HLA: Immunology Basics, Transplantation, Autoimmunity Flashcards

1
Q

Define MHC.

A

Major histocompatibility complex.
This is the cluster of genes that encode molecules involved in antigen presentation. Nearly every mammal has one in its genome.

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2
Q

Define HLA.

A

Human Leukocyte antigen.
It is used to refer to genes & to the molecules that they encode. The HLA region is the human MHC.
The loci are class I and class 2.

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3
Q

What are the class I loci? (3)

A

HLA-A, HLA-B & HLA-C

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4
Q

What are the class 2 loci? (3)

A

HLA-DP, HLA-DQ & HLA DR

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5
Q

Talk about alpha and beta chains in class II.

A

DQA, DPA, DRA encode alpha chains, & DPB, DQB, & DRB encode beta chains.

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6
Q

What do the HLA molecules do?

A

They present peptide antigen to T-lymphocytes.

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7
Q

Endogenous antigen is presented on what class?

What T lymphocytes do they present antigens to?

A

Class I HLA molecules
CD8 T cells
C locus seems to be more concerned with NK cells.

Think.. I ‘ate (8) killing in the END (endogenous/CD8/class I).

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8
Q

Exogenous antigen is presented on what class?

What T lymphocytes do they present antigens to?

A

Class II HLA molecules
CD4 T cells

Think… EXtra help 4 you 2 (exogenous/CD4/class II).

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9
Q

What upregulates expression of HLA molecules?

A

Cytokines, especially Interferon gamma.

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10
Q

What is meant by a haplotype?

A

The team of alleles encoded on a short section of one
chromosome. A single haplotype will have been inherited from one parent, & will usually be passed on intact to offspring, if the segment of chromosome is short enough. The longer the segment of chromosome considered, the more likely it is that crossovers
will occur in the formation of the gametes, & the haplotype. passed on to the child will be a mixture of one parent’s two haplotypes.

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11
Q

You would expect no association between particular alleles at one locus and particular alleles at a neighbouring locus if the alleles were randomly distributed.
However, there is a common haplotype.
What is this phenomenon called?

A

A1, B8, DR3, DQ2

Linkage disequilibrium

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12
Q

What are two explanations for the linkage disequilibrium phenomenon?

A
  1. Founder effect

2. Advantageous combination

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13
Q

Compare no. of different specificities on one cell in innate vs adaptive immunity.

A

Innate - A variety. 20-30? Toll, lectins.

Adaptive - One specificity

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14
Q

Comparing innate vs adaptive immunity - cells different from one another?

A

Innate - no, all cells of one kind/same

Adaptive - yes, diversity of specificities

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15
Q

Comparing innate vs adaptive immunity - is antigen receptor directly encoded?

A

Innate - yes

Adaptive - no, each cell randomly mutates gene

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16
Q

Comparing innate vs adaptive immunity - clonal? Mediate memory?

A

Innate - no

Adaptive - yes, clonal expansion

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17
Q

Comparing innate vs adaptive immunity - danger of autoimmunity?

A

Innate - no

Adaptive - yes, clonal deletion required

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18
Q

Comparing innate vs adaptive immunity - cells.

A

Innate - neutrophils, monocytes, eosinophils, mast cells

Adaptive - B and T lymphocytes

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19
Q

Where do T cells mature?

A

Thymus

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20
Q

Antigen receptor is antibody for T or B cells?

A

B cells

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21
Q

Recognition of antigen for B cells?

For T cells?

A

B cells - ANYWHERE
T cells - ONLY WHEN PRESENTED ON SURFACE OF
ANOTHER CELL, i.e. so antigen needs to presented by another cell

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22
Q

Explain clonal deletion of B lymphocytes.

A

A pool of lymphocytes in bone marrow are sensitive to clonal deletion at this stage. If they encounter a component of self, the lymphocyte is deleted. If they don’t, they survive and mature and move out of the bone marrow and into the circulation. They are no longer sensitive to clonal deletion. If they encounter an antigen that fits their receptor now, they will become activated and DIVIDE!!

Also, this can occur in lymph node cortex and germinal centre, for T-dependent B cells, if they fail to get help from CD4 T cells.

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23
Q

Explain clonal expansion.

A

A pool of lymphocytes in the peripheral lymphoid tissues. If they encounter an antigen, then a few days later, those with specificity to that antigen are greater in number than before and easier to activate (memory cells).

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24
Q

Class I molecules encoded at A, B and C loci.

How many locus alleles can any individual have?

