Block 1 Exam 4 Part 2 Flashcards

1
Q

What happens to anti-apoptotic proteins like BCL-2 and BCL-X_L as the T cell response declines?

A

Their levels drop, leading to increased cell death.

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2
Q

Which protein is activated due to growth factor deprivation and triggers apoptosis?

A

BH3-only protein BIM.

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3
Q

What role do phosphatases such as SHP-1 and SHP-2 play in T cell activation?

A

They dephosphorylate signaling substrates to limit the duration or magnitude of T cell activation.

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4
Q

What is the role of PD-1 in T cell regulation?

A

It restrains previously activated CD8+ T cells in peripheral tissues, limiting their activity.

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5
Q

How do regulatory T cells help in the decline of T cell responses?

A

By engaging CTLA-4 with B7 on APCs and suppressing effector T cell responses, thereby limiting immune responses and preventing autoimmunity and allergy.

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6
Q

What is the ultimate source of genetic variation?

A

Mutation

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7
Q

What is the probability that a parent will transmit a specific allele at a locus?

A

1/2, as each allele has an equal chance of being transmitted.

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8
Q

What is the multiplication rule in probability?

A

The probability of independent events happening together is the product of their individual probabilities.

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9
Q

What is the addition rule in probability?

A

The probability of either one outcome or another is the sum of their individual probabilities.

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10
Q

If a couple wants to know the probability that all three of their children will be girls, what is the answer?

A

1/2 _ 1/2 _ 1/2 = 1/8.

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11
Q

What is the probability of getting either two heads or two tails in two coin tosses?

A

1/4 + 1/4 = 1/2.

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12
Q

What is the probability that a couple planning three children will have all of the same sex (either all boys or all girls)?

A

1/8 + 1/8 = 1/4.

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13
Q

What does genotype frequency represent?

A

The proportion of each genotype in a population.

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14
Q

do you calculate the frequency of a genotype in a population?

A

Divide the number of individuals with that genotype by the total number of individuals in the population.

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15
Q

If 64 out of 200 people have the MM genotype, what is the frequency of MM?

A

0.32 (64/200)

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16
Q

What does gene frequency represent?

A

The proportion of each allele at a specific locus in a population.

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17
Q

How do you calculate the frequency of an allele in a population?

A

Divide the number of copies of the allele by the total number of alleles at that locus.

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18
Q

How do you calculate the frequency of allele M if there are 248 M alleles out of 400 total alleles?

A

0.62 (248/400).

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19
Q

What is the relationship between the sum of all genotype frequencies and the sum of all gene frequencies in a population?

A

Both sums must equal 1.

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20
Q

What does the Hardy-Weinberg principle describe?

A

The relationship between gene frequencies and genotype frequencies in a population under random mating conditions.

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21
Q

What are the allele frequencies labeled as in the Hardy-Weinberg principle?

A

p for allele A and q for allele a.

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22
Q

How do you calculate the frequency of the AA genotype using allele frequencies?

A

p_ (p multiplied by p).

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23
Q

How do you calculate the frequency of the aa genotype?

A

q_ (q multiplied by q).

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24
Q

What is the formula for the frequency of the heterozygote genotype (Aa)?

A

2pq.

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25
Q

In a population, if the frequency of allele A (p) is 0.7, what is the frequency of allele a (q)?

A

0.3 (since p + q = 1).

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26
Q

What does q_ represent in the context of recessive diseases?

A

The frequency of affected individuals (homozygotes aa) in the population.

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27
Q

If q_ for a recessive disease like cystic fibrosis is 1/2500, what is the value of q?

A

0.02 (q = Ã(1/2500)).

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28
Q

How do you estimate the frequency of heterozygous carriers (Aa) if q is 0.02?

A

2pq, which simplifies to 2q because p Å 1, so 2 _ 0.02 = 1/25.

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29
Q

Why are recessive disease alleles often hidden in populations?

A

Because they are commonly carried by heterozygotes (Aa) who do not show symptoms of the disease.

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30
Q

What is the source of all genetic variation?

A

Mutation

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31
Q

How does natural selection affect genetic variation?

A

It increases the frequency of favorable mutations and decreases the frequency of unfavorable ones.

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32
Q

What typically happens to disease-causing mutations in a population?

A

They are continually introduced through errors and removed by natural selection.

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33
Q

How can a disease mutation provide a selective advantage?

A

In certain environments, like areas with malaria, a mutation can provide survival benefits, as seen with sickle cell heterozygotes.

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34
Q

Why do sickle cell heterozygotes have an advantage in malaria-endemic regions?

A

The malaria parasite does not survive well in the erythrocytes of sickle cell heterozygotes, reducing their risk of dying from malaria.

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35
Q

What happens to the frequency of the sickle cell mutation in environments without malaria?

A

Natural selection acts against it, reducing its frequency.

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36
Q

Why does the sickle cell mutation persist at a high frequency in certain populations?

A

Because it provides a survival advantage in malaria-endemic regions, despite being harmful in homozygotes.

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37
Q

What does the example of sickle cell disease illustrate about genetic variation?

A

It shows how natural selection can cause variation in the incidence of genetic diseases among different populations based on environmental factors.

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38
Q

What is natural selection?

A

It is the process where alleles that provide survival or reproductive advantages increase in frequency, while those with disadvantages decrease.

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39
Q

How does natural selection affect skin pigmentation as humans moved to higher latitudes?

A

It increased the frequency of variants that adapted skin pigmentation to the new environments.

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40
Q

What is an example of natural selection related to lactase persistence?

A

In populations that began drinking cow’s milk through adulthood, natural selection increased the frequency of hereditary lactase persistence.

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41
Q

How has natural selection acted on populations living in high-altitude environments?

A

It has increased the frequency of adaptations in the hypoxia-inducing factor pathway, allowing survival in oxygen-deficient areas like the Tibetan plateau.

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42
Q

What is genetic drift?

A

A random evolutionary process that causes larger changes in gene frequencies in smaller populations.

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43
Q

What is the founder effect?

A

It is a special case of genetic drift where a small founder population experiences large changes in gene frequency due to its small size.

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44
Q

How did genetic drift affect the Old Order Amish population in Pennsylvania?

A

Genetic drift increased the frequency of Ellis-van Creveld syndrome among the Amish, a population founded by about 50 couples.

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45
Q

What is gene flow?

A

The exchange of genes between populations, which tends to make them genetically more similar over time.

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46
Q

What happens to sickle cell disease frequency in African Americans compared to African populations due to gene flow?

A

Gene flow between African Americans and European Americans decreased the frequency of sickle cell disease in African Americans.

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47
Q

What is mutation-selection balance?

A

It predicts a relatively constant gene frequency when new mutations introduce harmful alleles, while natural selection removes them.

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48
Q

Why are recessive disease-causing alleles generally more common than dominant ones?

A

Because recessive alleles are often hidden in heterozygotes, protecting them from natural selection.

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49
Q

What does the selection coefficient (s) represent?

A

It represents the reduction in offspring for those carrying a specific allele, used to predict gene frequency in mutation-selection balance.

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50
Q

What is non-Mendelian inheritance?

A

It refers to patterns of inheritance that do not follow Gregor Mendel’s principles, including sex-linked mutations, mitochondrial inheritance, anticipation, and imprinting.

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51
Q

What are sex-linked mutations?

A

Mutations that occur on the sex chromosomes (X and Y). Diseases caused by these mutations are referred to as X-linked or Y-linked.

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52
Q

What is significant about the X chromosome in relation to disease?

A

The X chromosome is large (155 Mb) and contains nearly 1300 genes, many of which are associated with X-linked diseases.

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53
Q

How does the Y chromosome compare to the X chromosome?

A

The Y chromosome is much smaller (60 Mb) and contains only a few dozen genes.

