti- PD1 , anti PD-L1
effective and less toxic

19
Q

boosting the immune response:
1- cytokinę therapy approach :
-Eg. Interferon therapy for –
- – MHC class I on tumour cells leading to – antigen presentation & attack by –
(but – from activation of immune response)
2- non specific inflammatory approach:
Eg. — of killed BCG in bladder cancers
-Get strong – immune response via –
Bacteria act as “ – ” promoting – activation

A

melanomas
up regulates
increased
side effects
local instillation
inane
macrophages
adjuvant
T cell

20
Q

training our own T cells to kill cancer:
- Adoptive cellular therapy…
Chimeric Antigen Receptor (CAR) T cell therapy
* Currently used for –
malignancies (ALL, CLL)
* In development for – , – tumours

A

b cell
malignant melanoma and brain tumours

21
Q

cancer vaccines could be:
* — : – vaccinate against viral antigens implicated in cancer
eg. Hepatitis B virus
Human Papilloma virus (HPV) – GardasilTM
* — : – assuming the existence of a target antigen which is
 – (or at least tumour-overexpressed)
 —
 Important for – / —
– and assuming that enough APCs can be activated to generate a good T cell response
(use adjuvants just like in “normal” vaccination against infectious organisms!)

A

preventative
tumour specific
immunogenic
cell survival and tumour progression

22
Q

limitation of cancer immunotherapy:
* Enhancing the immune response has — effects….eg. autoimmune-like disease, inflammation
* Skin rashes and autoimmune-like conditions are common following — treatment
(but can be easily managed with anti-inflammatories in most patients)
* – used to manage inflammation may promote infectious complications
* Risk-benefit ratio is not always simple (Eg. in immunocompromised, pregnant, transplant pts etc??)
* Side-effects may occur – after treatment and are not yet routinely recognized in primary care
*– are very expensive
* CAR T cell therapies not – outside specialist centres

A

knock on
checkpoint inhibitors
steroids
months
Mars
practicle

23
Q

overall perspective:
* Often desirable to – the immune response – > reduce excessive or inappropriate –
* Harnessing the immune response is a powerful tool
– > – the immune response to target tumours

A

down regulate
inflammation
up regulate