CNA and Autoimmunity

Question 1

What antibody is elevated in MS

Answer 1

IgG

Question 2

Where is this antibody formed

Answer 2

In the CSF

Question 3

What is the unique about this antobody

Answer 3

It is oligoclonal and the cells are making this IgG inside the brain

Question 4

How is the prognosis of the disease if this antibody is present

Answer 4

Presence of oligoclonal IgG indicated a poor prognosis

Question 5

What does it mean when an antibody is oligoclonal

Answer 5

It is made by many different B cell clones

Question 6

How does SPE results differ for polyclonal, oligoclonal and monoclonal

Answer 6

SPE results yield a thick band for serum albumin and then there are alpha and beta bands. For monoclonal, we will see one thick band in the gamma region, for oligoclonal we may see 2 or 3 thick bands and for polyclonal we will see a thick gamma region such that we cant differentiate one band from the other.

MS has an oligoclonal appearance on SPE

Question 7

What band appearence is observed in an infection

Answer 7

Oligoclonal

Question 8

What band appearence is in autoimmunity

Answer 8

Oligoclonal

Question 9

What is the ratio of the light chains in Ig

Answer 9

Kappa to lamda is 3:1

Question 10

Give an example of neoplasm that is example of monoclonal gammopathies

Answer 10

Multiple Myeloma

Question 11

Explain multiple myeloma

Answer 11

It is a monoclonal malignancy, one of the plasma cells in the bone marrow starts to divide aberrantly. The plasma cells make excessive same type of antibody. The cells pack up in the bone marrow to such an extent that other HSC processes are severly affected, the bone starts degrading and one of the clinical presentations of Multiple myeloma is bone fracture

Question 12

What does it mean if the IgG to albumin ratio is elevated in the CSF

Answer 12

That means the IgG is being made in the brain as it is coming from the CNS

Question 13

Expalin the causes of the lesions in the brain in MS

Answer 13

Follicles form in the brain which causes lesions to form right next to the follicles. During early onset of MS follicles are in greater number than the lesions

Question 14

Explain the pathogenesis of MS

Answer 14

MS targets a range of antigens found in the brain, the most common one being myelin basic protein. APC cells present the antigen to T cells which causes differentiation into Th1 cells. Th1 cells at the brain make cytokines to activate macrophages which then causes destruction of myelin sheaths. This releases more antigens and DAMPS which are then presented by a different set of APCs which further recruit more Th1 cells. This cycle keeps going on. This phenomena is called epitope spreading.

Question 15

What is the clinical significance of epitope spreading

Answer 15

Different patients has present with very different symptoms

Question 16

What are the roles of B cells in MS

Answer 16

1. Antigen presentation
2. They make follicles in the brain
3. Make antibodies
4. Release cytokines
5. Antibodies can then in turn activate complement

Question 17

What is the treatment of MS

Answer 17

Steroids, a lot of steroids - methylprednisolone

Question 18

What another treatment of MS and what are the functions of the drug

Answer 18

Administering IFNbeta

1. Increases production of IL-10 and TGFbea
2. Increases the apoptosis of T cells
3. Increases the production of Reg T Cells.

Question 19

What kind of hypersensitivity is vasculitis

Answer 19

Type 3