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54
Q

What is mitochondrial inheritance?

A

It refers to the inheritance of the mitochondrial genome, which is passed down only from the mother.

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55
Q

Why do mitochondrial diseases have a unique pattern of inheritance?

A

Because the mitochondrial genome is inherited exclusively from the mother, mitochondrial diseases show a maternal inheritance pattern.

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56
Q

What is anticipation in genetics?

A

Anticipation is the phenomenon where some genetic diseases manifest at an earlier age in more recent generations of a family.

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57
Q

What is genetic imprinting?

A

Imprinting is when certain genes are expressed only from the chromosome inherited from one parent, either maternal or paternal.

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58
Q

What is X inactivation?

A

It is the process by which one of the two X chromosomes in each somatic cell of a female is randomly inactivated to achieve dosage compensation.

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59
Q

Why is X inactivation necessary?

A

To equalize the amount of X-linked gene products between males (who have one X chromosome) and females (who have two X chromosomes).

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60
Q

When does X inactivation occur?

A

Early in female embryonic development.

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61
Q

How is the X chromosome chosen for inactivation?

A

The X chromosome to be inactivated is chosen randomly in each cell, resulting in roughly half of the cells having the maternal X chromosome active and the other half having the paternal X chromosome active.

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62
Q

What happens to the X chromosome after it is inactivated?

A

It remains inactive in all descendants of that cell.

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63
Q

Why are females considered mosaics in terms of X chromosome activity?

A

Because they have two populations of cells, one with an active maternal X chromosome and the other with an active paternal X chromosome.

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64
Q

Are males mosaics for the X chromosome?

A

No, males are hemizygous for the X chromosome, meaning they have only one X chromosome and do not undergo X inactivation.

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65
Q

What are sex-linked genes?

A

Genes located on either the X or the Y chromosome.

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66
Q

Why are X-linked diseases more common than Y-linked diseases?

A

The X chromosome is larger and contains more genes compared to the Y chromosome.

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67
Q

Why are X-linked recessive diseases more common in males than females?

A

Males have only one X chromosome, so if they inherit the disease-causing allele, they will express the disease.

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68
Q

Can X-linked recessive diseases be passed from father to son?

A

No, fathers pass their Y chromosome to sons, not the X chromosome.

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69
Q

How can X-linked recessive diseases appear to skip generations?

A

The disease can be passed through phenotypically normal heterozygous females (carriers), who may pass it on to their sons.

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70
Q

What is a manifesting heterozygote?

A

A female carrier of an X-linked recessive disease who shows mild symptoms due to random X inactivation favoring the diseased allele.

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71
Q

Why might a female with Turner syndrome be affected by an X-linked recessive disease?

A

Because she has only one X chromosome, any recessive disease allele on that chromosome will be expressed.

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72
Q

What is the probability of a female being affected by an X-linked recessive disease?

A

It is much lower than in males because females need two copies of the recessive allele to express the disease.

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73
Q

What is an example of an X-linked dominant disease?

A

Hypophosphatemic rickets, which impairs the kidneys’ ability to reabsorb phosphate.

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74
Q

Why are X-linked dominant diseases less common than X-linked recessive diseases?

A

X-linked dominant diseases are generally fewer and often less prevalent due to their inheritance patterns.

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75
Q

Why are X-linked dominant diseases more common in females than in males?

A

Females have two X chromosomes, so they are about twice as likely to inherit the disease-causing gene.

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76
Q

Can X-linked dominant diseases be passed from father to son?

A

No, because fathers pass the Y chromosome to their sons, not the X chromosome.

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77
Q

What happens to males with X-linked dominant diseases that are lethal?

A

They often do not survive to term, as seen in disorders like incontinentia pigmenti type 1 and Rett syndrome.

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78
Q

What is a key feature of Rett syndrome?

A

It is a neurodevelopmental disorder characterized by autistic behavior, intellectual disability, seizures, and gait ataxia.

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79
Q

How does random X inactivation affect the severity of X-linked dominant diseases in females?

A

It can lead to milder symptoms if a larger percentage of X chromosomes with the disease mutation are inactivated.

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80
Q

How are Y-linked traits inherited?

A

They are passed strictly from father to son.

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81
Q

What is an example of a Y-linked trait?

A

The gene that initiates differentiation of the embryo into a male.

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82
Q

What is a sex-limited trait?

A

A trait that occurs only in one of the sexes, such as uterine defects in females or testicular defects in males.

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83
Q

What is a sex-influenced trait?

A

A trait that occurs in both sexes but is more common in one sex, like male-pattern baldness.

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84
Q

Is male-pattern baldness strictly X-linked?

A

No, it is influenced by both X-linked and autosomal genes, which explains father-to-son transmission.

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85
Q

What is mitochondrial DNA (mtDNA)?

A

It is a small, circular DNA molecule found in mitochondria that encodes rRNAs, tRNAs, and polypeptides involved in oxidative phosphorylation.

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86
Q

How is mtDNA inherited?

A

Exclusively through the maternal line, as only eggs contribute mitochondria to the developing embryo.

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87
Q

What is heteroplasmy?

A

It is the presence of a mixture of normal and mutated mtDNA within a cell, leading to variable expression of mitochondrial diseases.

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88
Q

Why do mitochondrial diseases often affect the central nervous system?

A

The central nervous system requires large amounts of ATP, making it highly vulnerable to mtDNA mutations that impair energy production.

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89
Q

What is Leber hereditary optic neuropathy (LHON)?

A

A mitochondrial disease caused by missense mutations in mtDNA that leads to rapid loss of central vision due to optic nerve death

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90
Q

What is the role of single-base mutations in mitochondrial diseases?

A

They can cause disorders like myoclonic epilepsy with ragged-red fibers (MERRF) and mitochondrial encephalomyopathy with stroke-like episodes (MELAS), both of which are heteroplasmic and highly variable in expression.

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91
Q

What types of mutations cause Kearns-Sayre disease and Pearson syndrome?

A

Duplications and deletions in mtDNA.

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92
Q

How common are mitochondrial diseases?

A

Approximately 1 in 4000 individuals is affected by a mitochondrial disease, with most cases due to mitochondrial mutations

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93
Q

Can mitochondrial mutations contribute to aging?

A

Yes, it is suggested that mtDNA mutations accumulating through life due to free radical formation could contribute to the aging process.

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94
Q

What is the significance of mitochondrial mutations in common diseases?

A

Mitochondrial mutations are linked to late-onset deafness, some cases of type 2 diabetes, and possibly Alzheimer’s disease.

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95
Q

What is genomic imprinting?

A

It is a process where the expression of an allele depends on whether it is inherited from the mother or the father, leading to gene silencing of one allele.

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96
Q

How does genomic imprinting affect gene expression?

A

One allele is transcriptionally inactive due to imprinting, resulting in only one active copy of the gene.

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97
Q

What are imprinted genes typically associated with?

A

Heavily methylated DNA and chromatin condensation that inhibit transcription.

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98
Q

What is Prader-Willi syndrome (PWS) and how is it caused?

A

PWS is a disorder caused by a deletion on chromosome 15 inherited from the father, affecting genes that are normally active only on the paternal chromosome.

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99
Q

What is Angelman syndrome (AS) and how is it caused?

A

AS is a disorder caused by a deletion on chromosome 15 inherited from the mother, affecting genes that are normally active only on the maternal chromosome.

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100
Q

What is the gene associated with Angelman syndrome?

A

UBE3A, which is active only on the maternal chromosome in brain tissue.

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101
Q

What is Beckwith-Wiedemann syndrome and how is it caused?

A

It is an overgrowth disorder caused by imprinting errors on chromosome 11, leading to overexpression of genes like IGF2 or loss of expression of growth-regulating genes.

