German - Adaptive Immune Diseases

Question 1

T/F - T cells play a huge role in autoimmune disease.

Answer 1

TRUE

Question 2

What are autoimmune diseases?

Answer 2

Loss of tolerance leading to hypersensitivity reactions

Question 3

Where are B cells negatively selected?

Answer 3

Bone marrow

*If interacts with self, it will rearrange if possible, or undergo apoptosis

**Central tolerance is it doesn’t react to self in marrow

**Once in lymph nodes, if it reacts to self, it becomes anergic

**If it doesn’t react to self, it has peripheral tolerance

Question 4

Tell me more about autoimmune diseases (ADs).

Answer 4

Adaptive immune targeting of self

Humoral or cell-mediated

Often chronic and lifelong

Loss of self-tolerance

*All ADs are Type II, III, or IV hypersensitive

Question 5

ADs can be caused by what?

Answer 5

Genetics

Environment

OR

Both (Majority of time)

Question 6

T/F - ADs are among the 10 leading causes of death among women under 65.

Answer 6

TRUE

• Only 20% of predisposed individuals get autoimmune disease
• Infectious causes
• Non-infectious causes

Question 7

________ _________ influences AD development.

Answer 7

HLA subtype

Question 8

T/F - HLA genes associated with susceptibility in 50% of ADs.

Answer 8

TRUE

• Class II alleles most frequently implicated
• CD4 T cells closely tied to AD development
• Susceptibility does not always lead to disease

Question 9

Tell me about Type II Hypersensitivity ADs.

Answer 9

IgG or IgM

Cell surface proteins

Agonist or antagonistic

Opsonization

Graves’, Hashimotos, Type 2 DM, Hypoglycemia

Question 10

T/F - Rheumatic fever is caused by molecular mimicry.

Answer 10

TRUE

Strep pyogenes wall shares human episodes

• When body interacts with the cell wall, antibody response is activated
• These antibodies can cross-react with heart tissue, causing rheumatic fever

*T cells are necessary for prolonged autoimmunity

Question 11

T/F - Graves’ disease is antibody binding causing metabolic dysfx.

Answer 11

TRUE

Question 12

Tell me more about Graves.

Answer 12

Antibodies fx as a TSH agonist

CD4 Th2 Response

Excessive thyroid hormone release

Antibodies do not cause overt tissue damage

Question 13

Tell me about symptoms of Graves.

Answer 13

Weight loss

Heat intolerance

Anxiety, irritability

Bulging of eyes (Exophthalmos)

Tx
-Ablatement to avoid overproducing T3 and T4

Question 14

T/F - Antibody-mediated ADs can be temporarily transferred to newborns.

Answer 14

TRUE

Mother with Graves makes anti-TSHR antibodies

During pregnancy, antibodies cross the placenta into the fetus

Newborn infant also suffers from Graves’ disease

Plasmapheresis (filter out plasma removes maternal anti-TSHR antibodies and cures the infant’s disease

Question 15

What is the opposite of Graves’ disease?

Answer 15

Hashimoto’s disease

Question 16

Tell me about Hashimoto’s.

Answer 16

Destruction of normal thyroid tissue

CD4 Th1 response

HYPOTHYROIDISM

Growth of ectopic lymphoid tissue forms in the thyroid
-Enlarged, inflamed, under active thyroid (goiter)

Question 17

Salivary gland enlargement

Compromised PD health

Macroglossia

Glossitis

Dysgeusia

Delayed dental eruption and enamel hypoplasia

Ant open bite, micrognathia, thick lips, mouth breathing

Is what?

Answer 17

Hashimoto’s disease

Question 18

Increased caries

Increased susceptible PD

Enlargement of extraglandular thyroid tissue

Burning mouth syndrome

Accelerated dental eruption

Max and mandible osteoporosis

Dev of CT diseases like Sjogren’s syndrome or systemic lupus erythematosus

Is what?

Answer 18

Graves’ disease

Question 19

Tell me about Sjogren’s Syndrome.

Answer 19

Progressive destruction of the exocrine glands

One of the most common ADs

• 0.5-5% prevalence
• 9 times more prevalent in women
• Utah has large population of this

*Type II hypersensitivity

Unknown initiating factors

Dry mouth, eyes, arthritis
-Prominent caries, oral candidiasis

Question 20

Tell me about Type III ADs.

Answer 20

IgG mediated

Immune complexes

Rashes, kidney dysfx

Rheumatic diseases

Question 21

Are diseases specifically one hypersensitivity or multiple?

Answer 21

Can be multiple

• Sjogren’s
• Rheumatic diseases

Question 22

Tell me about Lupus.

Answer 22

Widespread self-antigen targeting and complex deposition

Unknown cause, potential environmental trigger

Deposits in bvs, kidneys, and jts

Epitope spreading leads to intracellular antigen targeting

Mouth ulcers and plaques
-Not necessarily painful at the onset

*Kidney dysfx

Question 23

T/F - Lupus causes INTERmolecular epitope spreading.

Answer 23

TRUE

Cluster of nuclear proteins

Macromolecular complex presentation

Slowly expanding adaptive response

Loss of tolerance

Question 24

Tell me about INTRAmolecular epitope spreading.

Answer 24

Self-epitope mimics a pathogenic epitope

Protein becomes a better antigen over time due to mimicry.

Question 25

T/F - An individual with Lupus gets worse with time and multiple flare ups because the CD4 T cells involved get more sensitive over time.

Answer 25

TRUE

*One molecule spreads its loss of tolerance

Question 26

Tell me about Type IV ADs.

Answer 26

CD4 and CD8 mediated

Contact hypersensitivity

Thymus involution tied to increased AD incidence

*Celiac disease

Question 27

Tell me about Celiac disease.

Answer 27

Gluten is degraded in gut lumen to give resistant fragment

Fragment enters gut tissue and is delaminates by transglutaminase

Naive CD4 T cell responds to deaminated peptides presented by HLA-DQ

Inflammatory effector T cells cause villous atrophy

Question 28

T/F - Type I DM is associated with autoimmunity.

Answer 28

TRUE

CD4 and CD8 T cell response kills pancreatic beta cells

Oral

• Reduced salivary flow
• Altered saliva composition
• Impaired wound healing
• Sweet breath