A

Any individual can have 2 A locus alleles, 2 B locus alleles, & 2 C locus alleles, and all of these can be expressed on each cell that expresses class I (most cells in the body).

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25
Q

Class II molecules encoded at DR, DQ, and DP loci.

How many locus alleles can any individual have?

A
Any individual can have 2 DR locus alleles, 2 DQ locus alleles, & 2 DP locus alleles, and all of these
can be expressed on each cell that expresses class II (mostly antigen presenting cells: dendritic cells, macrophages, monocytes, B-lymphocytes, though class II expression can be induced on other cells by cytokines).
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26
Q

In a full allelic name, there are 8 digits after the locus letter, e.g. A*02:01:02:11.
What do these digits mean?

A

The first pair of digits defines the “cross-reactive group”. All alleles that have the same first two digits have similar shapes on the exposed parts, & “look” the same to antibodies. They represent the alleles as they were originally defined by serology (antibodies).

The second pair of digits represent differences in the amino-acid sequence that cannot be detected by antibodies: these are revealed by molecular biology. The polymorphisms may be within the groove, where they cannot be detected by antibodies, but can effect peptide selection for presentation, and therefore
function.

The third pair of digits represent silent polymorphisms within the exons: where the amino-acid sequence is the same, but the DNA base sequence differs.

The fourth pair of digits represents polymorphisms in the introns.

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27
Q

Why is the nomenclature more complicated for class II alleles encoded at the DR, DQ, and DP loci?

A

Both chains are polymorphic. For example, the DPA locus encodes the DP alpha chain, and the DPB locus encodes the DP beta chain.
Alleles at each of these loci are named with the locus first, followed by eight digits with the same significance as in the class I loci above.
Eg DPB*01:04:10:05

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28
Q

To survive selection process in the thymus, T lymphocytes must be …? They must not be…?

A

Positively selected (i.e must be attracted to some of the “HLA + peptide” complexes displayed in the thymus)

Negatively selected (ie they must not be too strongly attracted to any “HLA + peptide” complex in the thymus).

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29
Q

When might T lymphocytes undergo clonal deletion?

A
  1. In the thymus, if the receptors on a developing T-lymphocyte show a “passionate interest” in any HLA + peptide being expressed on the thymic epithelial cells or dendritic cells.
  2. After leaving the thymus, if the T-lymphocyte recognises an HLA + peptide being expressed on a dendritic cell, but does not get the second signal via CD28 engaging with its CD80 & CD86.
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30
Q

Define autograft.

A

A graft of tissue given back to the same person: eg

skin in burns victims, or bone marrow stem cells.

31
Q

Define isograft.

A

Graft between two identical (twin etc) siblings.

32
Q

Define allograft.

A

Graft between two members of the same species who

are not identical. May be related.

33
Q

Define heterograft/xenograft.

A

Graft between two members of different species, eg pigs heart to human, pigs heart valves etc.

34
Q

Kidney transplants are usually what type of graft?

How can they be rejected?

A

Usually allografts.

Can be rejected by antibodies (against ABO blood group, against foreign class I HLA molecules) or by T-lymphocytes.

35
Q

What is hyperacute rejection?

A

Rejection immediately, within minutes, hours or up to about 4 days.
Antibody mediated with complement activation.

36
Q

What is acute rejection?

A

Rejection from 5 days to 3 months.

Antibody or T lymphocyte mediated.

37
Q

What is chronic rejection?

A

Rejection after 3 months

Antibody or T lymphocyte mediated.

38
Q

What type of kidney donor transplants do better - live or cadaveric?

A

Live

39
Q

How to avoid rejection?

A
  1. Do not do the transplant if the recipient has
    antibodies against the donor HLA molecules (i.e. if sensitised through blood transfusion, pregnancy etc). Screen for anti-HLA antibodies. Perform a cross-match between donor cells and recipient serum. Use ABO compatible donors.
  2. Match the donor & recipient for HLA alleles - try to match for A, B and DR loci (the broad-antigen groups, i.e. the first 2 digits).
  3. Use antirejection therapy.
40
Q

What antirejection drugs are used?

A

Glucocorticosteroids eg prednisolone
Immunosuppressives eg azathioprine & mycophenolate.
Immunosuppressives such as ciclosporine & tacrolimus, which interrupt the signalling within T-lymphocytes.
Monoclonal & polyclonal antibodies which deplete T-lymphocytes.

41
Q

In bone marrow transplants, what are all rejection problems mediated by?

A

T lymphocyte mediated.

42
Q

What is graft versus host disease?