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102
Q

How does uniparental disomy contribute to Beckwith-Wiedemann syndrome?

A

By inheriting two copies of the paternal chromosome 11 or losing imprinting on the maternal copy, leading to overexpression of IGF2.

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103
Q

What causes Silver-Russell syndrome?

A

A loss of methylation of DMR1 on chromosome 11p15.5, leading to underexpression of IGF2 and diminished growth.

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104
Q

What distinguishes Silver-Russell syndrome from Beckwith-Wiedemann syndrome in terms of IGF2 expression?

A

Beckwith-Wiedemann syndrome is caused by overexpression of IGF2, while Silver-Russell syndrome results from underexpression of IGF2.

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105
Q

What is humoral immunity mediated by?

A

B lymphocytes; secreted antibodies

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106
Q

What is the main function of humoral immunity?

A

Defense against extracellular microbes and microbial toxins.

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107
Q

What is the key difference between humoral immunity and cell-mediated immunity?

A

Humoral immunity uses antibodies, while cell-mediated immunity is mediated by T lymphocytes.

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108
Q

What types of microorganisms does humoral immunity primarily combat?

A

Extracellular bacteria, fungi, and viruses before they infect cells or after being released from infected cells.

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109
Q

What happens if there are defects in antibody production?

A

Increased susceptibility to infections by bacteria, fungi, and viruses.

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110
Q

How do most current vaccines provide protection?

A

By stimulating the production of antibodies.

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111
Q

In what harmful conditions can antibodies mediate tissue injury?

A

In allergies, autoimmune diseases, blood transfusion reactions, and transplant rejection.

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112
Q

What does antibody-mediated elimination of antigens involve?

A

Effector mechanisms involving phagocytes and complement proteins.

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113
Q

Where are antibodies produced?

A

Plasma cells in secondary lymphoid organs, inflamed tissues, and bone marrow.

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114
Q

What is the significance of antibodies being transported across the placenta?

A

They protect the developing fetus by entering the fetal circulation.

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115
Q

Where do long-lived plasma cells reside?

A

Mainly in the bone marrow.

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116
Q

Why are antibodies the primary defense mechanism in mucosal organs and the fetus?

A

T lymphocytes are not transported into mucosal secretions or across the placenta.

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117
Q

What region of immunoglobulin (Ig) molecules mediates many of the effector functions of antibodies?

A

The Fc region.

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118
Q

Which immunoglobulin isotypes activate the complement system?

A

IgM and some IgG subclasses (IgG1, IgG2 to a limited extent, IgG3).

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119
Q

What is the only antibody function mediated entirely by antigen binding?

A

Neutralization.

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120
Q

How is complement activation triggered by antibodies?

A

By binding to a multivalent antigen, clustering antibody molecules close together.

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121
Q

How do antibodies neutralize microbes and microbial toxins?

A

By blocking the binding of microbes and toxins to cellular receptors.

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122
Q

What is an example of a microbe that uses surface molecules to infect host cells?

A

Influenza virus uses hemagglutinin to infect respiratory epithelial cells.

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123
Q

How do antibodies prevent microbes from interacting with cellular receptors?

A

Through steric hindrance, preventing the microbes from binding to receptors.

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124
Q

How do microbial toxins like tetanus toxin and diphtheria toxin cause injury?

A

By binding to specific cellular receptors and interfering with normal cell functions.

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125
Q

How do antibodies protect against microbial toxins like tetanus and diphtheria?

A

By preventing toxins from binding to their target receptors and causing tissue injury.

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126
Q

What is the role of IgA antibodies in the lumen of the gut?

A

They agglutinate microbes, reducing infectivity and facilitating clearance by peristalsis.

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127
Q

What effect can antibodies have on microbes besides steric hindrance?

A

They can induce conformational changes in microbial surface molecules, preventing receptor interaction.

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128
Q

What are the two primary antibody isotypes involved in neutralization?

A

IgG in the blood and IgA at mucosal sites.

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129
Q

What makes antibodies most effective at neutralizing microbes?

A

High affinity for their antigens, produced by affinity maturation.

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130
Q

How do some microbes evade antibody-mediated neutralization?

A

By mutating the genes encoding their surface antigens.

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131
Q

How do IgG antibodies promote the phagocytosis of microbes?

A

By coating (opsonizing) the microbes and binding to Fc receptors on phagocytes.

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132
Q

What immune cells express Fc receptors that promote phagocytosis of opsonized particles?

A

Mononuclear phagocytes and neutrophils.

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133
Q

What is the function of the Fc_ receptors on phagocytes?

A

To bind IgG-coated particles and promote phagocytosis.

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134
Q

Which complement activation product can coat microbes to promote their phagocytosis?

A

C3b

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135
Q

What is the process of coating particles to promote phagocytosis called?

A

Opsonization

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136
Q

Which Fc_ receptor has the highest affinity for IgG antibodies?

A

Fc_RI (CD64).

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137
Q

Which immune cells express the high-affinity Fc_RI receptor?

A

Macrophages and neutrophils.

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138
Q

What is the function of the Fc_RIIB receptor?

A

It is an inhibitory receptor that regulates immune responses.

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139
Q

What happens when multiple Fc receptors are cross-linked by IgG-coated particles?

A

It leads to phagocyte activation and engulfment of the particles.

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140
Q

What are the primary microbicidal substances produced by activated phagocytes?

A

Reactive oxygen species, nitric oxide, and hydrolytic enzymes.

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141
Q

What is ADCC (Antibody-Dependent Cell-Mediated Cytotoxicity)?

A

Process where NK cells and other leukocytes destroy antibody-coated cells.

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142
Q

Which receptor do NK cells use in ADCC?

A

Fc_RIIIA (CD16).

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143
Q

What triggers NK cells to perform ADCC?

A

Antibody-coated target cells.

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144
Q

Why doesn’t ADCC occur with free IgG in the plasma?

A

Fc_RIII binds only to clustered IgG on cell surfaces, not to free IgG.

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145
Q

What do NK cells release during ADCC?

A

Cytokines like IFN-_ and granule contents to kill the target cells.

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146
Q

Can ADCC be mediated by other cells?

A

Yes, macrophages can also mediate ADCC.

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147
Q

What is the complement system?

A

A set of serum and cell surface proteins involved in eliminating microbes and complementing antibody function.

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148
Q

How does complement activation enhance immune response?

A

It focuses immune attack on microbial surfaces and amplifies the immune response through sequential proteolysis of proteins.

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149
Q

What are zymogens in the context of complement activation?

A

Inactivated proteins that gain proteolytic activity through sequential activation, leading to a proteolytic enzyme cascade.

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150
Q

How are complement proteins activated?

A

By binding to microbial surfaces, antibodies, and other antigens, leading to their stable activation.

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151
Q

What role do regulatory proteins play in complement activation?

A

They inhibit complement activation on normal host cells to prevent damage, while microbes lack these regulatory proteins and are susceptible to complement activation.

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152
Q

What are the three pathways of complement activation?

A

Classical, alternative, and lectin pathways.

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153
Q

What activates the classical pathway of complement activation?

A

IgM and IgG antibodies bound to antigens.

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154
Q

What activates the alternative pathway of complement activation?

A

Microbial cell surfaces in the absence of antibody.

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155
Q

What activates the lectin pathway of complement activation?

A

Plasma lectins binding to surface carbohydrates on microbes.

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156
Q

What is the central event in all complement activation pathways?

A

Proteolysis of the complement protein C3 to generate C3a and C3b.

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157
Q

What is the role of C3b in complement activation?

A

C3b covalently attaches to microbial surfaces or antibody-bound antigens and promotes phagocytosis.

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158
Q

What enzyme complex cleaves C5 into C5a and C5b?

A

The C5 convertase.

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159
Q

What are the functions of C5a and C5b in complement activation?

