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Clinical Pathology Year 2 > Core Immunology > Flashcards

Core Immunology Flashcards

1
Q

Features of the Innate Immune System? (inflammation in target tissue)

A 
Pattern recognition against broad classes of antigen
No memory
No amplification
Fast response
Short duration
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2
Q

Features of the Adaptive Immune System? (learned responses in immune organs)

A 
Highly specific (T & B cell receptors)
Strong memory & amplification component
Many regulatory mechanisms
Slow response, long duration
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3
Q

Examples of Innate vs Adaptive immune cells?

A 
Innate= Macrophages, Dendritic cells, Mast cells, Neutrophils, Complement
Adaptive= T & B cells
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4
Q

Give 4 examples of cross-talk between the 2 immune system components?

A
  • Chemokines: attract other immune cells to sites of inflammation
  • Cytokines: signal between different immune cells (T cell cytokines activate innate cells to cause inflammation)
  • Macrophages: also produce chemokines to attract other immune cells
  • Dendritic cells: also present antigen to adaptive immune system
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5
Q

What does the complement component of the Innate immune system do?

A

Directly attacks pathogens via alternative and lectin pathways.
May be activated by adaptive immune system via antibodies.

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6
Q

What are 2 specific mutations that may lead to an autoimmune disease?

A

1) Mutation of FOXP3 = failure to develop regulatory T cells, so severe autoimmunity from birth (immune dysregulation, polyendocrinopathy, X-linked syndrome)
2) Mutations in PTPN22 = T cells activated more easily so stronger immune response in general (type 1 diabetes, Rheumatoid Arthritis)

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7
Q

When may infections cause autoimmunity as well as a normal immune response?

A

Molecular Mimicry (eg in Rheumatoid fever, antibodies against M protein of Streptococcus also react against the glycoproteins of the heart)

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8
Q

3 examples of when a change in the nature or amount of autoantigens may cause autoimmunity?

A
  • Citrillination of proteins make them more immunogenic (–> rheumatoid arthritis)
  • Tissue transglutamase alters gluten to help it bind to HLA-DQ (–> coeliac disease)
  • Failure to clear apoptotic debris increases availability of sequestered antigens inside cell (–> SLE)
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9
Q

What is the definition of autoimmunity?

A

The ADAPTIVE immune system recognised & targets the body’s own molecules, cells & tissues.
Main characteristics= T cells that recognise self antigens. B cells & plasma cells that make autoantibodies. Inflammation is then secondary to this action.

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10
Q

What is the definition of autoinflammation?

A

INNATE immune system. Main cellular involvement are neutrophils & macrophages. Few or no autoantibodies.
No demonstrable source of infection as precipitating cause.

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11
Q

What are some examples of autoimmune and autinflammatory diseases?

A 
Autoimmune= Rheumatoid arthritis, coeliac disease, Addison disease, Myasthenia gravis, Type 1 diabetes, SLE
Autoinflammatory= Crohn's, UC, osteoarthritis, gout, giant cell arteritis, sarcoidosis.
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12
Q

(Autoimmune thyroid disease…)

a) Hashimotos Thyroiditis?
b) Grave’s disease?

A

a) (leads to hypothyroidism)… destruction of thyroid follicles by autoimmune response. Associated with autoantibodies to thyroglobulin & to thyroid peroxidase.
b) (leads to hyperthyroidism)… inappropriate stimulation of thyroid gland by anti-TSH-autoantibody

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13
Q

What is the brief pathology behind myasthenia gravis?

A

Autoantibodies block the Ach receptor in the post-synaptic membrane.

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14
Q

What is the pathology behind Systemic Lupus Erythematosus? (a connective tissue disease)

A

Antibodies against antigens in the nucleus combine with their targets to form IMMUNE COMPLEXES in the circulation. Immune complexes deposit in any organ- activate complement & cause inflammation.

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15
Q

Define… Sensitivity?

Specificity?

A 
Sensitivity= measure of how good is the test in identifying people with the disease
Specificity= measure of how good is the test at correctly defining people without the disease
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16
Q

What are some non-specific diagnostic tests of Autoimmune diseases?

A

Inflammatory markers: ESR, CRP, Ferritin, Fibrinogen, Albumin, Complement

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17
Q

(Specific Autoantibodies and clinical disease associations…)

  1. Anti-dsDNA?
  2. Anti-extractable nuclear agents (Anti-Sm, Anti-RNP)
  3. Anti-SSA / Anti-SSB
A
  1. Anti-dsDNA (antigenic determinant= dsDNA)… high specificity for SLE.
  2. (antigenic determinant= Smith, proteins containing U1-RNA)… SLE, RA, scleroderma, Sjogren syndrome
  3. (antigenic determinant= RNPs)… Sjogren syndrome, SLE, neonatal lupus/SLE
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18
Q

What are 2 markers for Rheumatoid Arthritis?