A

Donor T-lymphocytes react against host “HLA+ peptide” complexes.
–> severe skin rash, multi-organ involvement and failure, death

43
Q

How can HvG and GvH be prevented? (3)

A

Autografts are performed, eg in malignancy, using the patient’s purified stem cells with the malignant cells removed.

In allografts, the T-lymphocytes may be depleted from the donated marrow, or purified stem cells used.

Antirejection therapy is used as in kidney transplantation, but it can be stopped.

44
Q

What is meant by hypersensitivity?

A

Damage to the body by the body’s own immune system.

45
Q

What is type 1 hypersensitivity?

A

IgE-mediated release of histamine from mast cells/basophils.
E.g. Hayfever, asthma, anaphylactic shock.
Always allergic.
Some people genetically predisposed to making IgE to common environmental antigens = atopy.

46
Q

What is type 2 hypersensitivity?

A

IgG & IgM mediated destruction by complement &/or phagocytosis.
Eg. Antibody mediated haemolytic anaemia, thrombocytopenia, myasthenia gravis, Goodpastures,
pemphigus & pemphigoid.
Almost always autoimmune, occasionally “allergic”.

47
Q

What is type 3 hypersensitivity?

A

Immune complexes causing pathology either where they are formed (eg extrinsic allergic alveolitis) or when
deposited from circulation (vasculitis, glomerulonephritis, arthritis).
May be autoimmune, “allergic” or antimicrobial activity

48
Q

What is type 4 hypersensitivity?

A

Mediated by activated T lymphocytes.
Broadly two patterns: with granulomas,
involving CD4 T-lymphocytes & macrophages, & without granulomas, probably involving CD8 T-lymphocytes.
May be antimicrobial activity: tuberculosis (granulomatous), Hepatitis B (non-granulomatous), “allergy” eg nickel sensitivity, Coeliac, or autoimmune: possibly sarcoid (granulomatous) & all the organ-specific endocrine autoimmune diseases (non-granulomatous).

49
Q

What is type 5 hypersensitivity?

A

Mediated by antibodies which stimulate rather than destroying their target. Classical example is Graves’ disease. Autoimmune.

50
Q

What are the following conditions associated with?

Ankylosing spondylitis, Reactive arthritis, colitic arthritis, psoriatic arthritis

A

HLA B27

51
Q

What HLA is coeliac disease AND T1DM associated with?

A

DQ2 and DQ8

52
Q

What HLA is psoriasis associated with?

A

Cw6

53
Q

What HLA is MS associated with?

A

DQ6

54
Q

What HLA is rheumatoid arthritis associated with?

A

DR4

55
Q

What is the pathophys of Graves’ disease?

A
Autoantibody against TSH receptor stimulates thyroid into hypertrophy (Goitre) & increased secretion of T3 & T4: hyperthyroidism. Also causes inflammation of extrinsic eye muscles (diplopia) & growth of tissue
behind eyes (proptosis). Associated with DR3.
56
Q

What is the pathophys of myasthenia gravis?

A

Autoantibody to acetylcholine receptor causes muscle
weakness. Weakness, diplopia, respiratory paralysis, maybe death if untreated.
Association with thyoma or thymic hyperplasia. Association with DR3.

57
Q

What is the pathophys of Eaton-Lambert syndrome?

A

Autoantibody to pre-synaptic Ca++ channels in
neuromuscular junction. Causes weakness (myasthenia). Associated with
carcinoma of the lung (especially small cell).

58
Q

Auto-immune haemolytic anaemia pathophys.

A

Autoantibodies to red cells, causing destruction by complement system &/or phagocytes. Some antibodies act in the warm, some in the cold.
Causes: Idiopathic, Infections (syphilis,
mycoplasma, EBV & other viral infections), Neoplasms (especially CLL,
lymphoma), Other autoimmune disease (SLE, RA, PSS, UC), Drugs (penicillin,
alpha methyl dopa, these may be more allergic than autoimmune). Coombes
test.

59
Q

Autoimmune thrombocytopenia - pathophys.

A
Idiopathic (Idiopathic thrombocytopenic
purpura, ITP) but also associated with other autoimmune disease (SLE),
haematological malignancies (CLL, lymphoma) & drugs (lots, including antibiotics eg co-trimoxazole).
60
Q

Pemphigus pathophys.

A

Skin disease with autoantibodies to desmosomes. Bullae form within epidermis forming sores on the skin, & also mouth ulcers. Death can
occur from fluid loss & infection. Various subdivisions, including a
paraneoplastic form 2ary to lymphoma which involves oesophagus &
bronchioles.

61
Q

Pemphigoid pathophys.