A

C5a stimulates inflammation, and C5b contributes to pore formation in microbial membranes.

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160
Q

What initiates the alternative pathway of complement activation?

A

The stable attachment of C3b to microbial surfaces without the need for antibodies.

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161
Q

What is C3 tickover?

A

The continuous low-rate hydrolysis and cleavage of C3 to generate C3b.

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162
Q

What causes C3b to become covalently attached to cell surfaces?

A

The exposure of the reactive thioester bond in C3b after cleavage.

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163
Q

What happens to C3b if it does not form covalent bonds with cell surfaces?

A

It remains in the fluid phase and is quickly hydrolyzed, becoming inactive.

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164
Q

What is the role of Factor B in the alternative pathway?

A

Factor B binds to C3b on cell surfaces and is cleaved by Factor D to form the alternative pathway C3 convertase.

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165
Q

What is the C3bBb complex?

A

The alternative pathway C3 convertase that cleaves more C3 molecules.

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166
Q

How does the alternative pathway C3 convertase amplify complement activation?

A

By forming a complex with C3b and Bb, which cleaves additional C3 molecules.

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167
Q

What role does properdin play in the alternative pathway?

A

Properdin binds to and stabilizes the C3bBb complex, especially on microbial surfaces.

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168
Q

What forms the alternative pathway C5 convertase?

A

A complex containing one Bb moiety and two molecules of C3b.

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169
Q

What initiates the classical pathway of complement activation?

A

Binding of C1 to the CH2 domain of IgG or the CH3 domain of IgM bound to antigen.

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170
Q

Which IgG subclasses are the most efficient at activating the classical pathway?

A

IgG1 and IgG3.

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171
Q

Why can only antibodies bound to antigens initiate classical pathway activation?

A

Because C1q needs to bind to at least two Ig heavy chains to be activated, which requires antibodies to be bound to antigens.

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172
Q

What role does C1q play in the classical pathway?

A

C1q binds to the Fc regions of IgG or IgM, initiating the activation of C1r and C1s.

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173
Q

How does C1s contribute to complement activation in the classical pathway?

A

C1s cleaves C4 into C4b and C4a, with C4b forming covalent bonds on the cell surface.

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174
Q

What is the function of the C4b2a complex?

A

It is the classical pathway C3 convertase that cleaves C3 into C3a and C3b.

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175
Q

How does the C3b generated by the classical pathway affect the complement system?

A

C3b can bind Factor B, generating more C3 convertase and amplifying complement activation.

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176
Q

What forms the classical pathway C5 convertase?

A

The C4b2a3b complex, which cleaves C5 and initiates the late steps of complement activation.

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177
Q

Why is IgM a more efficient complement-fixing antibody than IgG?

A

Because a single IgM molecule can bind multiple C1q molecules, while IgG requires multiple molecules to bind C1q.

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178
Q

What triggers the lectin pathway of complement activation?

A

Binding of microbial polysaccharides to circulating lectins such as mannose-binding lectin (MBL) or ficolins.

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179
Q

What are the key components of MBL and ficolins involved in the lectin pathway?

A

MBL has a collagen-like domain and a carbohydrate recognition domain; ficolins have a collagen-like domain and a fibrinogen-like domain.

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180
Q

Which proteins are associated with MBL in the lectin pathway?

A

MBL-associated serine proteases (MASPs) including MASP1, MASP2, and MASP3.

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181
Q

What role do MASPs play in the lectin pathway?

A

MASPs cleave C4 and C2 to activate the complement pathway, similar to the function of C1r and C1s in the classical pathway.

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182
Q

MASPs cleave C4 and C2 to activate the complement pathway, similar to the function of C1r and C1s in the classical pathway.

A

Formation of the membrane attack complex (MAC) that can lyse cells.

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183
Q

What are the components that form the membrane attack complex (MAC)?

A

C5b, C6, C7, C8, and multiple C9 molecules.

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184
Q

What is the function of the C9 protein in the MAC?

A

C9 polymerizes to form pores in plasma membranes, allowing the movement of water and ions, leading to cell lysis.

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185
Q

How does C5b-8 contribute to the formation of pores in the membrane?

A

C5b-8 complex inserts into the lipid bilayer and forms unstable pores, which are then stabilized by C9.

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186
Q

What structural similarity does C9 have with perforin?

A

C9 is structurally homologous to perforin and forms similar membrane pores.

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187
Q

What is the main function of the type 1 complement receptor (CR1, CD35)?

A

Promotes phagocytosis of C3b- and C4b-coated particles and clearance of immune complexes from the circulation.

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188
Q

Where is CR1 primarily expressed?

A

On bone marrow-derived cells such as erythrocytes, neutrophils, monocytes, macrophages, eosinophils, T and B lymphocytes, and follicular dendritic cells.

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189
Q

What type of complement fragments does CR2 (CD21) bind?

A

C3d, C3dg, and iC3b.

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190
Q

What is the role of CR2 on B cells and follicular dendritic cells (FDCs)?

A

On B cells, CR2 enhances activation and response to antigens; on FDCs, it traps antigen-antibody complexes in germinal centers.

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191
Q

What is the primary function of the type 3 complement receptor (MAC-1, CR3)?

A

Promotes phagocytosis of microbes opsonized with iC3b and binds to ICAM-1 to aid in leukocyte attachment to endothelial cells.

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192
Q

What distinguishes CR4 (p150,95) from MAC-1 (CR3)?

A

CR4 has a different _ chain (CD11c) but the same _ chain (CD18) as MAC-1 and likely has similar functions.

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193
Q

Where is the complement receptor CRIg found and what is its role?

A

CRIg is found on macrophages in the liver (Kupffer cells) and is involved in the clearance of opsonized bacteria and blood-borne pathogens.

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194
Q

What is the role of C5aR1 and C3aR?

A

Both are G protein-coupled receptors that mediate the proinflammatory effects of C5a and C3a, respectively.

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195
Q

What is the function of the C1q receptor?

A

Assists in the clearance of apoptotic bodies and protein fibers such as amyloid fibrils by binding C1q.

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196
Q

What is the main role of C1 inhibitor (C1 INH) in complement regulation?

A

Inhibits the proteolytic activity of C1r, C1s, and MASP2 to prevent excessive activation of the classical and lectin pathways.

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197
Q

What disease is caused by a deficiency of C1 INH, and what are its symptoms?

A

Hereditary angioedema; symptoms include intermittent edema in the skin and mucosa, abdominal pain, vomiting, diarrhea, and airway obstruction.

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198
Q

How do regulatory proteins like MCP, CR1, and DAF inhibit complement activation on normal cells?

A

By binding to C3b and C4b on cell surfaces, preventing the assembly of C3 and C5 convertases.

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199
Q

What is the role of Factor H in complement regulation?

A

Inhibits the binding of Bb to C3b, regulating the alternative pathway of complement activation.

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200
Q

What disease is characterized by recurrent hemolysis due to unregulated complement activation, and what causes it?

A

Paroxysmal nocturnal hemoglobinuria; caused by a deficiency of GPI-linked proteins such as DAF and CD59 due to an acquired somatic mutation.

201
Q

What is the function of CD59 in complement regulation?

A

Inhibits the formation of the membrane attack complex (MAC) by preventing the addition of C9 molecules to the C5b-8 complex.

202
Q

How do plasma carboxypeptidases regulate inflammation induced by C3a and C5a?

A

By cleaving their C-terminal arginine residues to form C3a des-Arg and C5a des-Arg, which have reduced activity.

203
Q

What is the function of S protein in complement regulation?

A

Binds to soluble C5b-6-7 complexes to prevent their insertion into cell membranes and the formation of MACs.

204
Q

What is the hierarchy of importance for inhibiting complement activation based on the abundance of regulatory proteins on cell surfaces?