A

a) Rheumatoid Factor (RF)… Antibody (IgM, IgG or IgA) directed against the Fc portion of IgG. (Not diagnostic of the disease as seen in other chronic infections)
b) Anti-CCP (ACPA)… more specific for RA than RF, but similar sensitivity. ACPA positive patients have more severe disease.

19
Q

(autoimmune liver diseases)

a) Primary biliary sclerosis marker?
b) Autoimmune hepatitis?

A

a) Anti-mitochondrial Ab

b) Anti-smooth muscle and anti-liver/kidney/microsomal Abs

20
Q

What are the 4 types of Hypersensitivity reaction?

A

Type-I anaphylactic
Type-II cytotoxic
Type-III immune complex
Type-IV delayed type

21
Q

What are the antibodies and antigens associated with each?

A

Type-I–> antibody= IgE antigen= exogenous
Type-II–> antibody= IgG, IgM antigen= cell surface
Type-III–> antibody= IgG, IgM antigen= soluble
Type-IV–> antibody= none (transferred with T cells) antigen= tissues and organs

22
Q

What innocuous antigen in of each type of hypersensitivity reactiion?

A

Type-I anaphylactic= pollen/ hayfever
Type-II cytotoxic= penicillin
Type-III immune complex= mouldy hay, farmer’s lung
Type-IV delayed type= tuberculin test, poison ivy, metals (nickel)

23
Q

What is the immune response to a Parasitic Infection?

A
  • Increased levels of IgE
  • Tissue inflammation with Epsinophilia & mastocytosis, Basophil infiltration
  • Presence of CD4+ T cells secreting IL4, IL5 & IL13
24
Q

Genetic Influences on the ‘allergic’ immune response- what are the 4 characteristic groups of gene function?

A

1- Sensing the environment
2- Barrier function
3- Regulation of (atopic) inflammation
4- Tissue response genes

25
Q

What are some examples of Group 2 genes that create susceptibility for allergic disease by modifying barrier function?

A

FLG: directly affect dermal barrier function, associated with increased risk of atopic dermatitis.
ORMDL3/GSDML, PCDH1: help regulate epithelial barrier function.

26
Q

What are some examples of Group 3 genes that create susceptibility for allergic disease by regulating atopic inflammation?

A

IL13, IL4RA, STAT6: genes that regulate TH1/TH2 differentiation & effector function
IRAKM, PHF11: regulate atopic sensitization and inflammation.

27
Q

What are allergens?

A

Antigens that initiate an IgE-mediated response

First encounter results in innate and IgM response

28
Q

What is the role of IgE in Allergic response?

A

Immunopathogenesis: IgE Ab mediated mast cell and basophil degranulation- release of preformed and de novo inflammatory mediators.
Clinical features= fast onset, wheal and flare.

29
Q

What is the roll of the Th2 T cell?

A

Multiple cytokine release for INNATE inflammatory response, and also drive for immunoglobulin production.

30
Q

What is the Atopic Triad?

A

Rhinitis + Asthma + Eczema (atopic dermatitis)

31
Q

What is anaphylaxis?

A

An acute, potentially life-threatening, IgE mediated systemic hypersensitivity reaction.
Tests for diagnosis= skin prick test, oral challenge test (gold standard), Basophil activation test.

32
Q

Immunodeficiency with defects in both T-cells and B-cells?

A

Severe Combined Immunodeficiency

33
Q

Immunosuppressive drugs with side effects that includes diabetes, hyperlipidaemia, poor wound healing and osteoporosis?

A

Corticosteroids

34
Q

Anti-mitochondrial Antibody is a specific test for?

A

Primary biliary sclerosis

35
Q

Nitroblue tetrazolium test is a diagnostic test for?

A

Chronic Granulomatous Disease

36
Q

A cytotoxic drug that commonly causes cystitis? (cross links DNA)

A

Cyclophosphamide

37
Q

A commonly used cytotoxic drug that is a folate antagonist? (and side effect is pneumonitis)

A

Methotrexate

38
Q

Inflammatory cell that is commonly elevated in response to parasitic disease?

A

Eosinophil

39
Q

Locus of genes that encode for proteins on the surface of cells that are responsible for regulating the human immune system?

A

Human Leukocyte Antigen

40
Q

Basics of MHC?

A
  • Found in all higher vertebrates
  • Present ‘self’ and ‘non-self’ antigens for inspection by T cell antigen receptors
  • Highly polymorphic
  • Mendelian inheritance. Codominant expression.
41
Q

Human infection by this parasite is commonly due to contact with cat faeces?

A

Toxoplasma gondii (opportunist pathogen in T cell deficiencies)

42
Q

Prophylaxis after splenectomy?

A

Haemophilus influenzae type B vaccine

Penicillin

43
Q

X-linked condition associated with a lack of antibodies in the bloodstream?

A

Agammaglobulinaemia

can be acquired through multiple myeloma

44
Q

What is Rituximab used for?

A
  • Lymphomas/ leukaemias
  • Transplant rejection
  • Autoimmune disorders

Clinical Pathology Year 2 (11 decks)

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