A

Skin disease with autoantibodies to hemidesmosomes. Stable bullae that are less likely to break down than in pemphigus. Various
subdivisions, can affect mucous membranes.

62
Q

Goodpasture’s syndrome pathophys.

A

Autoantibodies to Type IV collagen in basement

membranes, causing glomerulonephritis (haematuria, renal failure & alveolitis (haemoptysis, respiratory failure).

63
Q

Systemic Lupus erythematosus (SLE) pathophys.

A

Fevers, malaise, lymphadenopathy,
arthralgia, arthritis, vasculitis, serositis, fibrosing alveolitis, glomerulonephritis, photosensitive skin rash. Various autoantibodies causing type II & type III
hypersensitivity: anti-red cell, anti-platelet, anti-cardiolipin & anti-clotting
factors. Anti-nuclear antibodies. Circulating immune complexes (type III
hypersensitivity) cause much of the pathology.
T-lymphocytes are also involved in the pathology, but the antibodies play an
important role.
Tests: Anti-nuclear antibody test (ANA) indirect immunoflurescence, anti-DNA
antibodies, & a variety of “Extractable nuclear antigen” tests (ENA).

64
Q

Type 1 Diabetes mellitus pathophys.

A

Infiltration of islets with lymphocytes, including CD8 Tlymphocytes:
“insulitis”. Specifically kills beta cells. There are auto-antibodies:
anti-islet cell antibodies, anti-insulin antibodies, but not in all patients, &
probably a byproduct of the damage, though anti-insulin antibodies may cause
insulin resistance. Can get autoantibodies against replacement insulin giving
insulin resistance. Autoantibodies not routinely used in diagnosis.

65
Q

Hashimoto’s thyroiditis pathophys.

A

Florid lymphocytic infiltration of the thyroid. Goitre &
reduction in thyroid function (hypothyroidism, mysoedema). Many Blymphocytes
& autoantibodies including anti thyroid peroxidase (TPO) & antithyroglobulin,
but most damage probably done by T-lymphocytes. Anti-TPO is the
usual test, together with thyroid function tests.

66
Q

Pernicious anaemia (autoimmune gastritis) pathophys.

A

Lymphocytic infiltrate in lamina propria.
Autoantibodies against parietal cells (anti-parietal cell antibody, useful diagnostic test), also
anti intrinsic factor antibodies in gastric juice. Prevents secretion of intrinsic factor, so no
absorption of B12. Also achlorhydria, & predisposition to stomach malignancy.

67
Q

Primary sclerosing cholangitis pathophys.

A

Associated with UC. Often ANCA positive.

68
Q

Primary biliary cirrhosis

A

. Immune attack against biliary tree, culminating in cirrhosis & liver
failure if untreated. Anti-micochondrial antibodies are the diagnostic test. ANA may also be
positive.

69
Q

Chronic autoimmune hepatitis

A

Classically affects young women. Untreated, ends in liver
failure. Various subtypes, partly distinguished by autoantibodies:
ANA positive, Anti-smooth muscle antibodies (SMA)
Anti-liver/kidney microsome,
Antibodies to Soluble liver antigen.

70
Q

Coeliac Disease

A

Basically an “allergy” to gluten (gliadin), but autoantibodies occur: antitransglutaminase
(an IgA antibody) & anti-endomysial. Also anti-gliadin antibodies.
Increased intraepithelial lymphocytes, lymphocytic infiltration in lamina propria, shortening
of villi, deepening of crypts, malabsorption with steatorrhoea, dermatitis herpetiformis,
predisposes to bowel malignancy especially MALT lymphoma. Association with DQ2 &
DQ8.

71
Q

Rheumatoid arthritis

A

Inflammatory multisystem disease. Synovium
forms inflammatory pannus, which attacks & destroys cartilage:
destructive arthritis. Also vasculitis, fibrosing alveolitis. 80% of cases
are Rheumatoid factor positive, autoantibody against antibodies!
Difficult to see how this can cause pathology, but useful diagnostic
test. Also (more specific anti citrullinate protein antibodies. Associated
with DR4.

72
Q

Vasculitis

A

PAN & Wegener’s ANCA is useful diagnostic test.

73
Q

Seronegative arthritis, ankylosing spondylitis.

A
Inflammation at “enthesis” where capsule & ligaments are attached to joint. Also iritis,
and aortitis.
No autoantibodies (hence “seronegative”). Strongly associated with HLA B27.
74
Q

Psoriasis

A

Patches of red flakey skin, which shows increased cell division.Microabscesses of Monro. No autoantibodies. Associated Cw6_