A

CD59 > DAF > MCP

205
Q

What is the role of complement fragments C3b and iC3b in phagocytosis?

A

They act as opsonins by binding to specific receptors on macrophages and neutrophils, enhancing the phagocytosis of coated microbes.

206
Q

How does the complement system contribute to the defense against bacteria with polysaccharide-rich capsules?

A

IgM antibodies against these capsules activate the classical pathway, leading to complement-mediated phagocytosis of the bacteria.

207
Q

Which complement fragment is the most potent mediator of mast cell degranulation?

A

C5a.

208
Q

What is the primary function of the membrane attack complex (MAC) in the complement system?

A

To mediate the lysis of foreign organisms by creating pores in their cell membranes.

209
Q

To mediate the lysis of foreign organisms by creating pores in their cell membranes.

A

By binding to antigen-antibody complexes, complement proteins help dissolve these complexes and facilitate their clearance by phagocytes.

210
Q

What is the function of C3d in relation to B cell activation?

A

C3d binds to CR2 on B cells, enhancing B cell activation and the development of humoral immune responses.

211
Q

What role do follicular dendritic cells (FDCs) play in complement-mediated humoral immunity?

A

They trap opsonized antigens in germinal centers, displaying them to B cells and aiding in the selection of high-affinity B cells.

212
Q

How does complement contribute to the clearance of apoptotic cells?

A

Complement proteins and natural antibodies help clear apoptotic cells and their fragments by promoting their recognition and phagocytosis.

213
Q

How can complement activation lead to ischemic tissue injury?

A

Complement activation can result in intravascular thrombosis and damage to endothelial cells, which favors coagulation and can lead to ischemic injury.

214
Q

What are immune complex-mediated diseases, and how are they related to complement activation?

A

These diseases are caused by the deposition of antigen-antibody complexes in blood vessels and kidney glomeruli, leading to complement activation, inflammation, and tissue damage.

215
Q

These diseases are caused by the deposition of antigen-antibody complexes in blood vessels and kidney glomeruli, leading to complement activation, inflammation, and tissue damage.

A

Complement activation by deposited immune complexes leads to inflammation, destruction of vessel walls or glomeruli, thrombosis, and ischemic damage.

216
Q

Complement activation by deposited immune complexes leads to inflammation, destruction of vessel walls or glomeruli, thrombosis, and ischemic damage.

A

Antibodies against C5 are used to treat paroxysmal nocturnal hemoglobinuria, complement-mediated hemolytic uremic syndrome, and neuromyelitis optica. Recombinant human C1 INH is used to treat hereditary angioedema.

217
Q

How do some pathogens use sialic acids to evade complement activation?

A

Pathogens recruit sialic acids to their surfaces, which attract Factor H, displacing C3b and inhibiting the alternative pathway of complement.

218
Q

Which pathogen incorporates host complement regulatory proteins into its envelope to evade complement?

A

Human immunodeficiency virus (HIV) incorporates GPI-anchored complement regulatory proteins DAF and CD59 into its envelope.

219
Q

What protein does Staphylococcus aureus produce to inhibit complement activation?

A

Staphylococcus aureus produces staphylococcal complement inhibitor, which binds to and inhibits both the classical and alternative pathway C3 convertases.

220
Q

How does the complement inhibitory protein of the vaccinia virus affect complement pathways?

A

The vaccinia virus complement inhibitory protein resembles human C4BP, binding to both C4b and C3b, and accelerates the decay of C3 and C5 convertases.

221
Q

What role does the protein chemokine inhibitory protein of staphylococci (CHIPS) play in complement evasion?

A

CHIPS acts as an antagonist of the C5a anaphylatoxin, inhibiting complement-mediated inflammation.

222
Q

Which cancer is curable?

A

Hodgkin lymphoma

223
Q

Which cancer is virtually always fatal?

A

Pancreatic adenocarcinoma

224
Q

What is necessary for controlling cancer?

A

Learning more about its causes and pathogenesis

225
Q

What happened to cancer mortality rates in the United States during the last decades?

A

Declined

226
Q

What helps to distinguish benign and malignant tumors?

A

Morphologic characteristics

227
Q

What provides a measure of the impact of cancer on human populations?

A

Epidemiology

228
Q

What plays a critical role in the development of neoplasia?

A

Genetic alterations

229
Q

What is the focus of new technologies in cancer diagnosis?

A

Targeting particular molecular lesions

230
Q

What does neoplasia mean?

A

New growth

231
Q

What does the term tumor originally describe?

A

Swelling caused by inflammation

232
Q

What is the study of tumors or neoplasms called?

A

Oncology

233
Q

What is a modern definition of neoplasm?

A

A genetic disorder of cell growth

234
Q

What gives neoplastic cells a survival and growth advantage?

A

Mutations affecting genes

235
Q

What are the two components of all tumors?

A

Neoplastic cells and reactive stroma

236
Q

What determines the classification and biologic behavior of tumors?

A

Parenchymal component

237
Q

What term describes tumors with abundant collagenous stroma?

A

Desmoplasia

238
Q

What are stony hard desmoplastic tumors called?

A

Scirrhous

239
Q

Where do benign tumors remain localized?

A

At their site of origin

240
Q

What is the general outcome for patients with benign tumors?

A

Survival

241
Q

What type of benign tumor occurs in the brain and may be fatal?

A

Benign brain tumors

242
Q

What suffix is used to name benign tumors of mesenchymal cells?

A

NAME?

243
Q

What is a benign tumor of fibroblast-like cells called?

A

Fibroma

244
Q

What is a benign cartilaginous tumor called?

A

Chondroma

245
Q

What is a benign epithelial neoplasm derived from glandular tissues called?

A

Adenoma

246
Q

What are benign epithelial neoplasms with fingerlike projections called?

A

Papillomas

247
Q

What is a benign epithelial tumor forming large cystic masses called?

A

Cystadenoma

248
Q

What is a tumor producing papillary projections into cystic spaces called?

A

Papillary cystadenoma

249
Q

What is a neoplasm producing a projection above a mucosal surface called?

A

Polyp

250
Q

What is a polyp with glandular tissue called?

A

Adenomatous polyp

251
Q

What can malignant tumors do that benign tumors cannot?

A

Invade and metastasize

252
Q

What are malignant tumors collectively referred to as?

A

Cancers

253
Q

What is the origin of the word “cancer”?

A

Latin for crab

254
Q

What is the outcome for some cancers discovered at early stages?

A

Surgical excision or cure

255
Q

What is the term for malignant tumors arising from solid mesenchymal tissues?

A

Sarcomas

256
Q

What are malignant tumors of blood-forming cells called?

A

Leukemias

257
Q

What are tumors of lymphocytes or their precursors called?

A

Lymphomas

258
Q

What are malignant neoplasms of epithelial origin called?

A

Carcinomas

259
Q

What type of carcinoma has tumor cells resembling stratified squamous epithelium?

A

Squamous cell carcinoma

260
Q

What is the term for malignant epithelial cells growing in a glandular pattern?

A

Adenocarcinoma

261
Q

What is the term for cancers with cells of unknown origin?

A

Undifferentiated malignant tumors

262
Q

What is an example of a mixed tumor?

A

Salivary gland mixed tumor

263
Q

What does pleomorphic adenoma refer to?

A

A neoplasm with both epithelial and mesenchymal components

264
Q

From how many germ layers are most neoplasms composed?

A

One

265
Q

What is a tumor containing cells from more than one germ layer called?

A

Teratoma

266
Q

Where do teratomas originate from?

A

Totipotential germ cells

267
Q

What type of tumor contains bone

A

epithelium, muscle, fat, and nerve tissue?,Teratoma

268
Q

What is a common pattern seen in ovarian cystic teratoma?

A

Differentiation along ectodermal lines

269
Q

What is an ovarian cystic teratoma also known as?

A

Dermoid cyst

270
Q

What is the key distinction between benign and malignant tumors?

A

Histologic and anatomic features

271
Q

What does differentiation refer to in neoplasms?

A

Extent of resemblance to normal cells

272
Q

What is the term for lack of differentiation in tumors?

A

Anaplasia

273
Q

What type of tumor is usually well differentiated?

A

Benign tumors

274
Q

What type of tumor is highly predictive of malignant behavior?

A

Highly anaplastic tumors

275
Q

What is pleomorphism?

A

Variation in cell size and shape

276
Q

What is the typical nuclear-to-cytoplasm ratio in cancer cells?

A

1:01

277
Q

What do undifferentiated cancers often contain many of?

A

Mitoses

278
Q

What is a key feature of malignant tumors regarding cell polarity?

A

Loss of polarity

279
Q

What causes areas of ischemic necrosis in rapidly growing cancers?

A

Insufficient blood supply

280
Q

What is metaplasia?

A

Replacement of one cell type with another

281
Q

What is dysplasia?

A

Disordered growth of cells

282
Q

What is carcinoma in situ?

A

Severe dysplasia involving the full thickness of epithelium without invasion

283
Q

Where are dysplastic changes often found?

A

Adjacent to foci of invasive carcinoma

284
Q

What frequently antedates the appearance of cancer in the cervix?

A

Severe epithelial dysplasia or carcinoma in situ

285
Q

Can mild dysplasias contain mutations associated with cancer?

A

Yes

286
Q

Does dysplasia always progress to cancer?

A

No

287
Q

What can happen to dysplasias with removal of inciting causes?

A

They may be completely reversible

288
Q

How long can carcinoma in situ persist before becoming invasive?

A

Years

289
Q

What is needed for the evolution of full-blown cancers from in situ lesions?

A

Accumulation of mutations

290
Q

Does dysplasia always occur in metaplastic epithelium?

A

No

291
Q

What is the growth of cancers accompanied by?

A

Progressive invasion and destruction of surrounding tissue

292
Q

What separates benign tumors from surrounding normal tissue?

A

A capsule

293
Q

What are benign neoplasms composed of tangled blood vessels called?

A

Hemangiomas

294
Q

What pattern of growth is typical of malignant tumors?

A

Crablike pattern

295
Q

What is the most reliable discriminator of malignant and benign tumors?

A

Invasiveness

296
Q

What defines metastasis?

A

Spread of a tumor to discontinuous sites

297
Q

What two malignant neoplasms rarely metastasize?

A

Gliomas and basal cell carcinomas

298
Q

What percentage of solid tumors present as metastatic disease?

A

30%

299
Q

What are the three pathways of cancer spread?

A

Direct seeding, lymphatic spread, hematogenous spread

300
Q

What type of cancer often spreads by seeding in the peritoneal cavity?

A

Ovarian carcinomas

301
Q

What is the term for a gelatinous neoplastic mass filling the peritoneal cavity?

A

Pseudomyxoma peritonei

302
Q

What is the most common pathway for carcinoma dissemination?

A

Lymphatic spread

303
Q

What is the first site breast cancer usually spreads to?

A

Axillary lymph nodes

304
Q

What is the term for bypassing local lymph nodes in cancer spread?

A

Skip metastasis

305
Q

What is a sentinel lymph node?

A

The first node to receive lymph flow from a primary tumor

306
Q

How is sentinel node mapping performed?

A

Injection of radiolabeled tracers or colored dyes

307
Q

What can cause enlarged lymph nodes besides metastasis?

A

Immune response or hyperplasia

308
Q

What type of tumors typically spread through hematogenous routes?

A

Sarcomas

309
Q

Which organs are most frequently involved in hematogenous metastasis?

A

Liver and lungs

310
Q

Which cancers often metastasize to the vertebrae via the paravertebral plexus?

A

Thyroid and prostate carcinomas

311
Q

Which cancer can invade the renal vein and grow into the inferior vena cava?

A

Renal cell carcinoma

312
Q

What are the main characteristics that distinguish benign from malignant tumors?

A

Differentiation, invasiveness, and spread

313
Q

How do benign tumors compare to malignant tumors in differentiation?

A

Benign tumors are well differentiated

314
Q

What type of tumor is more likely to retain functions of its cells of origin?

A

Benign tumors

315
Q

How do benign tumors compare to malignant tumors in growth rate?

A

Benign tumors grow slower

316
Q

How are benign tumors physically characterized?

A

Circumscribed with a capsule

317
Q

How do malignant tumors invade surrounding tissues?

A

They are poorly circumscribed and invasive

318
Q

Where do benign tumors remain?

A

Localized at the site of origin

319
Q

Which tumors prefer to spread via lymphatics?

A

Carcinomas

320
Q

Which tumors prefer the hematogenous route for spreading?

A

Sarcomas

321
Q

What has epidemiology linked smoking to?

A

Lung cancer

322
Q

What dietary pattern is linked to colon cancer?

A

High fat and low fiber diet

323
Q

What percentage of global deaths were caused by cancer in 2018?

A

Nearly 1 in 6

324
Q

Which cancers are the most common in men?

A

Prostate, lung, and colon/rectum

325
Q

Which cancers are the most common in women?

A

Breast, lung, and colon/rectum

326
Q

What test led to a decline in cervical cancer deaths?

A

Papanicolaou (Pap) smear

327
Q

What is the main cause of the decline in lung cancer deaths?

A

Decreased tobacco use

328
Q

Which infectious agent is associated with cervical cancer?

A

Human papillomavirus (HPV)

329
Q

Which cancer is linked to alcohol abuse?

A

Hepatocellular carcinoma

330
Q

What percentage of cancers worldwide are caused by infectious agents?

A

About 15%

331
Q

What is a sentinel lymph node?

A

The first node that receives lymph from the primary tumor

332
Q

Which cancers are more common in obese individuals?

A

Breast, colorectal, and endometrial cancers

333
Q

What is a major cancer risk factor in older adults?

A

Accumulation of somatic mutations

334
Q

What is the usual cause of cancer in families with inherited traits?

A

Germline mutations in tumor suppressor genes

335
Q

What percentage of cancers in the U.S. are sporadic?

A

Roughly 95%

336
Q

Can hereditary factors still play a role in sporadic cancers?

A

Yes

337
Q

What is an example of a gene mutation that increases breast cancer risk?

A

BRCA1 or BRCA2

338
Q

What environmental factor has been linked to an increased breast cancer risk in women with BRCA mutations?

A

Changes in reproductive history

339
Q

What genetic system influences the activation of procarcinogens?

A

Cytochrome P-450

340
Q

What gene polymorphism increases susceptibility to smoking-induced lung cancer?

A

P-450

341
Q

What factors influence the incidence of cancer?

A

Geography, age, race, and genetic background

342
Q

What age group is cancer most common in?

A

Adults older than 55

343
Q

What is the primary cause of geographic variation in cancer incidence?

A

Different environmental exposures

344
Q

What are important environmental factors implicated in carcinogenesis?

A

Infectious agents, smoking, alcohol, diet, obesity, reproductive history, and carcinogen exposure

345
Q

What increases cancer risk related to chronic inflammation or injury?

A

Reparative proliferations

346
Q

What other conditions increase the risk of cancer?

A

Certain forms of hyperplasia and immunodeficiency

347
Q

What may be important determinants of cancer risk?

A

Interactions between environmental and genetic factors

348
Q

What lies at the heart of carcinogenesis?

A

Nonlethal genetic damage

349
Q

What forms a tumor?

A

Clonal expansion of a single precursor cell with genetic damage

350
Q

What are the four principal gene targets of cancer-causing mutations?

A

Proto-oncogenes, tumor suppressor genes, apoptosis-regulating genes, DNA repair genes

351
Q

What do proto-oncogene mutations cause?

A

Gain of function

352
Q

What do tumor suppressor gene mutations cause?

A

Loss of function

353
Q

What is a mutator phenotype?

A

A state marked by genomic instability

354
Q

What is the result of carcinogenesis?

A

Accumulation of mutations over time

355
Q

What are driver mutations?

A

Mutations that contribute to cancer hallmarks

356
Q

What is an initiating mutation?

A

The first driver mutation that starts malignancy

357
Q

What increases the frequency of both driver and passenger mutations?

A

Genomic instability

358
Q

What are passenger mutations?

A

Mutations with no phenotypic consequence

359
Q

How do tumors evolve during their growth?

A

Under Darwinian selection (survival of the fittest)

360
Q

What happens to tumor cells during expansion?

A

They acquire additional mutations at random

361
Q

What is the term for tumors becoming more aggressive over time?

A

Tumor progression

362
Q

What is a common feature of tumors by the time they become clinically evident?

A

Genetic heterogeneity

363
Q

What explains changes in tumor behavior following therapy?

A

Selection of subclones resistant to treatment

364
Q

What epigenetic modification tends to silence gene expression?

A

DNA methylation

365
Q

What role do histone modifications play in gene expression?

A

They can enhance or dampen gene expression

366
Q

How are epigenetic changes different from DNA mutations in cancer treatment?

A

Epigenetic changes are potentially reversible by drugs

367
Q

What is responsible for silencing some tumor suppressor genes in cancer cells?

A

Aberrant DNA methylation

368
Q

What enables tumors to proliferate without external stimuli?

A

Oncogene activation

369
Q

Why do tumors not respond to growth-inhibitory signals?

A

Inactivation of tumor suppressor genes

370
Q

What metabolic switch do tumor cells undergo?

A

Aerobic glycolysis (Warburg effect)

371
Q

How do tumors evade programmed cell death?

A

By resisting apoptosis

372
Q

What allows tumors to have limitless replicative potential?

A

Avoidance of cellular senescence and mitotic catastrophe

373
Q

Why do tumors need to induce angiogenesis?

A

To supply nutrients and oxygen for growth

374
Q

What causes the majority of cancer deaths?

A

Tumor metastases

375
Q

How do tumors evade the host immune response?

A

By altering the immune recognition of abnormal antigens

376
Q

What two enabling characteristics accelerate tumor progression?

A

Genomic instability and cancer-promoting inflammation

377
Q

What are oncogenes?

A

Mutated genes that cause excessive cell growth

378
Q

What are normal cellular genes that can become oncogenes called?

A

Proto-oncogenes

379
Q

What do oncoproteins do?

A

Promote uncontrolled cell proliferation

380
Q

What is the first step in normal growth factor signaling?

A

Binding of a growth factor to its specific receptor

381
Q

What happens after growth factor receptor activation?

A

Activation of cytoplasmic signal-transducing proteins

382
Q

What is the result of signal transduction in normal cells?

A

Induction of transcription factors and gene expression

383
Q

What do oncoproteins disrupt in cancer cells?

A

Normal checkpoints that regulate cell proliferation

384
Q

Which signaling pathways are often implicated in cancer?

A

Receptor tyrosine kinase, JAK/STAT, WNT, Notch, Hedgehog, TGF-_/SMAD, and NF-_B pathways

385
Q

What does cell growth require besides DNA replication?

A

Biosynthesis of membrane, proteins, and organelles

386
Q

What is a new target for cancer therapies?

A

Oncogenic pro-growth signaling and altered cellular metabolism

387
Q

What do oncogenes encode?

A

Constitutively active oncoproteins

388
Q

How do cancer cells create an autocrine loop?

A

By synthesizing growth factors to which they are responsive

389
Q

What are receptor tyrosine kinases activated by?

A

Mutations that cause constitutive tyrosine kinase activity

390
Q

What gene is amplified in certain breast carcinomas?

A

ERBB2 (HER2)

391
Q

What fusion gene is found in a subset of lung adenocarcinomas?

A

EML4-ALK

392
Q

What is the most common type of proto-oncogene mutation in human tumors?

A

RAS mutations

393
Q

What causes RAS to remain in an active GTP-bound form?

A

Point mutations that reduce GTPase activity

394
Q

What role does NF1 play in RAS signaling?

A

It acts as a tumor suppressor by negatively regulating RAS

395
Q

What protein kinases are involved in downstream signaling from RAS?

A

BRAF and PI3K

396
Q

What phenomenon occurs when tumors are dependent on a specific oncogene for survival?

A

Oncogene addiction

397
Q

What is the BCR-ABL fusion gene associated with?

A

Chronic myeloid leukemia (CML)

398
Q

What has revolutionized the treatment of CML?

A

BCR-ABL kinase inhibitors

399
Q

What is an example of oncogene addiction in CML?

A

Dependence on BCR-ABL signaling

400
Q

Why is inhibition of BCR-ABL effective in CML treatment?

A

CML tumor cells require BCR-ABL signaling for proliferation and survival

401
Q

Why doesn’t treatment with BCR-ABL inhibitors cure CML?

A

Rare CML stem cells persist without requiring BCR-ABL signals

402
Q

What pathway is JAK2 involved in?

A

JAK/STAT signaling pathway

403
Q

What do activating mutations in JAK2 cause?

A

Independence from hematopoietic growth factors

404
Q

Where do all signal transduction pathways ultimately converge?

A

The nucleus

405
Q

What is the ultimate consequence of deregulated mitogenic signaling pathways?

A

Continuous stimulation of nuclear transcription factors

406
Q

What can cause growth autonomy in cancer cells?

A

Mutations affecting transcription factors that regulate pro-growth genes

407
Q

Which transcription factor is most commonly affected in cancer?

A

MYC

408
Q

What are some other transcription factors involved in cancer?

A

MYB, JUN, FOS, and REL

409
Q

What type of gene is MYC?

A

Proto-oncogene

410
Q

How is MYC normally regulated?

A

Through transcription, translation, and protein stability

411
Q

What is one way MYC contributes to cancer?

A

Activates expression of genes involved in cell growth

412
Q

Which genes involved in cell cycle progression are targets of MYC?

A

D cyclins

413
Q

How does MYC enhance protein synthesis?

A

By upregulating ribosomal RNA (rRNA) genes and processing

414
Q

How does MYC contribute to the Warburg effect?

A

Upregulates genes involved in glycolysis and glutamine metabolism

415
Q

Which type of cancer is associated with MYC translocation?

A

Burkitt lymphoma

416
Q

What role does MYC play in cell immortality?

A

Upregulates telomerase expression

417
Q

In which cancers is MYC often amplified?

A

Breast, colon, lung, neuroblastomas, and small cell lung cancers

418
Q

How do upstream signaling pathways elevate MYC levels?

A

By increasing MYC transcription, mRNA translation, and stabilizing MYC protein

419
Q

What do CDK-cyclin complexes do?

A

Phosphorylate target proteins to drive cell cycle progression

420
Q

What silences CDKs to exert negative control over the cell cycle?

A

CDK inhibitors

421
Q

Where are the two main cell cycle checkpoints located?

A

G1/S transition and G2/M transition

422
Q

What happens if DNA damage sensors are activated?

A

Cell cycle progression is arrested or apoptosis is initiated

423
Q

What type of mutations promote unregulated G1/S progression?

A

Gain-of-function mutations in D cyclin genes and CDK4

424
Q

In which cancers is CDK4 gene amplification commonly found?

A

Melanomas, sarcomas, and glioblastomas

425
Q

What effect do CDK4 inhibitors have in cancer treatment?

A

They are effective in treating advanced breast cancers with excessive CDK4 activity

426
Q

What type of mutations inhibit G1/S progression?

A

Loss-of-function mutations in tumor suppressor genes

427
Q

What gene mutation is common in melanoma-prone families?

A

Germline mutations of p16 (CDKN2A)

428
Q

Which tumor suppressor genes inhibit G1/S progression?

A

RB and TP53

429
Q

What are proto-oncogenes?

A

Normal genes that promote cell proliferation

430
Q

What are oncogenes?

A

Mutated or overexpressed proto-oncogenes that function autonomously

431
Q

What is an oncoprotein?

A

A protein encoded by an oncogene that drives increased cancer cell proliferation

432
Q

What creates an autocrine signaling loop in cancer cells?

A

Constitutive expression of growth factors and receptors

433
Q

Which mutation activates the EGF receptor in lung cancer?

A

Point mutations

434
Q

How is the HER2 receptor activated in breast cancer?

A

Gene amplification

435
Q

Which gene is involved in the BCR-ABL fusion in CML?

A

ABL nonreceptor tyrosine kinase

436
Q

What is the most common mutation in RAS activation?

A

Point mutations

437
Q

Which kinases are activated by mutations in many cancers?

A

PI3K and BRAF serine/threonine kinases

438
Q

How is MYC deregulated in Burkitt lymphoma?

A

Chromosomal translocations

439
Q

What promotes cell cycle progression in cancer cells?

A

Increased activity of CDK4/D cyclin complexes

440
Q

What do tumor suppressor genes do?

A

Apply brakes to cell proliferation

441
Q

What happens when tumor suppressor genes are mutated?

A

Failure of growth inhibition

442
Q

What regulatory network do many tumor suppressors belong to?

A

One that recognizes genotoxic stress and shuts down proliferation

443
Q

What happens when oncogenes are expressed in cells with intact tumor suppressors?

A

Quiescence or permanent cell cycle arrest (oncogene-induced senescence)

444
Q

What is the “two-hit” hypothesis for retinoblastoma?

A

Both RB alleles must be mutated for cancer to occur

445
Q

How is retinoblastoma inherited in familial cases?

A

As an autosomal dominant trait

446
Q

What happens in sporadic cases of retinoblastoma?

A

Both RB alleles undergo somatic mutation

447
Q

How does RB function at the cellular level?

A

As a recessive trait when lost in individual cells

448
Q

What is the role of many tumor suppressors?

A

Inhibiting cell cycle progression and ensuring genomic stability

449
Q

How can tumor suppressors prevent cellular transformation?

A

By altering cell metabolism or ensuring genomic stability

450
Q

What is RB’s role in the cell cycle?

A

Key negative regulator of the G1/S cell cycle transition

451
Q

In what state is RB active?

A

Hypophosphorylated state

452
Q

How can RB be inactivated?

A

Loss-of-function mutations or hyperphosphorylation by CDK/cyclin complexes

453
Q

What drives the expression of genes needed for S phase progression?

A

E2F transcription factors

454
Q

How does growth factor signaling affect RB?

A

Upregulates CDK/cyclin activity, leading to RB hyperphosphorylation

455
Q

Why do patients with RB mutations mainly develop retinoblastoma?

A

The reason is unclear, but other RB-like proteins may compensate in other tissues

456
Q

What mutations mimic RB loss in cancer?

A

Mutations in cyclin D, CDK4, or CDK inhibitors

457
Q

How do DNA viruses inactivate RB?

A

By binding to RB and releasing E2F transcription factors

458
Q

What does RB do when hypophosphorylated?

A

Binds and inhibits E2F transcription factors

459
Q

What leads to RB hyperphosphorylation and inactivation?

A

Normal growth factor signaling

460
Q

What is required for cells to pass the G1/S phase checkpoint?

A

E2F transcription factors

461
Q

How is the antiproliferative effect of RB abrogated in cancer?

A

Through loss-of-function RB mutations, CDK4/cyclin D amplification, or loss of CDK inhibitors

462
Q

Which viral oncoprotein inhibits RB?

A

E7 protein of HPV

463
Q

What does the TP53 gene encode?

A

The protein p53

464
Q

What is the role of p53?

A

Regulates cell cycle, DNA repair, senescence, and apoptosis

465
Q

What percentage of human cancers have TP53 mutations?

A

More than 50%

466
Q

What syndrome is associated with inherited TP53 mutations?

A

Li-Fraumeni syndrome

467
Q

How is p53 kept in check in normal cells?

A

By association with MDM2, which leads to p53 degradation

468
Q

What activates p53 in stressed cells?

A

DNA damage, hypoxia, or oncogenic stress

469
Q

What are the three possible outcomes of p53 activation?

A

Transient cell cycle arrest, senescence, or apoptosis

470
Q

What gene does p53 activate for cell cycle arrest?

A

CDKN1A, which encodes the CDK inhibitor p21

471
Q

How does p53 promote apoptosis?

A

By activating pro-apoptotic genes like BAX and PUMA

472
Q

What happens when p53 function is lost?

A

DNA damage goes unrepaired, leading to malignant transformation

473
Q

How does p53 status affect cancer treatment response?

A

Tumors with wild-type TP53 are more responsive to chemotherapy and radiation

474
Q

What does p53 monitor in the cell?

A

Stress from anoxia, mutated oncoproteins, or DNA damage

475
Q

What proteins does p53 control?

A

Proteins involved in cell cycle arrest, DNA repair, senescence, and apoptosis

476
Q

Which kinases phosphorylate p53 in response to DNA damage?

A

ATM/ATR family kinases

477
Q

What effect does p53 activation have on the cell cycle?

A

It upregulates p21, causing cell-cycle arrest at the G1/S checkpoint

478
Q

What happens if DNA damage cannot be repaired?

A

p53 induces senescence or apoptosis

479
Q

What mutation is found in the majority of human cancers?

A

Biallelic loss-of-function mutations in TP53

480
Q

What syndrome is associated with inherited TP53 mutations?

A

Li-Fraumeni syndrome

481
Q

How is p53 inactivated by viruses?

A

Viral oncoproteins like HPV E6 protein

482
Q

How are tumor suppressor genes often disabled?

A

Through recurrent chromosomal deletions

483
Q

What role does the APC gene play in colonic neoplasia?

A

It downregulates growth-promoting signaling pathways

484
Q

What disorder is associated with germline APC mutations?

A

Familial adenomatous polyposis

485
Q

What percentage of nonfamilial colorectal carcinomas show APC defects?

A

70% to 80%

486
Q

What pathway does APC regulate?

A

The WNT signaling pathway

487
Q

What does APC normally do to _-catenin?

A

It helps form a destruction complex that degrades _-catenin

488
Q

What happens when APC is lost in cells?

A

Beta-catenin is stabilized, leading to continuous growth signaling

489
Q

What genes are upregulated by _-catenin?

A

MYC, cyclin D1, and other growth-promoting genes

490
Q

What percentage of hepatocellular carcinomas have _-catenin gain-of-function mutations?

A

About 20%

491
Q

What is the role of E-cadherin?

A

Maintains intercellular adhesiveness and regulates _-catenin

492
Q

What happens when E-cadherin is lost?

A

Cells disaggregate, promoting invasion and metastasis

493
Q

Which cancers show reduced E-cadherin expression?

A

Esophagus, colon, breast, ovary, and prostate

494
Q

What syndrome is associated with germline E-cadherin mutations?

A

Familial gastric carcinoma

495
Q

What proteins are encoded by the CDKN2A gene?

A

p16/INK4a and p14/ARF

496
Q

What is the role of p16/INK4a?

A

Blocks CDK4/cyclin D-mediated phosphorylation of RB

497
Q

What cancers are associated with CDKN2A mutations?

A

Melanoma, bladder, head and neck, and cholangiocarcinoma

498
Q
A